{"doi":"10.1111/jgs.70077","title":"Comment on: Editor's Note on Clin‐ <scp>STAR</scp> Corner: Practice‐Changing Advances in Diabetes Care","abstract":"Type 1 diabetes is increasing in the older age group [1-3] and now accounts for > 10% of diabetes cases among Medicare beneficiaries [4]. Approximately two-thirds of these individuals, and even fewer with type 2 diabetes, do not receive endocrinology care [5], underscoring that most older people with diabetes are managed in primary care, and increasingly, in geriatrics care settings. For many older adults—including all those with type 1 diabetes as well as those with type 2 diabetes who have clinical contraindications or face access barriers to newer antihyperglycemic medications—discontinuing insulin may not be an option [6]. It is this challenge that underscores the opportunity for continuous glucose monitoring (CGM) to support patients, their care partners, and their providers in mitigating the inherent risks of a necessary therapy when no alternatives exist. Published studies highlight that CGM can be implemented at scale in routine care settings, including among more heterogeneous populations of older adults who may have been excluded from clinical trials [7]. The protective effects may be even more pronounced in real-world settings when considering severe outcomes; in Veterans Affairs (VA) Health Care System data, initiation of CGM among older adults with type 1 diabetes was associated with a 30% reduction in the risk of ER or hospital admissions for severe hypoglycemia and a 25% reduction in the risk of all-cause hospitalizations [8]. Importantly, the suggestion that many older adults are unable to use CGMs due to age-related impairments is not supported by available evidence. There are clinical trials [9] and real-world healthcare data analyses [10], suggesting positive effects of CGM among older adults with diabetes and comorbid cognitive impairment (ranging from mild impairment to dementia). A mixed-methods study in the United Kingdom found CGM to be acceptable for adults 65 years and older with dementia and their care partners; all participants said they would recommend CGM to others [11]. Meanwhile, CGM devices themselves have advanced to better accommodate individuals with limited executive functioning [12], dexterity challenges [13], and sensory impairments [14, 15]. In our work, older adults with type 1 diabetes described implementing their own home-made adaptions for hearing impairment [16]: “If you want your Dexcom louder… get a dish with pennies in it. Put it on top of the pennies…Set it on vibrate… Those pennies help resonate.” Categorical statements about the abilities of older adults are not only inaccurate, they are harmful. Qualitative studies suggest that older adults already internalize stigma around aging and technology, including stereotype threat, unnecessary intimidation, and shame [17]. Thus, ageism itself poses a real barrier to technology use among older adults. Reflecting more broadly, age-related impairments affect many aspects of diabetes management. More research is needed into ways to increase accessibility, access, and support for older adults and their care partners to use CGM and other advanced diabetes technologies, and the effects of these technologies on clinical and patient-related outcomes. In the meantime, to dismiss a role for CGM in reducing the risk of hypoglycemia risks withholding evolving treatments and advancing technologies from those who may benefit the most. A.R.K. and R.E.P. drafted and approved the manuscript. A.R.K. is supported by the National Institutes on Aging, National Institutes of Health, through Grant K01-AG084971. R.E.P. is supported by the National Institutes of Health, through Grants U01-DK127384-04, U01-DK127392, U01-DK35131, R01-DK138060, and R01-AG060153. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We thank the Editor for his note on our Clin-STAR Corner review and value the perspective from his clinical practice. The sponsor had no role in the study design, data collection, ana","journal":"Journal of the American Geriatrics Society","year":2025,"id":574486,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.962,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":231670,"name":"Richard E. Pratley","orcid":"0000-0002-2912-1389","position":1,"is_corresponding":false},{"id":273575,"name":"Anna R. Kahkoska","orcid":"0000-0003-2701-101X","position":0,"is_corresponding":true}],"reference_count":16,"raw_metadata":null,"created_at":"2026-07-19T02:57:40.686992Z","pmid":"40928304","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}