Telehealth for Diabetes in Older Adults

Introduction

Recent estimates indicate that about 29.2% of Americans aged 65 and older — representing more than 16.5 million older adults — are living with both diagnosed and undiagnosed diabetes.¹ This prevalence is expected to rise as the population ages, presenting distinct set of challenges for health care delivery in this unique demographic. However, with the increasing burden of diabetes among older adults, there is an urgent need for innovative models that address their complex medical and social needs at all levels of care.

Today, telehealth offers a promising interventional approach for enhancing access, continuity, and quality care for older adults across diverse settings.²

Telehealth and Diabetes Care in the United States

Telehealth encompasses a broad range of services and technologies, including video consultations, virtual patient monitoring, mobile health apps, and digital health platforms designed to deliver health care remotely. In diabetes care, telehealth enables real-time communication between patients and health care professionals, facilitating remote monitoring of blood glucose levels and other health metrics, as well as supporting patient education and self-management.³

In the past 15 years, medical experts have leveraged telehealth to develop innovative care models for specific patient subgroups with type 1 diabetes (T1D). These models include virtual diabetes check-ins for children and adolescents during school hours, remote behavioral therapy for patients and their families, group telehealth sessions for young adults, and monthly virtual follow-ups for individuals with poor glycemic control.⁴

The adoption of telehealth in diabetes management has accelerated in recent years, particularly following the COVID-19 pandemic, which led to increased reimbursement for virtual care services.⁴

During the pandemic, virtual care transformed health care delivery and sustained the quality of diabetes management. In a study of 16,588 patients with type 2 diabetes (T2D), researchers found that patients who utilized telehealth during the pandemic maintained quality care outcomes comparable to pre-pandemic levels, while those who relied solely on in-person visits experienced declines in health outcomes.⁵ Additional reports by Doximity, Inc. identified endocrinologists as one of the leading and earliest adopters of telehealth.⁶

During the pandemic, patients with T1D reported high satisfaction with telehealth, citing time savings (85%), reduced stress (44%), and lower costs (29%) as key benefits. In a national survey, 62% of respondents found telehealth to be more effective than in-person care, and 82% of respondents preferred using it for future appointments. Institutional data also showed that telehealth visits had satisfaction levels equal to or higher than in-person visits.⁴

Today, telehealth use in diabetes care has expanded with the adoption of HIPAA-compliant platforms, reimbursement codes, and technological advancements such as continuous glucose monitoring (CGM), Bluetooth glucose meters, and secure data-sharing tools. These innovations have enabled clinicians to integrate patient-generated health data (PGHD) into remote care and explore new care models beyond traditional in-person visits.⁴

Medha Munshi, MD, director of Joslin Geriatric Diabetes Program, associate professor of medicine at Harvard Medical School, and staff geriatrician at Beth Israel Lahey Hospital in Boston, gave an overview of the evolution of telehealth from the pre-pandemic era.

“Telehealth saw limited use pre-pandemic, even in advanced medical centers like the Joslin Diabetes Center. However, COVID-19 created an urgent need for remote care, accelerating the adoption of telehealth and vastly improving its infrastructure. Present-day telehealth platforms are more robust, and many older adults, including those in their 80s, are more open to virtual care than they were before,” she said.

While telehealth offers many benefits for diabetes care, older adults still face notable barriers to its optimal use.⁴

Age-related sensory, physical, and cognitive impairments create significant barriers to telehealth use among older adults, limiting their ability to engage with virtual care. Data from the Health and Retirement Study indicates that older adults (n=4453) with vision or cognitive impairments were less likely to utilize telehealth. These challenges are further compounded among those with more than 3 physical limitations, who were the least likely to use telehealth.⁷

Cognitive declines such as dementia and sensory deficits such as hearing or vision loss often require caregiver support, as they interfere with the ability to navigate audio-visual platforms. However, most telehealth technologies are rarely optimized for these needs, heightening the risk for telehealth exclusion among older populations.⁸

Commenting on practical strategies to help older adults with cognitive decline engage more effectively with telehealth, Dr Munshi noted that each type of impairment presents a unique challenge.

“Hearing loss is common in older adults, but many now use Bluetooth-enabled hearing aids and closed-captioning features to support communication during virtual visits,” she said. “Cognitive and memory impairments present greater challenges. That is why I strongly recommend having a caregiver present during virtual visits to help ensure instructions are understood, retained, and followed through.”

In agreement, Emilia Thurber, MD, MPH, an endocrinology fellow at Brigham and Women’s Hospital in Boston, affirmed that the help of family members is essential for patients in their 90s when completing virtual visits. “Having someone assist an older adult with telehealth navigation and communication is key and can make a big difference,” she said.

Language and Communication Barriers

For older adults, limited English proficiency can make it challenging to navigate platforms that lack multilingual functionality or tailored instructions. This challenge is exacerbated by low health literacy, which hinders the ability to comprehend medical information, adhere to care plans, and navigate digital health tools. Collectively, these challenges contribute to high hospitalization rates, longer lengths of hospital stay, and greater risks for possible readmissions among older adults with communicative and linguistic vulnerabilities.⁹

Researchers explored the adoption of telemedicine for subspecialty diabetes care at a UC Davis medical center during the COVID-19 nationwide lockdown restriction. They found that older adults, including those with publicly insured status, and individuals whose primary language was not English, were less likely to use telemedicine. As patients among these high-risk groups have limited options, these findings have significant health implications, including deferring care, relying on phone visits, or resorting to in-person visits.¹⁰

Dr Munshi said, “Language discordance is a significant barrier, especially when combined with hearing or cognitive difficulties, which is often the case in older adults.”

“Technologies like real-time translation tools show promise, but we are not yet there, as we also need to be mindful of cultural nuances. In person, I often rely on caregivers for context, body language, and cultural cues. Still, these are missing in many virtual encounters, making it harder to provide fully patient-centered care,” she further explained.

According to Anila Bindal, MD, a board-certified endocrinologist and the US medical director of Abbott Diabetes Care in Alameda, California, multilingual telehealth platforms are a helpful start, as they provide materials in multiple languages.

“Abbott, for example, has made its LibreView platform available in multiple languages, ensuring that patients and caregivers can access glucose data and insights in a way that’s meaningful to them.”

Digital Literacy Gaps

As of 2021, only 61% of adults aged 65 years and older were using smartphones, and those with visual impairments were even less likely to own or operate digital devices. Common challenges include high device costs, limited instruction or technical support, and discomfort with learning new technologies — factors that all together hinder engagement with remote care.¹¹

These practical limitations are often aggravated by implicit biases, such as ageism and ableism, which can lead to assumptions that older adults are incapable of using technology. Such biases, even among health care professionals, can negatively affect clinical decision-making and access to care.¹¹

Dr Bindal recommended hands-on training and printed step-by-step guides with visuals as 2 ways to help improve digital literacy among older adults living with diabetes.

“Older patients are more likely to succeed with telehealth when they are gradually introduced to the platform and receive step-by-step support from the customer care and technical teams. Once they get a better understanding of how easy it is to view trends in real-time, their engagement often grows,” she added.

Dr Munshi emphasized that older adults are not a homogeneous group, and the key to improving digital literacy is to make the benefits of technology relatable to them.

“Community centers, senior day programs, and libraries can offer digital literacy sessions in supportive environments to bridge the learning curve. Start with phone-based visits before transitioning to video, and ensure the platforms are simple, featuring large fonts and high-contrast displays,” she told Endocrinology Advisor.

Accessibility Challenges

Limited access to high-speed internet and up-to-date mobile devices, particularly among older adults from low-income households or those living in rural areas, restricts the use of video-based telehealth services.⁴

About 40% of US adults aged 65 years and older — and as many as 72% of those aged 85 years and older — are not prepared for video visits due to functional limitations or a lack of access to or familiarity with internet-enabled devices. In one study of older adults with limited mobility, 82% required caregiver support to participate in virtual visits. While health care professionals recognized cognitive and sensory barriers, many were unaware of other critical access-related challenges, such as patients’ internet connectivity, ability to afford data plans, or access to video-enabled devices, which further complicates equitable telehealth use.¹²

One notable study found that old age was independently linked to lower rates of both telemedicine and video visit use, likely due to reduced internet access, slower technology adoption, and physical limitations such as impaired vision, hearing, and dexterity. The study authors also found that patients whose preferred language was not English had a 16% lower rate of completing telemedicine visits, even after adjusting for other variables. Despite these barriers, older adults who successfully engaged with telehealth services reported high satisfaction rates, primarily because of its convenience.¹³

The lack of internet and smart devices, Dr Munshi said, “is a systemic issue that calls for policy advocacy, as broadband access is now a health need, not just an optional resource. Until that gap is closed, we should explore partnerships with community centers, libraries, or senior centers that can provide private spaces and devices for virtual visits.”

For those without caregivers, she recommends relying on neighbors, volunteers, or digital navigators within community centers for help.

“Without such support, we often rely on phone calls, but this limits the quality of care, especially when we need to review or upload data,” Dr Munshi said.

Looking Ahead

As telehealth becomes an integral component of modern health care delivery, proactively identifying and addressing the specific barriers faced by older adults is essential. Implementing targeted, evidence-based strategies to overcome these obstacles is critical not only for reducing health disparities but also for ensuring equitable access, improving chronic disease management, and enhancing the quality of life for an ever-growing aging population.¹¹

Although limited data exist on the optimal delivery of telemedicine for older adults, improving uptake in this population may depend on platforms that accommodate age-related visual, auditory, and motor impairments, ensure adequate broadband access, and proactively address privacy-related concerns.¹³

Efforts including structured outreach to patients in their native languages, fully integrated translation services throughout the entire telemedicine care spectrum — from check-in to follow-up — and translation of all setup instructions into the preferred languages may help reduce disparities among older adults with diabetes.¹³

In addition, programs offering income-based discounted devices and broadband services such as Comcast’s Affordable Connectivity Program (ACP) can support underserved populations, but awareness and enrollment remain limited. Expanding outreach through community health workers may increase participation and help close the digital access divide among older adults who require telehealth for their diabetes care plan.¹¹

To ensure equitable access to telehealth, endocrinologists, geriatricians, and primary care physicians need targeted training to identify and overcome implicit biases on the suitability of older adults for virtual care. Rather than questioning who is appropriate for telehealth, health systems must train and equip physicians on how to make telehealth feasible for all patients. In response, many health care organizations are increasingly adopting implicit bias training programs to support this shift in mindset and promote inclusive care delivery across all patient populations.¹¹

Establishing formal guidelines for telehealth in diabetes care would provide much-needed structure, enhance health care-professional training, and promote consistent, evidence-based practices. To meet the growing demand for personalized care, health systems should also adjust reimbursement models to support unscheduled remote interactions, such as phone calls and electronic messaging. Expanding the role of nonphysician team members in telehealth workflows is equally critical to help manage excess workload and ensure the sustainability of the already strained endocrinology workforce.⁴

Furthermore, in a recent investigation, researchers found that simplifying treatment regimens significantly improved health outcomes among geriatric populations with T1D and multiple comorbidities, highlighting the need for simple, easy-to-use technology models for older adults.¹⁴

“Technology should adapt to the user, not the other way around,” Dr Bindal said. “The telehealth interface must be designed to be discreet, easy to use, and accessible across a wide range of digital literacy levels, with additional support available to meet the needs of individuals who can truly benefit from this technology.”

Adding to these comments, Dr Munshi emphasized that simplicity should be the anchor of age-inclusive telehealth design.

“Many older adults experience age-related cognitive decline, which can make it difficult to navigate complex processes and comprehend cluttered data displays,” she reiterated.

To design age-inclusive, equitable digital care models for older adults with diabetes, Dr Munshi recommended that endocrinologists, health systems, and tech innovators should consider:

• Prioritizing large fonts, high-contrast visuals, clear voice prompts, and streamlined interfaces with minimal steps;
• Reducing the need for user input for better outcomes, even with sophisticated interfaces; and,
• Building in simplified modes as a standard practice, recognizing that not every user needs or benefits from complex functionalities.

According to Dr Thurber, telemedicine has become a standard part of health care, serving as a critical lifeline for older adults who face challenges with in-person visits.

“Platforms should be simple, intuitive, and accessible to those with visual or hearing impairments,” she concluded. “However, we must continue to enhance accessibility and ensure that essential components of care, such as vital signs and laboratory work, are not overlooked. Striking the right balance between convenience and comprehensive care is key.”