The Digitalization of Diabetes: Who is Left Behind?

Authored by: Syed Hasan

Art by: Alex Song

In a rapidly modernizing world, for the vast majority, the digitalization of blood glucose monitors has led to much better outcomes for diabetes patients. Particularly because it has allowed for the automated tracking of insulin injections and a reduction of needle usage. However, it has also left behind many who are unable to switch to digital devices. Reliance solely on online technology creates a gap in access to healthcare, especially for aging or lower-income communities, where the prevalence of disease is already higher. A stable wi-fi connection, electricity to charge a phone or laptop, and the ability to use handheld technology all create obstacles in prospective patients’ access to new devices. 

While this is not a major issue today, as older manual methods begin to get phased out and widespread implementation occurs, it will become increasingly difficult for vulnerable elderly populations to keep up. Without further interventions by public health representatives and care providers, disparities in access could widen to the point of leaving behind those who are not provided with the initiatives and step-by-step procedures needed for effective integration.

The efficacy of continuous glucose monitors as opposed to the original methods of pricking and test strips is widely praised, and a research study found that both blood glucose levels and BMIs in individuals with type 2 diabetes improved when using home monitors, and symptoms were managed much better when compared with pre-monitor regulation [1]. However, while monitors sound ideal in theory, their high costs and reliance on digital literacy build barriers faced most greatly by those who need this life-saving care the most. As one study expanding on both benefits and challenges states: “age-related comorbidities, especially cognitive and physical decline, can make technology use difficult in older adults,” and these are the individuals facing the greatest burden of the diabetes disease [2]. With app interfaces that rely on touchscreen handling, specific language settings, and small, hard-to-read buttons, many are left with progress that is inaccessible to them without full outside assistance. These recent shifts have left those without children or caretakers who can facilitate usage completely helpless.

In addition to the limitations that arise with unequal broadband capability across the United States is the ability to afford the utility at all. The cost of smartphones that can run individualized applications that most new monitors utilize, the cost of a phone plan, and most notably, the cost of monitors range from hundreds to thousands of dollars. Depending on the frequency of insulin delivery, these become massive expenses! To those who can’t get full insurance coverage, these prices are difficult to justify, even with proven health benefits. This results in a continuation of finger-pricking, not from the luxury of choice, but out of necessity. 

However, in the long term, continuous glucose monitors reduce the healthcare burden of aging populations and provide room for growth. A study focused on the integration of technology found that “older people with diabetes benefit from technology in terms of glucose management, reductions in hypoglycaemic events, emergency department attendance and hospital admissions, and improvement in quality of life,” [3]. This emphasizes the extent to which new leaps in medicine have huge proven benefits for diabetes patients. Although they require additional initiatives to encourage long-term implementation, the rise in artificial intelligence (AI) can fast-track the creation of educational modules that meet people where they are. In an article published by Science Direct on existing digital solutions, they highlight: “the algorithm predicts the future values of glucose for 1 hour ahead… send verbal (voice) or written messages,” [4]. The usage of AI here emphasizes how algorithms can provide informed diet choices to diabetes patients, and in this case, provide further assistance and care to those who may be making these decisions alone otherwise. This illustrates the importance of viewing the other side of the influx of information that digital monitors bring, and their many benefits.

In a survey conducted on over 3,000 diabetes patients to view perspectives on the emerging digitalization of glucose management, they found that the vast majority of participants were extremely receptive to adopting new technologies and had positive attitudes towards this shift in the management of their disease [5]. While promising, these results exacerbate the notion that the success of these technologies relies most prominently on how effectively they are made accessible to the entire population facing disease, as they will be received well by the majority. In all cases, the need for policies that drive equitable interventions and the incorporation of AI to ease the switch to new technologies is required now more than ever. With these changes in mind, evidence across all studies shows the potential for significant improvements to both outcomes on patient lifespans and day-to-day glycemic control that digitalization offers. 

References:

1. Xiao, Yuping et al. “Effectiveness of Digital Diabetes Management Technology on Blood Glucose in Patients With Type 2 Diabetes at Home: Systematic Review and Meta-Analysis.” Journal of Medical Internet Research vol. 27 e66441. 3 Mar. 2025, doi:10.2196/66441 https://pmc.ncbi.nlm.nih.gov/articles/PMC11914849/ 

2. Toschi, Elena, and Medha N Munshi. “Benefits and Challenges of Diabetes Technology Use in Older Adults.” Endocrinology and metabolism clinics of North America vol. 49,1 (2020): 57-67. doi:10.1016/j.ecl.2019.10.001 https://pmc.ncbi.nlm.nih.gov/articles/PMC6983469/

3. Maltese, Giuseppe et al. “Ageing well with diabetes: the role of technology.” Diabetologia vol. 67,10 (2024): 2085-2102. doi:10.1007/s00125-024-06240-2 https://pmc.ncbi.nlm.nih.gov/articles/PMC11446974/

4. Neborachko, M. (2018, July). Current trends of Digital Solutions for diabetes management. Science Direct. https://www.sciencedirect.com/science/article/abs/pii/S1871402118303266 

5. Kulzer, B., Heinemann, L., & Roos, T. (2021). Patients’ experience of new technologies and digitalization in diabetes care in Germany. Journal of Diabetes Science and Technology, 16(6), 1521–1531. https://doi.org/10.1177/19322968211041377