Barriers to self-monitoring of blood glucose include pain from finger sticks, inconvenience of testing, and the expense of test strips. 25 The newer glucometers and test strips use smaller amounts of blood from other body parts such as the upper arm, calf, or thigh, and these glucometers are ideally suited for older adults. 20
Lifestyle Modifications
Lifestyle interventions, including weight loss and exercise, are the mainstay in glycemic control of diabetes. The Diabetes Prevention Program study found a group of patients on lifestyle intervention alone (weight loss goal of 7% and ≥ 150 minutes of weekly exercise) had a 58% lower prevalence of DM compared with a group of patients taking metformin, which had a 31% lower prevalence. 26 When older adults were compared with younger persons, lifestyle interventions were more effective than was taking metformin. High-intensity resistance training with moderate weights and repetition lowered glycemic index and caused a 3-fold reduction in A 1c in older patients. 27,28
Case Management
Older adults may have difficulty getting in touch with HCPs through traditional automated telephone systems. Many have difficulty transmitting glucose monitoring log sheets to HCPs for medication adjustments, which can result in delayed interventions. Telephone visits initiated by a competent case manager can serve as a primary point of contact between HCPs and older adults to optimize treatment and effectively get patients to targeted goals.
Telemedicine is an important tool for monitoring older adults in their home. The technology includes installing a home telemedicine unit, which supports videoconferencing, exchanging messages with case managers, uploading blood glucose readings, and accessing DM educational materials. A study on medication adherence in older diabetic patients found increased adherence through telemonitoring. 29 Telemedicine can quickly identify new or persistent barriers between clinic visits so interventions can be made.
A case manager can also facilitate family and social support to address issues such as infrequent glucose monitoring, infrequent medical appointments, caregiver stress, lack of transportation, and financial difficulties, all of which can adversely affect DM care for older adults. The use of a network of family and friends is a good tool for DM management. One study found that when family or friends attended clinic visits, patients were more motivated to understand, follow HCP advice, and find resolutions to difficult issues in DM care. 30
Conclusion
Diabetes is a chronic illness with a high burden for older adults. It is important to understand the experiences of patients and HCPs that influence common diabetes barriers. In older adults, barriers should be evaluated in an age-specific context to devise practical interventions to overcome them. Individualizing therapies and empowering older adults prepares them to live confidently while maintaining a sense of control over their lives. A patientcentered collaboration between HCPs and older adults that incorporates a multidisciplinary team approach to resolve problems can improve patient outcomes.
Additional research is needed to identify methods that are most suitable and applicable to older adults. If new evidenced-based research can eliminate diabetes barriers and improve diabetes care in older adults, the consequential burden of diabetes is more likely to decline.