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Continuous Glucose Monitoring for Older Adults with Type 2 Diabetes: A Care Integration Framework

Uche Carine Ekemezie, Glory Ohunyon, and Emily Sydney

Abstract

Continuous glucose monitoring represents a transformative advance in diabetes management for older adults, yet evidence-based implementation guidance for the specific clinical, functional, and social characteristics of Medicare-eligible populations remains underdeveloped. This paper proposes a structured CGM programme implementation and governance framework for older adults with type 2 diabetes — integrating clinical eligibility criteria, care pathway design, geriatric adaptation specifications, and equity implementation protocols for the diverse Medicare population. The 2023 CMS coverage expansion extending CGM to all Medicare beneficiaries using insulin or experiencing recurrent hypoglycaemia creates a critical implementation window that requires structured clinical guidance to ensure that expanded coverage translates to equitable clinical benefit across the full eligible population. The proposed framework specifies sensor selection criteria calibrated to geriatric-specific device requirements, alert threshold adjustment protocols for hypoglycaemia unawareness, caregiver integration models for patients with cognitive impairment or functional limitations, and CGM population analytics dashboards for health system quality management. An equity implementation protocol identifies social determinant barriers — food insecurity, digital connectivity gaps, health technology literacy — and specifies community health worker engagement strategies for overcoming them. Institutional CGM programme design for nursing home and memory care settings is addressed as a distinct implementation domain. The framework provides health systems, physician practices, and Medicare Advantage plans with an evidence-grounded implementation blueprint that promotes equitable CGM access and clinical outcomes across the heterogeneous older adult population. Index Terms — continuous glucose monitoring; older adults; geriatric diabetes; time-in-range; hypoglycaemia; telehealth; caregiver integration; CGM coverage.

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