目的:连续血糖监测(CGM)可以减少患有1型糖尿病(T1D)的老年人的低血糖。我们旨在表征影响该年龄组有效使用的因素。
方法:T1D型(年龄≥65岁)的老年人及其照顾者参加了一系列平行组模型构建研讨会之一,一种参与式的系统动力学方法,涉及绘图和脚本化的小组活动。数据是在假设的因素系统的定性模型中合成的,这些因素在老年人中产生不同的CGM使用模式。通过虚拟随访访谈对模型进行了验证。
结果:数据来自33名参与者(4名患者-护理人员,平均年龄73.8±4.4岁[66-85岁];16%的非CGM用户,79%的泵用户)。系统模型描绘了CGM摄取的驱动因素,持续使用CGM的驱动因素,和反馈循环,以加强或抵消未来的CGM使用。与会者强调了在CGM使用期间的不同时间点的不同反馈回路集合的重要性。
结论:整体系统模型强调,推动老年人有效使用CGM的因素和反馈回路既是个性化的,也是动态的(例如,随时间变化),建议分阶段和量身定制的针对特定年龄的教育和支持的机会。简短标题:CGM在1型糖尿病老年人中的使用。
OBJECTIVE: Continuous glucose monitoring (CGM) can reduce hypoglycemia in older adults with type 1 diabetes (T1D). We aimed to characterize factors that influence effective use in this age group.
METHODS: Older adults with type T1D (age ≥ 65) and their caregivers participated in one of a series of parallel group model building workshops, a participatory approach to system dynamics involving drawing and scripted group activities. Data were synthesized in a qualitative model of the hypothesized system of factors producing distinct patterns of CGM use in older adults. The model was validated through virtual follow-up interviews.
RESULTS: Data were collected from 33 participants (four patient-caregiver dyads, mean age 73.8 ± 4.4 years [range 66-85 years]; 16 % non-CGM users, 79 % pump users). The system model delineates drivers of CGM uptake, drivers of ongoing CGM use, and feedback loops that either reinforce or counteract future CGM use. Participants emphasized the importance of different sets of feedback loops at different points in the duration of CGM use.
CONCLUSIONS: The holistic system model underscores that factors and feedback loops driving effective CGM use in older adults are both individualized and dynamic (e.g., changing over time), suggesting opportunities for staged and tailored age-specific education and support.