Joanne Milo remembers getting her first glucometer as a high school student in 1970. “It was better than urine testing,” she said about the expensive, clunky machine. Milo, now 70, has been an early adopter of diabetes technology, continually upgrading as newer, smaller, faster, and more accurate options appear.  

Milo, who writes The Savvy Diabetic blog, uses the Omnipod Dash with her Dexcom G6 (or G7, depending on connectivity) and the Trio/iAPS open-source, closed-loop system. She said her life has been improved by tremendous advances in diabetes technology, but for older adults, devices can bring challenges. 

“It gets way more complicated for tech as we age. I feel the burden of my DIY tech — it’s just harder,” Milo said.  “After almost 60 years of managing my T1D and living with the concept of ‘control,’ I’m quite tired of being vigilant. And with more complicated devices, there is more to be vigilant about.” 

 

How are aging adults adapting to T1D tech? 

People with type 1 diabetes (T1D) are living longer, which means an increasing number are using continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery (AID) devices to help with glucose management and improve quality of life.   

Diana Isaacs, an endocrine pharmacist at Cleveland Clinic, where she’s director of education and training in diabetes technology, said that there’s no age limit for using diabetes technology. 

“There are misconceptions about older people and what they can handle or that they are not interested in technology,” Isaacs said. “That’s changing as most now have a smartphone. Older adults do very well with technology, and it’s essential to use a CGM, especially when it comes to reducing hypoglycemia.” 

Isaacs recounted working with a woman in her 70s who has lived with T1D for 66 years and never used a CGM until this year. They discovered she was having frequent episodes of undetected hypoglycemia. “We eventually put her on an AID system and got rid of most of the lows,” she said. “It’s just incredible. For so long, she had no idea, and there are things that can help.” 

 

What are the barriers to T1D tech adoption? 

Aging can present obstacles. The biggest one, Isaacs said, is that most technology, especially pumps, don’t address visual impairments and dexterity issues that come with age. “It’s possible that as people start to have issues like severe arthritis or not being able to see as well, they might need assistance to do things like filling pumps, changing out cartridges, or inserting sensors,” she said.  

This doesn’t mean older adults should shy away or be discouraged from using technology. Still, there may be safety concerns, especially if cognitive issues, such as forgetfulness or early dementia, are evident.   

“Then it becomes harder to do basic problem solving, which is really necessary with diabetes management and especially with technology,” Isaacs said. It’s important to understand what alerts mean or what to do when their pump is low on insulin, for example. In such instances, someone will need help.  

“I would like to see advocacy efforts to ensure that technology is made with all people in mind and that we address, at least, some of the dexterity and visual issues,” Isaacs said, noting that pumps controlled by mobile apps can be modified on the phone for large print or audio. “Technology should be reachable for everybody.”

 

What does research say?  

Device use among aging adults with diabetes has been a focus area for researchers to better understand the challenges of tech use with age-related impairments. 

A recent TID Exchange study examined diabetes technology use rates in adults 60 years and older, recognizing that while its use has grown, it remains underreported. The study, which compared two patient registries, discovered: 

  • Use of diabetes devices decreased with age 
  • CGM use was close to 50% in both registries 
  • Insulin pump and AID use was significantly lower

 

What’s it like to age with T1D?   

One of the advantages of aging with T1D, many say, is that they know themselves and their condition well, essentially becoming experts in managing their T1D. 

“I’ll turn 50 in the spring, and so far, the biggest adjustment I’ve had to make is using reading glasses to see details on my diabetes devices, and I opt for the larger screen options of the commercial devices I buy,” said Scott Johnson, community manager with Blue Circle Health in San Diego. After decades of experimenting, he uses the DIY automated Trio system, linking an iPhone, Dexcom G7, and OmniPod DASH pods. “I’m doing better now than in years past,” he said, “and I’m working less hard.” 

Riva Greenberg, 71, a health coach, writer, industry advisor, and diabetes advocate in New York, agreed. “As I age, the good news about my diabetes is that I’m very familiar with it, it’s just part of me,” she said. “We need to stop using language like ‘fighting’ diabetes and learn how to live with it.”  

Greenberg, diagnosed in 1972, has worn a CGM for just over a decade. For her, the device has been life-changing, but not without challenges. “My current Libre 3 tells me my blood sugar every minute. It’s great to know where I am and how I’m trending, but the amount of data can sometimes be overwhelming.”   

Greenberg has resisted adding a pump. “A pump might give me more ‘elegant’ management and would help me head off the dawn effect, which I have,” she said, “but that doesn’t outweigh the extra weight and hassle of wearing one.”  

Greenberg recently saw the Tandem Mobi, the smallest pump available, but still wasn’t moved. However, wearing a CGM is a must. “People over 60 with type 1 are more prone to hypo unawareness because we have had so many years of diabetes and lows. That’s a great reason to use a CGM as you age,” she said.  

 

What is the most helpful piece of T1D technology to age with? 

“For diabetes across the lifespan, the most useful piece of tech is the CGM, hands down,” echoed Amy Hess-Fischl, a diabetes care specialist at the University of Chicago Medical Center and past American Diabetes Association educator of the year. “It empowers those who live with this condition 24/7 to see cause and effect and make changes on the fly and adapt to their situations and reduces the risk of severe lows.” 

Hess-Fischl cautioned that adopting new technology at any age usually comes with a cost, both financial and mental. 

“I’m thinking of several of my 70- to 80-year-olds who started on one type of pump,” Hess-Fischl said. “When they transitioned to a different brand, they required a lot more follow up and training. Now, I suppose I could say that about all my patients, regardless of age, but that is a conversation that needs to be included in tech selection. I have had many patients say to me that they are comfortable with what they are doing and don’t want to change or upgrade.”  

For those without significant hypoglycemia, who also have a current treatment plan that’s working, “I have a ‘if it is not broken, don’t fix it’ kind of approach.” At the same time, Hess-Fischl added, regardless of age, ethnicity, or someone’s socioeconomic situation, everyone should be offered choices when it comes to using tech, including the option of deciding not to. 

 

Hess-Fischl suggests considering: 

  • What your level of independence is with technology 
  • How the technology will benefit you  
  • How long it will take you to learn  
  • What technology options your health insurance might cover 
  • If new technology might cause increased emotional distress 
  • If adding or changing T1D tech is a personal preference or something the provider wants 

 

Greenberg added she’s open to new technology as her needs shift. “When I think about being older, like in my 80s, I really can’t imagine if my age will create obstacles, it doesn’t now. Will it be hard to see the little half-unit lines on my syringes? Or am I going to be living with other conditions that make my management more difficult?” she said. “I’ll only know when I get there, but for now, I can say I have historical gratitude. For the first ten years, I didn’t have a glucose meter, and now I know my blood sugar every minute.”