📚  Additional Resources

Joanne Milo: The Lived Experience

Start at 16:30 to see our very own Joanne Milo present on her lived experience as an aging T1D and what we need to support ourselves and each other.

Individualized care, support system key to initiating diabetes devices for older adults

A Healio.com article on how health care workers need to adjust to the barriers Type 1 diabetics face.

Facing the Future: Aging with Type 1 Diabetes and the Need for Change

Published by Breakthrough T1D in June 2025, the Facing the Future report explores the challenges faced by people over age 45 who are living with type 1 diabetes (T1D). With more people living longer with T1D than ever before, the report reveals how healthcare systems are unprepared to meet their complex needs as they age.

Based on national surveys and interviews, the report describes the physical, emotional, and logistical burdens of managing T1D in later life—including worsening symptoms, menopause, memory loss, and declining independence. Participants shared stories of poor hospital care, restricted access to insulin, and care home staff untrained in T1D. Women in particular described a lack of menopause-related support. The report highlights how diabetes technology has helped many maintain control and reduce stress, but access is unequal.

It calls for urgent reforms, including mandatory training for care providers, expanded access to technology, updated clinical guidelines, and better research into ageing with T1D—so that people can age with dignity, safety, and support.

Download the full report (PDF)

Type 1 Diabetes in Older People Has Nearly Tripled Globally Since the ’90s

Published by MedPage Today, 2024

A global study reported by MedPage Today shows that type 1 diabetes in people over 65 has almost tripled since the 1990s. Researchers believe this increase isn’t necessarily negative—it may reflect improved survival rates and better detection, rather than a rise in new cases among seniors. The growing number of older adults with type 1 diabetes highlights the need for specialized care strategies tailored to their unique health challenges and lifestyles.

Medicare Promoting ‘Age-Friendly’ Hospitals in Quality Push

Published by Modern Healthcare, July 2025 (requires an account to access)

Starting January 2025, Medicare will require hospitals to report on how they provide “age-friendly” care for older adults, with payment incentives beginning in 2027. Hospitals must show they are addressing five key areas: honoring patient care goals, reviewing medications, screening for frailty, assessing social risks, and appointing geriatric-focused leadership. The goal is to improve outcomes for seniors, such as reducing complications and hospital stays, while also lowering costs. Experts see this as a first step toward broader reforms that tie payments to performance and expand age-friendly care across all healthcare settings.

Reforming Diabetes Care in Care Homes: Training, Collaboration, and Compassion

Published by Integrated Care Journal, April 14, 2025

This article explores how better training, teamwork, and compassion can improve diabetes care in care homes. Many residents face preventable complications and hospital visits due to poor diabetes management, often worsened by isolation. A successful example from Swale CCG in 2016 showed that training all levels of care staff, including non-clinical workers, led to more personalized, effective care. The 2025 Diabetes Care Programme builds on this by bringing together patients, caregivers, and professionals to deliver compassionate, team-based support. The article emphasizes that even basic training combined with a culture of empathy can significantly improve outcomes and uphold the dignity of older adults living with diabetes.

Celebrating 50 years of diabetes treatment, advancements, and hope (Video)

In this November 2023 video hosted by the Johns Hopkins Division of Endocrinology, Diabetes, and Metabolism, nine patients, who were diagnosed with type 1 diabetes more than 50 years ago, talk about their firsthand experiences growing up with this chronic condition, how treatments have advanced through the years, and how they continue to live full lives full of hope.

Realigning diabetes regimens in older adults: a 4S Pathway to guide simplification and deprescribing strategies

This article, published in The Lancet Diabetes & Endocrinology on February 17, 2025, addresses the challenges of managing diabetes in older adults and proposes a safer, more personalized approach to care. As people age, diabetes management becomes more complex due to multiple health issues, memory problems, physical limitations, and the use of many medications. Traditional treatment plans often aim to lower blood sugar levels strictly, but in older adults, this can sometimes do more harm than good, especially when it increases the risk of hypoglycemia, which can lead to falls, confusion, or hospital stays.

To address this, experts developed the “4S Pathway” — a simple, four-step guide to help healthcare providers adjust diabetes treatment for seniors when things aren’t going well. The first step is to identify any red flags or changes in the patient’s health or life that could be making diabetes management more challenging. The second step involves open conversations among the patient, their caregivers, and the healthcare team to agree on the best course of action. The third step is to set or adjust goals that are more realistic and focused on safety and quality of life, rather than just strict blood sugar numbers. The final step is simplifying medications — using fewer or safer drugs, avoiding those that cause low blood sugar, and making treatment easier to follow.

The 4S Pathway emphasizes reducing harm, improving quality of life, and tailoring treatment to each person’s changing needs. It’s especially helpful for people living in long-term care or those with serious health conditions, where comfort and safety are top priorities. This strategy isn’t about stopping treatment—it’s about ensuring it fits the person’s life and current health in the best possible way.

Supporting Deaf and Hard-of-Hearing Adults With Diabetes

This study, published in Diabetes Spectrum in March 2024, explores the experiences of individuals who assist deaf and hard-of-hearing (DHH) adults in managing their diabetes. It highlights the unique challenges faced by care partners in this context, including communication barriers with healthcare providers and limited access to diabetes education in American Sign Language. The research identifies that care partners often feel overwhelmed by the continuous demands of supporting DHH individuals with diabetes. To address these challenges, the study suggests the need for tailored educational programs and resources to better support care partners and promote equitable diabetes care for the DHH community.

The study also emphasized that both DHH adults and their care partners are underserved in current healthcare systems. To improve outcomes, the authors recommend developing accessible diabetes education resources (such as those in ASL), better communication support in healthcare settings, and programs designed specifically for care partners of DHH individuals.

Advocates for Seniors who don’t Have Family: Who Will Care for ‘Kinless’ Seniors?

Nearly one million Americans have no immediate family members to provide assistance if needed and this number is expected to grow. This New York Time article, published in December 2023 and updated in June 2023 discusses this idea of “kinlessness and its impact on care as we age.

CGM Geriatric Principles

Continuous Glucose Monitoring With Geriatric Principles in Older Adults With Type 1 Diabetes and Hypoglycemia: A Randomized Controlled Trial

Published in Diabetes Care (Volume 48, Issue 5) in May 2025, this article examines how continuous glucose monitoring (CGM) can be effectively used for older individuals with diabetes. The study emphasizes adapting CGM—traditionally used by younger populations—to consider the unique needs of geriatric patients, including their risk of low blood sugar, complex medication regimens, and varying levels of daily activity and cognitive ability. By integrating CGM technology with care tailored for older adults, the research suggests potential improvements in safely managing blood sugar levels and enhancing overall quality of life in this vulnerable group.

Diabetes Management in Older Adults

As people with diabetes age, the glucose management strategies they’ve relied on for decades may need some adjustment. Researchers at ATTD 2025 presented various strategies for simplifying treatment plans in older adults with diabetes. Using advanced technologies like CGMs and AID systems can help older adults manage their diabetes more effectively, safely, and independently.

“Nobody’s Talking About It” – The unique issue of getting older with T1D

An interview with T1D to 100’s founder, Joanne Milo.

US Senate Special Committee on Aging

Follow along with news and current events on a national level by reading the updates from the US Senate Special Committee on Aging and make your voices heard!

Standards of Care in Older Diabetics

The 2025 American Diabetes Association guidelines for older adults with diabetes emphasize a personalized, age-friendly approach to care. Treatment should take into account each person’s overall health, cognitive function, physical ability, and personal goals. The “4Ms” framework—what matters most, medication, mentation, and mobility—helps guide decisions. Blood sugar targets should be flexible: healthier adults may aim for tighter control, while those with multiple health issues or cognitive decline may need less strict goals to avoid risks like hypoglycemia.

Simplifying medication regimens and avoiding treatments with high side effects or complexity is recommended, especially for those with limited life expectancy or frailty. Metformin remains the preferred first-line drug, but other options should be carefully chosen based on safety and ease of use. Lifestyle measures like nutrition and physical activity are important for maintaining strength and independence, rather than weight loss. Regular screening for memory and mood issues is encouraged, and care should include family or caregivers, especially during transitions between care settings. Overall, the goal is to provide safe, effective, and individualized care that supports both health and quality of life.

Tidepool’s Redefining Diabetes Spotlight: Seniors

The nuances that come with managing diabetes in conjunction with the challenges that come with age are often overlooked. In February 2022, Tidepool hosted a webinar with a panel of experts including Dr. Irl Hirsch, Dr. Michelle Litchman, Dr. Nancy Allen, and Joanne Milo who share their insights on the unique challenges of the aging population with diabetes.

Ageing well with diabetes: A workshop to co-design research recommendations for improving the diabetes care of older people

A series of online workshops dedicated to exploring diabetes care and research areas of interest.