Contemporary Diabetes Technology and the Patient Experience.

IMPORTANCE

Use of insulin pumps, continuous glucose monitors (CGMs), and automated insulin delivery (AID) systems has increased substantially in type 1 diabetes (T1D) care. Although these technologies improve glycemic outcomes, their broader impact on patients' daily lives and psychosocial well-being remains incompletely understood.

OBJECTIVE

To identify psychosocial and other emerging dimensions of contemporary diabetes technology use among adults with T1D.

DESIGN, SETTING, AND

PARTICIPANTS

This qualitative study used thematic analysis of free-text survey responses collected between August 1, 2024, and February 28, 2025, from adults (aged ≥18 years) with T1D receiving care within a single, large, academic health system in the US. Participants represented a range of ages, diabetes duration, and age at onset; most were users of CGMs and AID systems.

RESULTS

Of 5650 individuals who were invited to participate in the study, 945 eligible patients responded to the survey and 535 (mean [range] age, 48 [18 to ≥70] years; 282 [52.8%] female) provided free-text responses regarding the impact of diabetes technology on daily life that were included in the qualitative analysis. The median (range) diabetes duration was 25 (0 to ≥31) years. Overall, 508 (95.0%) were using CGMs and 369 (69.0%) were using insulin pumps. Participants described diverse experiences with modern diabetes technology, reflecting both benefits and burdens. In addition to established psychosocial themes, several novel concerns were identified: environmental impact from device-related waste, travel-related stress due to supply logistics and inconsistent airport security procedures, distress related to premature device failures and challenges navigating manufacturer and insurance replacement processes, and apprehension about digital security. These structural and societal factors were described as meaningful contributors to overall technology experience.

CONCLUSIONS AND RELEVANCE: In this study of adults with T1D, contemporary diabetes technology affected more than glycemic control; environmental sustainability, administrative burden, travel logistics, and digital trust represented emerging dimensions of technology-dependent care. Addressing these concerns through patient-centered design, streamlined system processes, and transparent cybersecurity protections may enhance the long-term sustainability and acceptability of advanced diabetes technologies.