Wearable devices for diabetes have revolutionized patient care delivery and clinical workflows in post-acute care settings.
Optimizing workflows in post-acute and long-term care facilities is a crucial part of clinicians’ ability to provide quality patient care. With the growing adoption of technology in healthcare, wearable devices have been increasingly recognized as a valuable way to enhance clinical efficiency in a variety of post-acute settings including skilled nursing, long-term acute care hospitals (LTACHs), inpatient rehabilitation and home health care.
Wearable devices, which perform functions such as tracking a patient’s heart rate, respiratory rate, blood pressure, glucose levels, movement and more – allow for the continuous remote monitoring of critical patient health data, according to a National Library of Medicine study.
Repertoire Magazine recently spoke to Dr. Naushira Pandya, Professor and the Chair of the Department of Geriatrics at Nova Southeastern University’s Kiran C. Patel College of Osteopathic Medicine and Director of the Geriatrics Workforce Enhancement Program, south Florida, to discuss wearable devices within post-acute care settings.
Integrating wearables
Post-acute care facilities often have a higher rate of patients with multiple comorbidities as well as cognitive and psychosocial problems compared to other types of medical facilities, requiring practitioners to treat many patients with more than one health concern.
“After residency, I was very interested in endocrinology and had the opportunity to work in a long-term care setting with medically complex and challenging patients that had chronic medical conditions along with geriatric syndromes such as falling, weight loss and incontinence,” said Dr. Pandya.
In addition to teaching geriatrics to medical students, fellows in Geriatrics, and residents; Dr. Pandya has an active nursing home and ambulatory care practice in Geriatrics and Endocrinology.
“My area of specialty and the area that I have been most interested in for many years is diabetes in older adults, and my research publications have largely been surrounding this topic,” said Dr. Pandya.
Dr. Pandya, who has served on the Board of Directors with the Post-Acute and Long-Term Care Medical Association (PALTmed) and was its President in 2015, contributed a clinical perspective to the organization as Chair of the Diabetes Clinical Practice Guideline (CPG) for Long-Term Care. This is a popular guideline and has undergone three revisions in addition to a pocket guide and is supported by other diabetes publications.
“There are a broad range of definitions describing the long-term care setting,” says Dr. Pandya. “Focusing in on skilled nursing facility settings, patients in these facilities are often more medically complex with longer-stay patients needing ongoing care.”
Diabetes is common among older adults, and according to the National Council on Aging, can exacerbate patients’ already existing geriatric conditions.
“Nearly 25% to 34% of patients in long-term care settings have diabetes,” said Dr. Pandya.
In most facilities, staff conduct point-of-care blood glucose testing to monitor patients’ diabetes, which involves a blood glucose meter to check blood sugar levels with a fingerstick blood sample. Checking blood glucose levels may be required multiple times per day and can be time-consuming for long-term care staff.
Complex patients may need their finger pricked up to three to four times a day with traditional glucose monitoring and may also require multiple insulin injections, according to Dr. Pandya.
“Blood glucose testing only provides health information in the moment – we don’t know what happens to blood glucose levels between blood sugar tests. The levels may drop, or they may be quite elevated between those traditional tests,” said Dr. Pandya. “The other way to monitor diabetes is through A1C testing, which gives you a look back at blood glucose levels from the last three months. For older people, this method is not always reliable because a patient may be anemic, has had a previous blood transfusion, or they may have other medical issues which can affect the reliability of A1C levels.”
Most wearable devices for diabetes, however, can monitor a patient’s blood glucose levels continuously. By integrating wearable medical devices into clinical workflows, providers can instead remotely monitor patient health and access real-time data instantaneously.
Specifically, continuous glucose monitoring (CGM), a wearable technology worn by the patient 24 hours a day, tracks a patient’s glucose (blood sugar) levels over time.
CGM devices have the potential to help practitioners in long-term care settings spot trends in glucose data and react to changes in patients’ blood glucose on demand.
“Studies have shown that for patients wearing CGMs, practitioners were able to detect episodes of severe hypoglycemia (less than 54 milligrams per deciliter) and severe hyperglycemia (over 250 milligrams per deciliter), which can be very dangerous in older people – without the use of CGM technology, clinicians couldn’t detect these episodes before,” said Dr. Pandya. “Tracking these highs and lows is important because hypoglycemia specifically can lead to adverse clinical events such as falls, cognitive impairment, cardiac events and in extreme cases seizure and death.”
Prepping for wearable integration
Wearables for monitoring diabetes also include more advanced technologies such as insulin pumps, automated insulin delivery (glucose sensor that communicates with pump to automatically deliver insulin) and even technologies that only require the patient to input meal announcements to allow tailoring of the mealtime insulin dose, with automated control of between meal glucose levels.
“Patients with diabetes are living longer and aging and are now coming into skilled nursing facilities and long-term care with their own automatic insulin pumps,” said Dr. Pandya. “The question that remains is how practitioners are going to prepare for these types of patients. This is an area we must continue to be thinking about and planning for.”
Many patients may have already been using these types of wearable devices outside of health care settings – with support from family members and at-home care teams – and desire to continue using them when they are admitted to a long-term care facility.
For long-term care staff, the challenge is to learn about how these new types of devices work and how to interpret their data for patient care decisions.
“Different facilities have varying levels of expertise, so education and support are important for the integration of wearable devices,” said Dr. Pandya. “Use of these devices requires knowledge and expertise from physicians but also nurses and nurse aides and rely on staff and caregivers to actually interpret their data and make changes in the patient care regimen.”
Going forward, educating long-term care staff on the use and integration of personal and clinical wearable technology ensures that they are prepared to interpret data and incorporate it into daily care. This is consistent with recommendations made by the American Diabetes Association in their 2025 Standards of Care guidance.
“The next push for clinicians in the post-acute and long-term care space is to expand beyond small studies on the benefit of these types of devices into larger clinical outcome studies,” said Dr. Pandya.
Cost-savings of wearables
If physicians receive the proper education and training on the clinical use of wearable devices, they have the potential to be integrated at a larger scale within post-acute care workflows and lead to cost-savings.
“It saves a lot of time for a facility if nurses don’t have to perform routine finger sticks, document a patient’s blood glucose each time, and then decide on the insulin dose based on what orders are present,” said Dr. Pandya. “The increased adoption of wearables in long-term care promotes cost-savings in terms of less equipment used, less nursing time spent at the bedside and an overall improved quality of life for patients.”
Automatic insulin pumps, in addition to glucose sensors, can also help to reduce the amount of times insulin has to be administered to patients by nurses.
The widespread integration of wearable technology does, however, come with logistical challenges including payment and coverage issues and incorporation into existing workflows.
“If we integrate more widespread use of CGM in long-term care, we must have centralized monitoring of all the data from all the patients using CGM,” said Dr. Pandya. “I introduce CGM in the courses I teach, including the interpretation of trends, what the reports mean, etc. This needs to be reinforced and retrained in residency and then throughout a physician’s career.”
Additionally, insurance coverage for obtaining continuous monitoring devices isn’t always consistent for each patient and facility. According to Dr. Pandya, the widespread use of CGM and other wearable technology across healthcare facilities can be patchy and dependent on each individual facility’s resources and coverage of devices.
“An issue for integration of these devices is payment and something we really must push in the medical industry,” said Dr. Pandya. “Patients with Medicare Part B or outpatients are covered and can receive CGM, but in the subacute setting under Part A Medicare, the cost of care varies and is covered by what Medicare pays the nursing home per day, per patient.”
Insurance coverage for wearable devices can be inconsistent and depend on the complexity of a patient’s health issues, what therapies they need, and how medically intensive the care is that is required.
“For patients who happen to already have CGM, they can bring in their sensors and equipment into post-acute care settings from the outpatient side, but it is important to note that they aren’t always covered in a subacute setting,” said Dr. Pandya.
Policy and action for wearables
To support and advocate for the use of wearable devices across post-acute and long-term care facilities, physicians and advocacy organizations must come together to spread information on its benefits.
“The medical community now has a consensus that we must come together nationally to research, conduct more studies, provide clinical training to practitioners and persuade CMS to increase coverage for these wearable devices so that older adults can access them,” said Dr. Pandya.
More widespread integration of wearable devices has the potential to transform patient monitoring and improve workflows, especially for the care of patients with diabetes.
“The face of diabetes has changed, and the American Diabetes Association is making an effort to recommend wearable devices, which been shown in many studies to improve outcomes. They also have a strong older adult’s interest group, and their focus this year is how to promote the use of CGM in long-term care,” said Dr. Pandya. “At PALTmed, and within the long-term care industry, we are also trying to strengthen our recommendations on wearable devices and support them going forward with training and efficacy.”