Timm Roos

Objective: As part of the 2025 diabetes and technology (dt)-report, this study explored indications for use, barriers to adoption, and perceived functionality of smart pens. Methods: An online survey conducted between November and December 2024 gathered responses from diabetes specialists and diabetes educators (health care professionals [HCPs]) in Germany (DE), Austria (AT), Switzerland (CH), and Spain (ES). Participants estimated the proportion of individuals with diabetes who would benefit from smart pens, rated the significance of specific functions, and evaluated barriers on 5-point scales. Results: The survey included 1294 HCPs (69.2% DE, 9.7% AT, 7.0% CH; 14.1% ES). Current usage of smart pens is estimated at 4% to 15% for people with type 1 diabetes and 3% to 6% for those with type 2 diabetes. However, the indication rate is markedly higher, ranging from 51% to 73% for people with type 1 and up to 69% for those with type 2 with intensive insulin therapy. Most valued features included reminders for missed insulin doses (4.4 ± 0.7), bolus dose suggestions (4.1 ± 0.8), integration with continuous glucose monitoring (CGM) apps (4.1 ± 0.8), and temperature alerts (3.7 ± 1.0). Basal insulin suggestions were considered less important (3.3 ± 1.1). No significant differences were found between physicians and diabetes educators. Major barriers included preference for disposable pens (57%), limited device options (54%), and high cost (53%). Among DE respondents, concerns over cost reimbursement rose compared to the 2024 dt-report. Conclusion: Smart pens are underutilized compared to expectations. Cost and reimbursement remain the predominant barriers, while reminder functionality stands out as the most valued feature.

Background: The number of adults with diabetes and older age is increasing, yet little is known about age-related differences in real-world diabetes technology use. This analysis examines how uptake, clinical outcomes, and user experience vary across age groups in people with type 1 or type 2 diabetes. Methods: Self-reported data from 2056 individuals with diabetes in Germany, Austria, and Switzerland who completed the diabetes technology report 2024/2025 survey were analyzed. Age-related trends in the use of continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII), and automated insulin delivery (AID) were assessed using generalized additive and segmented logistic regression models. Outcomes included HbA1c, diabetes distress (PAID-5), severe hypoglycemia (SH), and, among AID users, satisfaction. Results: Among people with type 1 diabetes, CGM usage was consistently high across age groups (eg, 94% in 20-29 years; 92% in ≥70 years). Automated insulin delivery usage peaked in adolescents (81% in 10-19 years) and declined to 36% in adults ≥70 years. In type 2 diabetes, CGM use increased with age (48% in 35-44 years; 72% in ≥70 years). The HbA1c remained stable over the age span (±0.25%). Diabetes distress declined with age (Problems Areas in Diabetes Ouestionnaire – 5 Items (PAID-5): 7.8 in p = .001). Automated insulin delivery satisfaction was highest in adults aged 60 to 69 years (88.7/100) and lowest in adolescents (79.1/100). Conclusions: Diabetes technologies are widely used and well tolerated across age groups. Older adults benefit comparably, but barriers to AID use remain.

Background: Automated insulin delivery (AID) systems can significantly improve glycemic outcomes in people with type 1 diabetes (PWT1D). Despite their clinical efficacy, little is known about their uptake in clinical care, or about the perspectives and experiences of health care professionals (HCPs) and people with diabetes (PWD) with this relatively new technology. Furthermore, research is limited on broader populations, such as people with type 2 diabetes (PWT2D) and cross-country comparisons. Methods: This study analyzes data from the dt-report 2025, a multinational online survey of PWD and HCPs from Germany, Austria, Switzerland, and Spain, which was conducted at the end of 2024. The surveys assessed, among others, AID relevance, indications, barriers, daily use, satisfaction, and support needs. Results: In total, 1294 HCPs and 2535 PWD from Germany, Austria, Switzerland, and Spain took part. Health care professionals identified fully closed-loop systems as the most promising future therapy. While 90% of PWT1D were seen as candidates for AID therapy, 55% of PWT2D on intensified insulin therapy were also considered likely to benefit. Nonetheless, 22% of eligible PWD rejected AID, citing device burden and general concerns regarding its usability. Health care professionals reported a discontinuation rate of 8%. Satisfaction with AID was generally high. Regression analyses identified technical problems, lack of trust, and unrealistic expectations as significant predictors of lower satisfaction and poorer management in PWD. Conclusion: Despite increasing user rates of AID systems, a significant proportion reports problems in managing this technology or aborting its use. Addressing reasons for this may increase the uptake in clinical care. There was also a positive view of HCPs on AID use in PWT2D.

Background: Automated insulin delivery (AID) systems improve glycemic control and reduce treatment burden in people with type 1 diabetes, yet their uptake remains suboptimal in many countries. Understanding barriers to the usage of AID systems from the health care professional (HCP) perspective is essential to support wider adoption. Methods: Physicians and diabetes educators/nurses were invited to complete an online survey assessing the current use of diabetes technology as well as attitudes and barriers to AID and insulin pump therapy. The survey was conducted from October to December 2022. A network analysis was conducted to analyze the associations between different barriers to usage of AID systems and insulin pumps. Results: Data from 594 HCPs (220 physicians and 374 diabetes educators/nurses) were analyzed. In 2022, HCPs estimated that 11% of their patients with type 1 diabetes used an AID system. They reported that 20% to 27% of eligible patients refuse to use an AID system; 5% to 7% of the users of an AID system stopped using it. The majority of HCPs (68.4% and 60.7%) reported an increased need for education. The most important barriers to start using an AID system were a lack of training and education materials, body image issues, overload, and insufficient training of the members of the diabetes team. Conclusions: There was a sharp increase in AID use in Germany from 2019 to 2022. The results highlight the need for adequate training materials for people with diabetes and the diabetes team.

Background: Diabetes technologies, such as continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID) systems, are increasingly used by people with type 2 diabetes (PWT2D), with growing clinical evidence supporting their therapeutic benefit. To describe the extent of adoption, perceived benefits, and future expectations, both health care professionals (HCPs) and PWT2D data from the dt-report 2025 were analyzed. Methods: From November to December 2025, HCP and PWT2D participated in the dt-report providing their attitudes, expectations, and predictions regarding the use of diabetes technology in type 2 diabetes. Frequencies from specific responses were analyzed. Results: Data from 1078 HCPs and 450 PWT2D from the DACH region were analyzed for questions regarding the use of technology in type 2 diabetes. Continuous glucose monitoring was the most widely endorsed technology across both groups, with 58% of the survey participants using a CGM, and 1% using a pump. Health care professionals estimated 87% of PWT2D on intensive insulin therapy would benefit from CGM and saw indications among non-intensive insulin users (62%) and those on oral therapies (55%). Future use of CGM and AID systems was anticipated by both HCPs and PWT2D, including many currently not using such systems. Smart pens and stand-alone insulin pumps were viewed less favorably. Reported barriers included lack of awareness, reimbursement limitations, digital literacy, and usability concerns. Conclusion: The findings indicate growing openness toward diabetes technologies among PWT2D and broader perceived indications among HCPs. However, uptake remains limited, particularly outside of intensive insulin therapy. These insights are of relevance for future clinical guidance, access strategies, and patient education.

Background: The rapid rise of diabetes technology has markedly improved glycemic outcomes, quality of life, and empowerment of people living with diabetes (PwD). However, the increased use of devices such as continuous glucose monitoring systems, insulin pumps, and smart pens has also introduced significant environmental concerns, contributing to waste from plastic, electronics (e-waste) and packaging, and greenhouse gas emissions. Methods: In this paper, we describe results from an online survey conducted in Germany, Austria, and Switzerland, between November and December 2024, focused on the level of concern PwD have, regarding the environmental impacts of single-use medical device, supplies and packaging, resulting from diabetes treatment, and whether these considerations influence technology choices. Results: Among 1934 PwD surveyed, 1332 (69%) favored more reusable devices, and 865 (45%) expressed concern about packaging waste. However, environmental factors ranked far below safety, effectiveness, and usability when selecting diabetes technologies. Conclusions: Expecting PwD to drive substantial environmental improvements is therefore neither realistic nor fair given prevailing priorities on safety and outcomes. Meaningful progress toward greener diabetes care will depend on manufacturers, policymakers, and healthcare systems embracing eco-design, establishing recycling infrastructure, and integrating sustainability into regulatory and reimbursement frameworks. Only through coordinated efforts can optimal diabetes management be achieved alongside environmental stewardship.

Smarte Insulinpens können wichtige Daten zur Insulininjektion speichern, diese dem Nutzer anzeigen oder an weitere Endgeräte, Glukoseauswertsoftwares übermitteln. 2021 wurden 305, 2022 336 Diabetologen in Deutschland (2022; 38% weiblich, Durchschnittsalter 55,2 Jahre) zur Bedeutung und zum Einsatz von Smart-Pens befragt. 2022 nutzten nur 4,8% aller Menschen mit Typ-1-Diabetes und 1,5% aller Menschen mit Typ-2-Diabetes einen Smart Pen. Die geschätzte Gesamtnutzung in 5 Jahren beträgt 18,3% (2021: 23,9%). Die Bedeutung von Smart-Pens wird von Diabetologen derzeit auf 8,0% (Skala: 0%=sehr unbedeutend; 100%=sehr bedeutend) geschätzt und damit niedriger als 2021 (15,5%). Dies gilt auch für die geschätzte Bedeutung in 5 Jahren (2022: 24,7%; 2021: 37,9%). Allerdings wird bei 29,7% aller Menschen mit Typ-1-Diabetes eine Indikation für einen Smart-Pen gesehen sowie bei 30,8% der Menschen mit Typ-2-Diabetes und einer Basalinsulintherapie, bei 37,6% mit einer ICT. Als Haupthindernisse für die Verbreitung von Smart-Pens wurden die Präferenz der Patienten für vorgefertigte Pens (54,6% Zustimmung), der geringe Zusatznutzen (49,4%), die fehlende Interoperabilität mit der Glukoseanalysesoftware (44,3%), die fehlende Interoperabilität mit Apps (35,6%), die zu geringe Auswahl (Notwendigkeit des Insulinwechsels) und die zu hohen Kosten (33,9%) genannt. Trotz einer sehr positiven Einstellung der Ärzte zur Digitalisierung der Diabetestherapie (2021: 81,9%; 2022: 86,3%) werden Smart-Pens derzeit nur sehr selten eingesetzt und ihre Bedeutung für die Diabetestherapie als eher gering eingeschätzt. Bessere, einfachere und patientenfreundliche Lösungen sind erforderlich, damit Smart-Pens problemlos von Glukosemanagement-Softwares gelesen werden können und die Nutzer spürbare Vorteile erfahren. Article published online: 02 May 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany