Empowering Older Adults with Type 2 Diabetes Using Continuous Glucose Monitoring and Health Coaching for Individualized, Values-Concordant Care

About This Grant

Project Summary/Abstract Type 2 diabetes mellitus (T2DM) affects nearly 30% of adults aged ≥65 in the United States and imposes a substantial clinical and economic burden, accounting for more than 60% of the $413 billion in diabetes-related costs. Older adults with T2DM experience high rates of multimorbidity, functional decline, frailty, falls, cognitive impairment, and hospitalizations. These geriatric syndromes are often exacerbated by treatment-related harms such as hypoglycemia and orthostatic hypotension when therapy is not individualized to a patient’s health status, life expectancy, or goals. Although the American Diabetes Association recommends individualized treatment, many older adults remain on regimens misaligned with their clinical status and personal values, in part due to low patient activation, limited health literacy, and barriers to shared decision-making. Continuous glucose monitoring (CGM) offers real-time insights into glucose patterns, and when paired with structured coaching, can empower patients to interpret data, clarify personal goals, and engage clinicians in values-concordant decision- making. This randomized controlled trial will test the efficacy of a patient-centered intervention combining CGM, values clarification, and weekly remote health coaching among 300 older adults (≥65) with poorly controlled T2DM (HbA1c ≥9%). Participants will be randomized 1:1 to the intervention or standard care. We will test whether the intervention improves (1) patient-centered outcomes including activation, shared decision-making, and satisfaction; (2) quality of life and physical, mental, and social functioning; and (3) health care utilization and geriatric syndromes including frailty, functional decline, cognitive decline, and falls. By equipping older adults with actionable data, tailored coaching, and communication tools, this project aims to transform diabetes care toward personalized, values-driven, and safer management, ultimately improving outcomes and reducing unnecessary healthcare utilization in this vulnerable population.