Diabetes technology has revolutionized the management of type 1 diabetes (T1D), but it has also introduced a wide range of real-world burdens for patients who use the devices, new qualitative research found.

In a survey, more than 500 adults with T1D provided free-text narratives about how diabetes technology — insulin pumps, continuous glucose monitors (CGMs), and automated insulin delivery (AID) systems that integrate both — affected their daily lives. The results were published recently in JAMA Network Open.

Some concerns, including affordability and dealing with insurance companies, are fairly well recognized. Others, such as the physical and emotional consequences of device failures, travel and airport security challenges, and apprehension about the environmental impact of device waste, may be less likely to come up during routine clinical conversations.

“If we’re not asking about it, we really don’t know,” study author Estelle M. Everett, MD, an endocrinologist and health services researcher at the Geffen School of Medicine at the University of California, Los Angeles (UCLA), told Medscape Medical News. “I think the mental capacity and all it takes to manage the systems is underrecognized.”

Everett emphasized that, overall, these technologies provide substantial benefits compared with multiple daily injections or traditional glucose meters.

“But we still have to be cognizant that the burdens are now different,” she said. “Now the patients have to manage the devices, which is a whole other set of responsibilities. I think it’s important to be aware of the burden and toll on our patients, so that we can best support them.”

Commenting on the study, David T. Ahn, MD, chief of diabetes services at Hoag Hospital in Newport Beach, California, said the findings “illuminate the soft underbelly of diabetes technology.”

“Amidst the great benefits of CGM and AID are common frustrations among people living with T1D,” Ahn told Medscape Medical News. “Too often, the medical community highlights the promises of devices without recognizing or educating around some of the potential pitfalls. All of the issues raised in the article are being experienced by our patients, so long as we, clinicians, take the time to listen and ask the right questions.”

Over 500 Patients Surveyed

Participants were adults with T1D receiving care at UCLA, who were invited to take the survey between August 2024 and February 2025.

Of 5650 patients invited, 945 responded, and 535 answered the open-ended question: “Tell the research team anything else you would like us to know about how your diabetes regimen or technology affects your life.”

Of the 535 respondents, 52.8% were women and 64.9% were White individuals. Patients had a mean age of 48 years, with at least 15% of the participants representing several age groups across an age range spanning 18 years to 70 years or older. More than one third had lived with T1D for over 30 years. Most participants (95%) currently used CGMs, and 69% currently used insulin pumps, nearly all as part of AID systems.

Qualitative analysis identified four main themes: psychosocial and emotional impact, daily functioning and lifestyle, environmental impact, and device performance and user experience. Some responses contributed to more than one theme.

Psychological Impact: Anxiety, Financial Stress, and Visibility

Participants described both decreased and increased anxiety related to diabetes technology.

Some said the devices made them feel more secure, particularly overnight. Others felt that constantly seeing their glucose numbers constituted “information overload.”

Financial stress was also commonly cited, even among those with comprehensive health insurance, with one young adult man calling the problem “crippling.”

“This is really challenging,” Everett said. “Every insurance differs in terms of their copays and deductibles. This isn’t something I was surprised about, but I think it’s probably the thing that patients have the most concerns about.”

Some participants also expressed discomfort with the visibility of devices in public and stress related to long-term changes at infusion sites, including fat accumulation and scarring.

Travel and Daily Life Create Additional Challenges

Travel emerged as a notable burden, particularly because of inconsistent airport security policies and the need to carry backup supplies.

Everett said this issue had not been well described in the previous literature.

“Multiple people mentioned that [Transportation Security Administration] personnel are very inconsistent with what devices — pumps and CGMs — can go through [the scanners] vs not, and then what procedures they’re subject to,” she said. “This emphasized to me the importance of having a standard that’s consistent across airports.”

She added that clinicians also need to do a better job of preparing patients for travel, noting that she had consulted various device websites on this issue to try to guide her patients.

Other lifestyle-related experiences were mixed. Some patients slept better because they worried less about nocturnal hypoglycemia, whereas others lost sleep because of excessive alarms. Exercise could improve blood sugar management but also create difficulties when devices became dislodge. Alarms could also be disruptive or embarrassing in the work setting.

Environmental Impact: An Unexpected Theme

Several participants expressed feeling guilty about the amount of unrecyclable plastic and other waste generated by diabetes devices and their accessories.

“This was something I never really thought about, or would have thought would bother patients,” Everett said. “But several reported that the amount of waste and plastic around site changes was concerning to them.”

“With all the burdens of living with diabetes, I was just surprised that concern about the environment was one of them,” she added.

Device Failures Loom Large

Numerous subthemes emerged around device performance, with inaccuracy, failures, and difficulties obtaining replacements topping the list.

Some participants said inaccurate readings, errors, and device failures caused fear and frustration and interfered with glucose management. Obtaining replacements was often challenging, involving long customer service interactions and delays.

Everett said these concerns were nearly as prominent as those surrounding cost.

“This is maybe more of a problem with the newer generation devices as there’s been such an explosion in advancement of the technology and newer devices are coming out quicker,” she said. “There have been many reports of devices failing early. This is very frustrating for patients when they can’t rely on their technology.”

The consequences can be more significant when devices are connected through an AID system, she noted. If the CGM fails, the entire automated “loop” may be disrupted.

The situation can also frustrate clinicians.

“As physicians, we’re kind of powerless,” Everett said. “I would love to be able to write my patients a prescription that has some extra CGMs in case they fail, but the insurance companies won’t pay for it.”

Other concerns included wearability challenges, especially among women with tubed pumps with certain clothing, and worries about using smartphone apps because of potential hacking or misuse of personal health data.

Ahn said he might add skin sensitivity and adhesive-related skin rashes to the list of commonly seen burdens.

Overall, he said, “the data collected in this study are crucial to increasing awareness of the shortcomings of diabetes technology, which is the only way to realistically help lead to better solutions over time.”

Everett said two additional papers are coming out soon in this area, one focused specifically on alarms and alerts and another examining broader device-related distress. She previously presented some of the findings at the 2025 American Diabetes Association’s Scientific Sessions.

Everett reported receiving grants from the National Institutes of Health. Ahn reported receiving speaker and/or consulting fees from Abbott, Ascensia, Dexcom, Eli Lilly, MannKind, Insulet, Novo Nordisk, Sequel, and Xeris; and having consulting/advisory relationships with Ascensia, Eli Lilly, MannKind, and Tandem Diabetes Care.

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