ADA 2026: Clinical Pharmacist–Led Group Sessions Show Promise for Hypoglycemia Prevention in Older Adults With Type 2 Diabetes

Hypoglycemia remains one of the most serious threats facing older adults with type 2 diabetes (T2D). For patients aged 75 years and older using insulin, a single hypoglycemic event can trigger a cascade of consequences, including falls, cognitive decline, emergency hospitalization, and even death. New data presented at the American Diabetes Association (ADA) 2026 Scientific Sessions suggest that pairing continuous glucose monitoring (CGM) with pharmacist-led group education sessions may meaningfully shift how these high-risk patients understand and manage their glucose levels.¹

The Burden of Hypoglycemia in Older Adults

Hypoglycemia disproportionately affects older adults with T2D, a population that is growing rapidly and often excluded from landmark clinical trials. CGM has emerged as a valuable tool to improve hypoglycemia detection in this group, with evidence showing it can reduce hypoglycemic episodes by more than 50% compared with standard monitoring in adults over 65 years of age; however, detection alone is insufficient. Translating CGM data into meaningful behavioral change requires structured education and support—particularly for patients who may have limited health literacy, polypharmacy burdens, or hypoglycemia unawareness.^2,3

The SAGE Trial: CGM Plus Group Education

The Safer Aging with Diabetes Monitoring (SAGE) clinical trial (NCT06296485) was designed to address this gap. The trial enrolled insulin-using adults with T2D aged 75 years and older, initiating CGM and pairing it with 2 virtual, pharmacist-led group sessions held one month apart. Sessions were structured around reviewing and discussing participant-reported, CGM-identified hypoglycemia events.¹

Researchers analyzed detailed field notes from 32 group sessions conducted between July 2024 and October 2025, capturing data from 61 participants (mean age 79.8 ± 3.4 years; 34 women, 27 men) using a grounded theory approach.^1,4

Four Key Themes Emerged

Thematic analysis of session field notes revealed four overarching themes that illustrate how participants' thinking and behavior evolved over the course of the intervention.¹

Cognitive shifting was the first theme identified, reflecting a transition from reactive to proactive glucose management, moving away from simply avoiding highs and lows toward actively maintaining time-in-range.¹

Proactive prevention emerged as participants began combining real-time CGM data with insights from group discussions to modify daily routines, identify root causes of hypoglycemic episodes, and recognize previously undetected hypoglycemia unawareness and nocturnal lows.¹

Increased emotional safety was a notable finding, with participants reporting greater confidence and a sense of security in their ability to prevent and treat future low glucose events.¹

A fourth theme, greater self-management confidence, emerged specifically during follow-up sessions. Participants initiated conversations with their own health care providers that frequently led to deprescribing of high-risk diabetes medications, an outcome consistent with findings from recent pharmacist-led intervention trials showing safer prescribing in up to 28% of patients contacted.^1,4

Implications for Pharmacy Practice

These findings emphasize the unique and expanding role of clinical pharmacists in diabetes care. Pharmacist-led interventions targeting hypoglycemia-prone regimens have demonstrated measurable improvements in prescribing safety in older adults with T2D, and the SAGE trial suggests that group-based, experiential education amplifies those gains by building patient agency. When patients arrive at provider appointments armed with CGM data and the language to describe their experiences, deprescribing conversations become more accessible.⁴

The study authors conclude that individualized CGM data combined with expert problem-solving guidance was associated with more engaged, proactive self-management. They recommend that future research should examine whether this paired approach reduces long-term hypoglycemia-related complications in diverse older adult populations.¹

REFERENCES

1. Fernandez EM, Gonzalez SC, Jamal O, et al. 1355-P — Hypoglycemia Prevention in Older Adults with Type 2 Diabetes via Clinical Pharmacist–Led Group Sessions. Poster presented at: American Diabetes Association 2026 Scientific Sessions; 2026.

2. Price C, Callahan KE, Aloi JA, Usoh CO. Continuous Glucose Monitoring in Older Adults: What We Know and What We Have Yet to Learn. J Diabetes Sci Technol. 2024 May;18(3):577-583. doi: 10.1177/19322968241234651

3. Wilson A, Morrison D, Sainsbury C, Jones G. Narrative Review: Continuous Glucose Monitoring (CGM) in Older Adults with Diabetes. Diabetes Ther. 2025 Jun;16(6):1139-1154. doi: 10.1007/s13300-025-01720-z.

4. Gilliam LK, Parker MM, Chen MW,et al. Pharmacist Intervention for Safer Prescribing in Patients With Type 2 Diabetes at High Risk: A Randomized Clinical Trial. JAMA Netw Open. 2026 Feb 2;9(2):e2559946. doi: 10.1001/jamanetworkopen.2025.59946