Beyond Blood Sugar: An NIH-Funded Study of Personalized Approach to Diabetes Care for Older Adults

By Dirk Hoffman

The randomized clinical trial will test whether continuous glucose monitoring (CGM) combined with telephone-based health coaching can help older adults with Type 2 diabetes receive safer, more individualized care aligned with their health status, goals and preferences.

Many older adults must manage diabetes alongside other chronic conditions, changing physical or cognitive abilities, complex medication regimens, and personal priorities that extend beyond glucose control.

The study will examine whether combining CGM with personalized coaching helps participants recognize their glucose patterns, identify what matters most to them, and communicate more effectively with their clinicians.

Participants assigned to the intervention will use CGM and coaching to learn how food, physical activity, medications, symptoms, and daily routines affect their glucose.

Fraser is principal investigator on the grant titled “Empowering Older Adults with Type 2 Diabetes Using Continuous Glucose Monitoring and Health Coaching for Individualized, Values-Concordant Care.”

By connecting CGM information to each participant’s priorities, the intervention is intended to support treatment decisions that are both clinically appropriate and consistent with what matters most to the individual.

Coaches will help patients clarify priorities, such as maintaining independence, avoiding low blood sugar, reducing medication burden, or preserving quality of life, and prepare questions and talking points for clinical visits, Fraser notes.

“The central goal is not simply to lower a laboratory value. It is to help make diabetes care safer, more individualized, and better aligned with each person’s health status, goals and preferences,” he says.

Older adults with Type 2 diabetes frequently have multiple chronic conditions and may also experience frailty, cognitive decline, reduced mobility, functional limitations, or difficulty with vision, hearing, or manual dexterity.

These challenges can make it harder to manage medications, use diabetes technology, interpret glucose information, and participate fully in treatment decisions, Fraser says.

“Treatment that is not appropriately individualized can increase the risks of hypoglycemia, dizziness, falls, and excessive treatment burden,” he adds. “Sustained hyperglycemia can contribute to complications, emergency department visits or hospitalization.”

The study will enroll 300 community-dwelling adults aged 65 years or older with Type 2 diabetes and an HbA1c of at least 9% documented within the previous six months. HbA1c reflects average glucose levels over approximately the previous two to three months; the 9% threshold is an eligibility criterion for this study, not a universal treatment target for older adults.

Recruitment will occur through clinical practices, senior housing organizations, aging and community networks, community events, print and digital outreach, and participant referrals.

After baseline assessments, participants will be randomly assigned in equal numbers to the intervention or usual-care group.

Participants in the intervention group will use CGM device for 12 months, structured assistance identifying their health goals and values, and telephone-based health coaching.

The primary question is whether the intervention improves participants’ experiences of individualized diabetes care, patient activation, shared decision-making, satisfaction with care, quality of life, physical and cognitive functioning, frailty, falls, and health care use.

If effective, the intervention could provide a practical and scalable model for helping health care systems translate recommendations for individualized diabetes care into routine practice, Fraser says.

The telephone-based format, large-print and mailed materials, technical assistance, and optional caregiver involvement are designed to make the intervention accessible to older adults who may have difficulty attending frequent in-person programs or using smartphone-based services, he adds.

“Ultimately, we want older adults to have the information, confidence, and support needed to make diabetes treatment fit their lives, rather than asking them to fit their lives around a one-size-fits-all treatment plan,” Fraser says.

The multidisciplinary investigative team includes several faculty members from the Jacobs School’s Division of Population Health:

• Leonard E. Egede, MD, SUNY Distinguished Professor and the Charles and Mary Bauer Professor and chair of medicine, who contributes expertise in diabetes care, health services research, and clinical trials
• Rebekah J. Walker, PhD, associate professor of medicine, a health services researcher with expertise in social determinants of health and community-based trials
• Jennifer A. Campbell, PhD, MPH, associate professor of medicine, an implementation scientist with expertise in recruiting and retaining underserved older adults
• Obinna Ekwunife, PhD, assistant professor of medicine, a health economist and implementation scientist

Mahmoud I. Ismail, MD, clinical assistant professor of medicine, a general internist and geriatrician, also serves as a co-investigator and brings clinical expertise in caring for older adults.

The researchers will collaborate with clinical and community partners across Western New York, including UBMD Internal Medicine, Kaleida Health, Erie County Medical Center, Great Lakes Integrated Network, the Diabetes-Endocrinology Center of Western New York, the Western New York Integrated Care Collaborative, FeedMore WNY, the Erie County Department for the Aging, the UB Clinical and Translational Science Institute, the Buffalo Center for Health Equity, senior housing organizations, and federally qualified health centers.

“These partnerships will support recruitment, retention, access to clinical information, and community engagement,” Fraser says.