Adults with Type 1 Diabetes Describe Tech Tradeoffs
Key Takeaways
- Four major themes were identified in qualitative responses from adults with type 1 diabetes using contemporary diabetes technology: psychosocial and emotional impact, daily functioning and lifestyle, environmental impact, and device performance and user experience.
- Adults with type 1 diabetes described mixed psychosocial and day-to-day effects from continuous glucose monitors, insulin pumps, and automated insulin delivery systems, including relief and reassurance for some, but anxiety, sleep disruption, work or school interruption, exercise tradeoffs, and travel burden for others.
- The authors also highlighted newer structural concerns tied to technology-dependent care, including device failures and replacement hassles, environmental waste from disposable supplies, and worries about digital privacy and security.
The researchers invited 5650 adults aged 18 years or older with type 1 diabetes through the health system patient portal; 945 eligible participants responded, and 535 free-text responses were analyzed. Responses were collected from August 1, 2024, to February 28, 2025, and most participants were already using diabetes technology, with 508 of 535 using CGMs, or 95.0%, and 369 of 535 using insulin pumps, or 69.0%. The mean age was 48 years, 282 of 535 participants were female, or 52.8%, and median diabetes duration was 25 years. Participants answered an open-ended question about how their diabetes regimen or technology affected their lives, and two researchers independently coded the comments with iterative recoding after additional subthemes emerged. Of the 535 responses, 443 were technology related, or 82.8%, which grounded the thematic analysis.
Psychosocial comments described both reassurance from real-time data and distress related to information overload, along with financial stress, visibility to others, and physical marks from long-term device wear. Daily functioning responses pointed to sleep disruption from alerts, exercise constraints, interruptions at work or school, and the burden of carrying backup supplies while navigating inconsistent airport screening during travel. Environmental concerns centered on guilt over nonrecyclable device waste. Device experience concerns included perceived CGM inaccuracy, false low alerts, pump-site or sensor failures, connectivity disruptions, time-consuming replacement processes involving manufacturers or insurers, wearability challenges, and apprehension about smartphone-linked privacy or hacking.
The authors framed environmental sustainability, travel logistics, administrative burden around replacements, and digital trust as emerging dimensions of technology-dependent care. They also noted that responses came from an open-ended survey question rather than interviews, participation was voluntary, and the sample reflected one academic health system with a group skewed toward White, highly educated, experienced technology users and specific device brands, which narrows generalizability. The analysis described diabetes technology as a source of both support and strain in everyday life.
Clinician Questions
What themes did adults with type 1 diabetes report about CGMs, insulin pumps, and automated insulin delivery systems?
Adults with type 1 diabetes reported four major themes related to CGMs, insulin pumps, and automated insulin delivery systems: psychosocial and emotional impact, daily functioning and lifestyle, environmental impact, and device performance and user experience, based on qualitative free-text responses from 535 adults with type 1 diabetes.
What day-to-day burdens of diabetes technology were described by adults with type 1 diabetes?
Adults with type 1 diabetes described day-to-day burdens from diabetes technology that included sleep disruption from alerts, exercise constraints, work or school interruptions, and travel stress related to carrying backup supplies and navigating inconsistent airport screening while using diabetes devices.
What device-related concerns did adults with type 1 diabetes describe about CGMs and insulin pumps?
Adults with type 1 diabetes described concerns about perceived CGM inaccuracy, false low alerts, pump-site or sensor failures, connectivity problems, time-consuming replacement processes involving manufacturers or insurers, wearability challenges, and worries about smartphone-linked privacy or hacking.
How was the qualitative study of diabetes technology experience in adults with type 1 diabetes conducted?
Adults aged 18 years or older with type 1 diabetes receiving care in a single large US academic health system were invited through the patient portal; 5650 were invited, 945 eligible participants responded, and 535 free-text responses were analyzed using thematic analysis, with two researchers independently coding responses and recoding after additional subthemes emerged.