The Unseen Problem in Health Tech: When Cognitive Impairment Meets Diabetes Care

Smartphone app mamangement for diabetes care using a CGM

Diabetes care has changed beyond recognition in the past decade. Digital tools like continuous glucose monitors (CGMs) and smartphone apps have empowered millions to take greater control of their health. With real-time glucose readings and alerts, people can act quickly to avoid complications — at least, that’s the idea.

But beneath this success story lies a quieter, more uncomfortable truth. Almost half of those living with type 2 diabetes are also living with some form of cognitive impairment. That means millions of people may be struggling with memory, decision-making and attention — even as they are asked to manage one of the most demanding chronic conditions. It’s a hidden intersection that health technology is largely failing to address.

The overlooked complication

While diabetes is often associated with physical health problems, such as nerve damage or heart disease, the cognitive impact is significant. Research has confirmed that people with diabetes are at far greater risk of developing dementia and Alzheimer’s. Even without dementia, many experience mild cognitive impairment (MCI) — slower thinking, forgetfulness, poor concentration — long before diagnosis.

These subtle cognitive changes often go unnoticed in everyday life. But they can make the self-management of diabetes much harder. Everyday tasks like calculating insulin doses, interpreting blood sugar readings or reacting to an alert in the early hours become potential minefields when memory or problem-solving abilities falter. And because poor glucose control can itself worsen cognitive decline, many patients find themselves in a vicious circle, where managing their condition becomes progressively harder.

When health tech assumes too much

In theory, diabetes tech should help solve this problem. Devices like CGMs offer real-time feedback and sophisticated analytics. Yet these tools often come with an unspoken assumption - that the user is digitally literate, cognitively capable, and able to engage meaningfully with the device.

For many, that assumption does not hold. Imagine waking to a blood sugar alert at 2am while cognitively impaired. The alarm may be heard but not understood. Instructions might be missed or misinterpreted. Even people without cognitive issues can find diabetes tech overwhelming. Data overload, frequent alerts and complex interfaces can be stressful. For those living with cognitive decline, it can be alienating or even dangerous.

Despite good intentions, the very technology designed to make life easier can become a source of anxiety, confusion or disengagement. The human cost? Missed alerts, poor decision-making, and serious medical emergencies that could have been prevented.

The real user isn’t always the patient

Another problem is how we define the ‘user’. When cognitive impairment enters the equation, it is often caregivers — family members, friends, home support workers - who are central to managing the condition. Yet health technology still tends to be designed for a single user experience. Few systems fully integrate caregivers into the day-to-day management process. Those that do often require technical skills or resources that caregivers themselves may not have. Inclusive design means accepting this reality and meeting it head-on. We need to rethink how devices support not just patients, but the teams around them.

Towards more thoughtful innovation

So what does truly inclusive diabetes technology look like?

First and foremost, it should reduce cognitive load. Devices must be intuitive, simple to set up, and easy to interpret — especially in moments of stress. Visual clarity, larger fonts, colour coding and easy-to-understand prompts are all essential.

Passive wearables, which monitor glucose levels in the background and automatically alert caregivers or services during critical events, offer real promise. These solutions can provide reassurance without burdening the patient with constant decision-making.

However, innovation should never come at the expense of dignity and autonomy. Many people with mild cognitive issues still want to play an active role in their care. Simplifying technology is not about removing choice, but about creating a safety net that supports them when needed. Beyond the technology itself, healthcare systems and policymakers also have a part to play. Training programmes, caregiver support and thoughtful policy around accessibility and cost are all essential. Simply put, subsidising the latest devices is meaningless if the people most at risk cannot use them effectively.

No one should be left behind

Health technology promises a better future - but only if it works for everyone. Cognitive impairment is not a niche issue. It is a widespread and growing reality that intersects with age, chronic disease and social inequality. By ignoring this, we risk creating a two-tier system, where those fortunate enough to remain cognitively sharp benefit from innovation, while others fall through the cracks.

True progress will only happen when we stop designing for the ideal user and start designing for the human one - frailties, forgetfulness, and all. The next chapter of diabetes care must be inclusive. In doing so, it can become not just smarter, but more compassionate.

Sources

• International Diabetes Federation (2023). IDF Diabetes Atlas.

• You et al. (2021). Prevalence of mild cognitive impairment in type 2 diabetes: a systematic review and meta-analysis. Acta Diabetologica.

• Alzheimer’s Society (UK). Diabetes and dementia risk.

• Heintzman et al. (2023). Digital health technologies and diabetes care: addressing disparities. Diabetes Care.

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