Why we need to rethink T1D care in older age

“When people talk about type 1 diabetes (T1D) technology, the focus is often on young people or those newly diagnosed with T1D. Yet one of the most important conversations we need to have is what happens as people grow older with type 1, especially when they develop additional health needs or become reliant on others for their care.  

Over the past few years, I’ve been involved in introducing hybrid closed loop (HCL) technology to some of our most complex patients; people with complex care requirements, learning disabilities, frailty, and people living with advanced dementia. What we’ve learned is simple: we should never assume that technology isn’t suitable for someone because they are older or have complex care needs.  

A change in approach

Too often, healthcare focuses on fixing a problem rather than understanding an individual. My approach has always been to ask: what’s happening in this person’s life, what matters to them, and how can we make things work around them?  

That philosophy shaped our approach when we began introducing HCL to people who, historically, might never have been considered for it. Many were receiving insulin support from district nursing teams. Some had highly unpredictable glucose levels, resulting in frequent interventions and hospital admissions. On paper they were eligible for technology, but the assumption was often that it would be too difficult to implement. We discovered the opposite is often true. 

Better predictability, improved efficiency

One of the first people we onboarded onto HCL was an older gentleman who had complex care needs. He had extremely unstable glucose levels and required significant nursing input. Since starting on the system, his glucose levels have become far more predictable and both his health and quality of life have improved dramatically. His district nurses describe him as “a new man”.  

In turn, this significantly improved care efficiency for the nursing team. 

Previously, nurses would visit the gentleman in the morning and find his glucose levels dangerously low or extremely high. Either situation would trigger additional visits and unplanned workload. With HCL, glucose levels became much more stable, reducing the need for repeated interventions throughout the day. The result has been less stress Previously, nurses would visit the gentleman in the morning and find his glucose levels dangerously low or extremely high. Either situation would trigger additional visits and unplanned workload. With HCL, glucose levels became much more stable, reducing the need for repeated interventions throughout the day. The result has been less stress and unexpected workload for staff and, most importantly, a better experience for the patient. 

Making the right choice for you

Of course, technology isn’t right for everyone. A lot of older people simply don’t want it, and that’s okay. Nobody should feel pressured into using technology because someone else thinks it’s the right thing to do. Instead, we should create opportunities for people to try it and make an informed decision for themselves. We’ve learned that building relationships, providing support and working together to address concerns is essential.

An ageing population

Currently in the UK, there are about 14,400 people aged 80 and over living with T1D. Better treatments, improved care and advances in technology mean people are living longer than ever before. That’s something to celebrate. It also means we must think carefully about how we support people as they age.  

One of the biggest challenges I see is that as people age, they become focused on trying to control levels by eating less, rather than adjusting management appropriately. Over time this can contribute to malnutrition, loss of muscle mass and increased frailty.  

This is where technology can help. HCL can absorb some of the variability that comes with everyday life. The tech can help manage things like a piece of cake, extra roast potatoes at Sunday lunch or changes in routine in a way that traditional insulin approaches often struggle to accommodate. 

Technology is for everyone

My hope is that where someone lives or the support they receive will never become a barrier to accessing T1D technology. 

The goal isn’t for everyone to have the same experience but the same opportunity. Whether someone lives independently or resides in a care home, they should be able to access technology if it could benefit them.  

The future of type 1 care isn’t only about helping people live longer. It’s about helping them live well.”