Redesigning diabetes technology to detect low blood sugar in older adults with diabetes and Alzheimer’s

Regenstrief Institute

INDIANAPOLIS — Regenstrief Institute Research Scientist April Savoy, PhD, a human factors engineer and health services researcher, is developing and testing user-friendly health information tools and technology designed to enhance accessibility and value to older adults with both diabetes and Alzheimer’s disease, and their caregivers. Without numerous finger sticks, these tools and technology will be designed to provide patients, caregivers, and clinicians with glucose metrics needed to diagnose hypoglycemia and identify treatment options.

Older adults with Alzheimer’s and Type 1 or Type 2 diabetes have a high risk of low blood sugar, known as hypoglycemia, which is often undetected. Hypoglycemia can cause dizziness, confusion, mood changes, hospitalization, and even death. Diagnosis and treatment of hypoglycemia can prevent complications.

“Alzheimer’s disease is a progressive disease, and hypoglycemic events can accelerate cognitive decline. That’s why we are focusing on detection of low blood sugar in these older adults with both Alzheimer’s and diabetes,” said Dr. Savoy, assistant professor in the Purdue School of Engineering and Technology at IUPUI.

Dementia hinders the ability of patients and caregivers to manage blood sugar levels, potentially resulting in hypoglycemic events and further cognitive loss. Repeated finger sticks to test blood sugar levels, following a prescribed diet and exercising can be difficult for patients with Alzheimer’s. Use of traditional blood sugar monitors may be problematic for individuals with Alzheimer’s as well as caregivers.

The study, “Enhancing shared decision-making to prompt and guide individualized care for people with Alzheimer’s Disease and diabetes,” will enroll 75 pairs of older adults with both Alzheimer’s and diabetes, and their family caregivers. Twenty clinicians who see patients with both conditions will also participate.

Other studies have investigated how poor management of diabetes increases risk of dementia. But this new research, implementing a human factors engineering approach, targets older adults who have already been diagnosed with both Alzheimer’s and diabetes. Dr. Savoy and colleagues will investigate unique population dynamics, including how much data about glucose levels are needed, how to acquire them, and what works to enable shared decision-making for all involved — patients, caregivers, and clinicians.

“We hope to increase awareness and empower patients and caregivers to make individualized, patient-focused decisions about effective treatment options. Our goal is to prevent hypoglycemia for the growing population of older adults with Alzheimer’s disease and diabetes,” said Dr. Savoy.

Collaborating with Dr. Savoy on this work, which is supported by a new five-year grant from the National Institutes of Health’s National Institute on Aging, are Regenstrief Institute investigators and Indiana University School of Medicine faculty members Michael Weiner, M.D., MPH, who has conducted research on hypoglycemia and dementia, and Greg Sachs, M.D., a geriatrician focused on the aging brain; Regenstrief Institute and Indiana University School of Public Health-Bloomington faculty member Richard Holden, PhD, a human factors engineer who is developing technology for individuals with Alzheimer’s along with their caregivers; and Indiana University School of Medicine faculty member Mary DeGroot, PhD, who studies and treats patients with diabetes.

Dr. Savoy and colleagues recently authored a commentary in the peer-reviewed Journal of Diabetes Science and Technology, on the importance of applying the human-centered design process to continuous glucose monitoring and investigating design solutions and interventions to integrate continuous glucose monitoring into the healthcare of patients with dementia and diabetes. With the use of human-centered design, the authors indicate that they will be able to identify and inform continuous glucose monitoring designs for people with dementia and diabetes, broadening access to continuous glucose monitoring with what they believe is the attainable goal of increasing detection and treatment of the silent threat posed by low blood sugar.

Authors of “Improving Care for People Living with Dementia and Diabetes: Applying the Human-Centered Design Process to Continuous Glucose Monitoring,” in addition to Dr. Savoy and the collaborators on the new grant (noted above), are Daniel O. Clark, PhD, of Regenstrief Institute and Indiana University School of Medicine, and David Klonoff, M.D., University of California, San Francisco.

This research was supported by the National Institute on Aging of the National Institutes of Health under award number K01AG076971-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About April Savoy, PhD

In addition to her role as a research scientist at Regenstrief Institute, April Savoy, PhD, is the director of the U.S. Department of Veterans Affairs Health Services Research and Development Human-Computer Interaction and Simulation Laboratory in Indianapolis, and a core investigator for the Center for Health Information and Communication, Richard L. Roudebush VA Medical Center. She is also an assistant professor of computer and information technology at the Purdue School of Engineering and Technology at IUPUI.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe. 

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About the Richard L. Roudebush Veterans Affairs (VA) Medical Center

Established in 1932, the Richard L. Roudebush VA Medical Center serves Veterans from across Indiana and western Illinois. The Roudebush VAMC is one of the largest and most complex medical centers in the Department of Veterans Affairs, and provides acute inpatient medical, surgical, psychiatric, rehabilitation, and neurological care to more than 60,000 Veterans annually. Some of the many services available to Veterans include emergency medicine, primary care, cardiac care, radiation oncology, audiology, community-based extended care, and community VA clinics.

About the Purdue School of Engineering and Technology at IUPUI

The Purdue School of Engineering and Technology at IUPUI is regarded as one of America’s premier urban schools of engineering and technology. It offers undergraduate and graduate degree programs that prepare students for careers in a global economy, and is recognized regionally, nationally and internationally for its excellence in teaching and learning, research and creative activities, and community engagement.

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