Glucose monitoring strategy may influence clinical outcomes in older adults with both diabetes and cognitive impairment. A study published in JAMA Network Open compared CGM with SMBG in insulin-treated older adults living with Alzheimer disease and related dementias (ADRD).

This retrospective prevalent-new user cohort study used a 15% nationwide Medicare claims sample from 2016 to 2020. After 1:1 propensity score matching, 2,022 adults aged ≥66 years with insulin-treated diabetes and ADRD were included (1,011 CGM users and 1,011 SMBG users). Cox proportional hazards models assessed the risk of glycemic-related outcomes and adverse events.

CGM use was associated with a lower risk of all-cause hospitalization (hazard ratio [HR] 0.86; 95% CI 0.76–0.96) and lower mortality (HR 0.57; 95% CI 0.48–0.67) compared with SMBG. CGM use also showed lower point estimates for hypoglycemia hospitalization (HR 0.66) and falls (HR 0.86), but these associations were not statistically significant. A higher point estimate for hyperglycemia crisis (HR 1.38) did not reach significance.

Results from negative control analyses demonstrated no differences between groups. These findings suggest potential long-term clinical benefit of CGM in this high-risk population. Pragmatic trials are needed to confirm effectiveness and assess feasibility in routine ADRD care.