Alexandra Szilagyi

Background: The global aging population faces an increasing prevalence of type 2 diabetes mellitus (T2DM), often complicated by frailty, cognitive decline, and impaired manual dexterity. These factors make glucose self-monitoring particularly challenging. Minimally invasive glucose monitoring methods, particularly continuous glucose monitoring (CGM) as well as emerging non-invasive glucose monitoring technologies offer potential solutions, but remain insufficiently evaluated in older adults. Objective: To systematically review and synthesize available evidence on the advantages of continuous glucose monitoring (CGM) and non-invasive glucose monitoring methods in older adults aged ≥65 years, focusing on clinical efficacy, usability, adherence, and existing knowledge gaps. Methods: A systematic literature search was conducted across PubMed, Scopus, and Web of Science, including studies from 2020 to 2025. Eligible studies included participants aged ≥65 years and evaluated the clinical performance of CGM or other minimally invasive or non-invasive glucose monitoring technologies. The PRISMA framework guided screening and selection. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Due to substantial heterogeneity among study designs and reported outcomes, a narrative synthesis approach was adopted. Results: A total of 426 records were identified, of which 13 met the predefined eligibility criteria after full-text screening. After risk of bias assessment, one study was excluded, resulting in 12 studies included in the final synthesis. No eligible studies evaluating completely non-invasive glucose monitoring technologies were identified, highlighting a significant research gap in this area specifically for older adults. CGM was associated with improved glycemic control, reduced hypoglycemia, and increased time in range among older adults. Usability was generally high, particularly with newer, user-friendly devices. Conclusions: CGM is associated with improved glycemic outcomes and favorable usability in adults aged ≥65 years. However, a significant gap exists in research on non-invasive glucose monitoring technologies in this population. Future studies should address the accuracy, feasibility, and usability of non-invasive glucose monitoring devices, while accounting for the physiological and behavioral complexities associated with aging.