Growing old with type 1 diabetes (T1D) is a relatively new positive phenomenon, thanks in part to more physiologic insulin formations and increasingly sophisticated glucose management technology. Such advances have dramatically reduced acute and chronic complications that historically shortened life expectancy.

Data published in 2012 showed that life expectancy at diagnosis rose by approximately 15 years for patients with T1D in the US diagnosed from 1965 to 1980 compared with those diagnosed from 1955 to 1964 (68.8 vs 53.4 years, respectively). More recent Finnish data from 2023 projected that a 20-year-old diagnosed during the 2020s could expect to live an additional 55-60 years.

A recent publication from Breakthrough T1D highlights how dramatically the demographic has shifted, as just 13.3% of the 1.5 million Americans with T1D are children younger than 20 years, while most are between the ages of 45 and 65, and can expect to live much longer.

New Risks for an Aging Population

With greater longevity, people with T1D are developing age-related physical and cognitive deficits that can compromise their ability to perform the complex self-management tasks the condition requires. Many lack family support or healthcare professionals trained to step in when necessary.

Some older adults with T1D may outlive their spouses, and many never had children, partly because earlier generations of women with T1D were advised against pregnancy. At the same time, hospitals, long-term care facilities, and nursing homes often lack expertise in T1D management. Some privately owned facilities even exclude those with the condition or charge them higher fees.

Even endocrinologists rarely receive formal training in this area, said Irl B. Hirsch, MD, professor of medicine and medical director of the Diabetes Care Center at the University of Washington Medical Center in Seattle.

“This is a population that didn’t exist 30 years ago,” he told Medscape Medical News. “There are no studies assessing blood glucose, blood pressure, or lipid targets, let alone how does cognition change after 60-70 years of T1D.”

Cardiovascular disease and cancer are the leading causes of death in T1D, yet many cardiologists cannot distinguish T1D from type 2 diabetes, Hirsch noted, and may not recognize when sodium-glucose cotransporter 2 inhibitors could be unsafe.

“In oncology, there’s a high number of regimens requiring high-dose steroids [which can dramatically raise blood glucose levels],” he noted. “The entire system will need to think about keeping these patients out of diabetic ketoacidosis.”

Realignment, Not Deprescribing

Medha Munshi, MD, director of the Geriatric Diabetes Program at the Joslin Diabetes Center and professor of medicine at Harvard Medical School in Boston, has long been concerned about this gap.

“I don’t think people understand how complex it is to manage aging issues with type 1 diabetes,” she told Medscape Medical News.

Recognizing the need, Munshi founded the International Geriatric Diabetes Society (IGDS) in 2019.

“There is an awareness that you treat children differently, but for 20 years I’ve been trying to tell people that the other end of the spectrum is also different,” she said. “It’s about risk and benefit and time to benefit.”

A recently published paper resulting from the 2024 IGDS workshop outlined challenges and opportunities for improving care in older adults with T1D. Priorities included individualized care, leveraging technology, expanding insurance coverage, and developing novel care models incorporating telehealth, home health, interdisciplinary teams, and specialty support within assisted living facilities and long-term care settings.

Munshi has also published guidance on simplifying and realigning insulin therapy for older adults struggling with current regimens and led a randomized study in this population demonstrating that continuous glucose monitoring can reduce hypoglycemia without worsening glycemic control.

“We do not have to give up on glycemic control by changing our approach or realignment,” she said. “But we really need to change strategies when people begin struggling as they get older. It’s shared decision-making.”

Momentum Builds Within the ADA

Munshi was the lead author of the American Diabetes Association’s (ADA) 2016 Position Statement on diabetes management in long-term care and skilled nursing facilities and the ADA’s 2025 Standards of Care chapter on older adults with diabetes.

In addition, she serves as a member of a small ADA working group on older adults with diabetes, which has recently gained momentum. Chaired by Chalisa A. Nuzhat, MD, the group hosted an invitation-only event during the 2025 ADA Scientific Sessions and aims to expand to a larger event in 2026. They are also working toward establishing an official professional interest group.

“We have recognized a few things that we can do with the help of ADA,” said Nuzhat, director of the endocrinology, diabetes, and obesity clinic at Morris Hospital and Healthcare Center, Morris, Illinois. These include formalizing the group and developing webinars, continuing education courses, and podcasts.

While the group is expected to cover type 2 diabetes as well, Nuzhat anticipates a strong focus on T1D, particularly around technology use and the shift from tight glycemic control to greater comfort, simplicity, and reduced hypoglycemia risk.

Nuzhat and Munshi also hope to promote greater adherence to the current ADA Standards of Care guidelines and to push for continuous glucose monitoring use in long-term care facilities, beginning with advocacy for research funding.

Raising awareness in primary care, where many adults with T1D are seen, is another priority, Nuzhat told Medscape Medical News.

“How do we get this information to them? How do we get them more involved?,” Nuzhat asked.

Preparing for the Future

The ADA’s efforts parallel advocacy within the T1D community. In 2024, T1D blogger Joanne Milo, who was diagnosed in 1965 at age 10, founded a group called “T1D to 100” and has launched a website and a Facebook community. The moves came after encountering troubling lapses in T1D awareness during her own hospitalizations, such as staff asking whether she used insulin. Indeed, Munshi and Nuzhat both noted that they frequently must remind hospital staff never to withhold insulin in people with T1D.

“Many with T1D are frightened about who’s going to take care of us,” Milo told Medscape Medical News. “As we get older, nobody knows what to do with us, to comprehensively take care of us, and make sure we’re safe as we approach the end of life.”

She added, “We need to educate ourselves and advocate for ourselves, and we need to educate the caregivers how to deal with us. We’re not as cute as the 10-year-olds and we’re far more complicated. We take more time. How do we prepare for our future?”

Milo’s website offers resources on preparedness, living arrangements, bodily changes, and advocacy. Another major goal of T1D to 100, supported by Munshi on the ADA advisory panel, is educating healthcare professionals.

“I think the website is amazing,” Munshi said. “The fact that Milo and her team are so able to think it through is great.”

Nuzhat agrees. “It’s very useful information. We need to come up with similar information from endocrinologists and geriatricians, and we need to share that information with the medical community. It’s not only important to talk about numbers and complications but day-to-day problems and issues that older adults face.”

As of December 1, 2025, a separate Facebook group for people living with the condition for over 50 years has 2790 members, of whom 40 are 70+ year "Masters" and two are 80+ year "Platinum Masters." The first member to reach that milestone passed away in November 2025 at age 83, having lived 81 of those years with T1D.

Hirsch reported receiving personal fees from Roche, Abbott, and Hagar and grants from Dexcom and MannKind. Munshi reported being a consultant for Sanofi, Abbott, and Medtronic and receiving investigator-initiated funding from Dexcom. Nuzhat and Milo reported having no disclosures. 

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR’s Shots blog, and diaTribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.