In the rapidly advancing field of diabetes management, technology has quickly become one of the most effective tools available. Continuous glucose monitors (CGMs) provide superior insight into diabetes control and hypoglycemia risk by expanding available data to include time in range, variability measures, and trend tracking. Insulin pumps and automated insulin delivery (AID) systems enhance opportunities for self-management through real-time feedback, eliminate the need for frequent finger sticks and injections, and reduce the burden of constant monitoring and decision-making. Through well formulated algorithms automatically adjusting insulin, these delivery systems are proven to effectively reduce hypoglycemia, increase time in range, and support day-to-day flexibility in meals and activities.
These advanced technologies have transformed how we manage diabetes. Patients and clinicians can more effectively track progress over time and make data-supported decisions on therapy changes to help patients reach their goals faster. The result is greater glucose control, improved safety, and better quality of life.
And yet, despite these widely accepted benefits, many patients are not offered the opportunity to access these devices. As technology advances in complexity and ability, assumptions about patients’ capability and trainability to safely utilize these devices may be preventing some of the best successes. This begs the question: Is clinician bias limiting patient access to advanced diabetes technology?
Clinician bias reflects the impressions and judgments that health care professionals make about patients that are devoid of objective fact. This form of implicit bias stems from unconscious stereotypes. In my experience in diabetes management, this bias targets characteristics like advanced age, health literacy, and social circumstances. This is a critical connection to be made, as diabetes prevalence increases with age and disproportionately affects racial minorities and those with lower health literacy. When clinicians project doubts onto patients without fully assessing their interest or willingness in using advanced tech, these unconscious attitudes transform bias into barriers and ultimately into clinical decisions and treatment disparities. Assumptions about perceived limitations are often an underestimation of our patients’ abilities and are preventing patients, who may actually stand to gain the most from these tools, from even having the opportunity to consider the option.
At face value, clinician hesitation around recommending this technology may seem reasonable and even understandable. Recommending advanced technologies to patients always raises questions of safety. When these frequently prejudiced characteristics are added into consideration, however, it becomes all too easy for bias to take hold. Can a patient with cognitive limitations or limited health literacy manage these tools without potentially harmful errors? Will an older adult be confused, frustrated, and unsafe? While these questions are important to ask and assess, we need to be cautious in answering for patients without weighing the patient and/or their caregiver’s interest, providing an opportunity to build knowledge and skills, and offering the appropriate resources to safely initiate more advanced support.
In many cases, concern stems from clinician discomfort — a cognitive dissonance arising from confronting their bias — rather than the actual abilities of the people they are supporting. This mental tension, while unpleasant, is essential for clinician growth, as it opens the door to greater fairness and inclusivity. We must make intentional efforts not to underestimate our patients, project doubts onto them, or overstate the difficulty of learning a new device in a way that would dissuade them from choosing to move forward with the process, thus denying them access to potentially life-changing tools.
My goal is to demonstrate favorable outcomes achieved by challenging bias. Below, I highlight several success stories from my practice that show patients with clearly identifiable “barriers” who are now thriving on advanced technology with the support of certified diabetes care and education specialists (CDCES), caregivers, and community resources. My intention is to challenge the idea of “suitability” and advocate for a more equitable approach to offering diabetes technology.
Patient 1:
Mr. F, a 61-year-old man with insulin dependent type 2 diabetes, had an A1c greater than 10% and a complex social history. Initially, he struggled to use his CGM consistently, but with the support of a CDCES he learned to manage his glucose more effectively through awareness of his individual glucose goals, tracking dietary choices on his CGM, and dosing insulin consistently. His A1c improved and remained between 7.5%-8% for several years until health changes began causing blood sugar fluctuations and recurrent hypoglycemia, prompting consideration for an AID pump. With education and encouragement his hesitancy transformed and he adapted to the new device. His time in range improved by nearly 20% and his glucose variability decreased substantially. Today, he wears his pump proudly and has become a champion for diabetes technology, openly discussing his experience with his community members.
Patient 2:
Mr. B, a 21-year-old man with autism and type 1 diabetes, resided in a group home and had repeatedly expressed interest in an insulin pump. Staff had denied consideration, citing concerns about his ability to operate the device and their inability to safely support him. Believing in his potential and honoring his goals, I engaged a CDCES to build a collaborative educational program for residential staff. After six months, he transitioned to insulin pump therapy and was thrilled to be included in the medical decision-making process. Now, two years later, his blood sugar control is excellent and he expresses his gratitude at every clinic visit.
Patient 3:
Mrs. M, a 46-year-old mother with limited English proficiency and low health literacy, had struggled with balancing motherhood and managing her insulin-dependent type 2 diabetes. Despite demonstrating a commitment to her health by maintaining consistent attendance of her health center’s program for high complexity, high-needs patients, her prior endocrinologist told her she wasn’t a “good fit” for an insulin pump. With the help of a CDCES and translator, she learned how to operate the pump independently and her A1c improved by 2% in the first three months of use. She said she felt more in control of her health and empowered to model healthy choices for her children.
Patient 4:
Mr. A, a 76-year-old man with type 1 diabetes and Alzheimer’s disease, previously managed his diabetes very well with a manual insulin pump, but was taken off due to safety concerns. His wife had assumed control over monitoring his CGM and calculating his insulin doses, but had grown increasingly concerned about worsening hyperglycemia triggering agitation. Mr. A and his wife welcomed the discussion about resuming an insulin pump and jointly agreed to move forward. We selected an integrated pump and CGM system requiring minimal manual input. His wife grew confident in managing the pump and his blood sugars returned to goal range. This change reduced caregiver burden and granted both peace of mind.
These stories are not unusual, but I would be remiss to not highlight the care team champions of these cases whom I rely on every day to support these outcomes. I am fortunate to have a comprehensive diabetes self-management education and support program (DSMES) partnering with me on site. For those without this team of educators down the hall, these success stories are still possible by taking a little time to find a program near you or partner with your regional product representatives. Let these successes serve as reminders that people are often far more capable than we give them credit for and our own busy schedules are no excuse. It is time for us to stop making decisions for patients without ever giving them a chance.
Of course, we must set expectations and timelines for patients to safely start on more advanced devices, but we need to stop offering technology based on who we think will succeed today and trust that in time and with the right tools, education, and engagement we can help almost everyone succeed, even patients with significant challenges. Not all of my cases are success stories (yet). Distance remains my biggest barrier. Telehealth has narrowed this gap, but has not closed it. But I am honored to have helped more patients than either of us would have imagined.
It is time for clinicians to be intentional about recognizing and challenging our biases to move forward and support the best outcomes. It is not our role to decide WHO will succeed, but to determine HOW to help patients with challenges succeed. To shift away from the role of gatekeeper of technology to equitable prescriber. We must champion one another toward a greater awareness of bias and to shift from asking, “Can they handle it?” to “How can we help them succeed?”
Technology is only as powerful as our willingness to use it. Our patients, regardless of how we perceive their limitations, deserve the chance to benefit from the best tools we have available. That is the only way that bias does not become a barrier to equitable care.
Carrie Keyes, PA-C, is a physician assistant in endocrinology based in Winston-Salem, NC, where she champions tech-forward diabetes care. She is passionate about advancing clinician education and shaping the future of diabetes management through research and advocacy. She is also involved in PA education and a strong voice for clinician well-being and safe, effective patient care. She is a 2025–2026 Doximity Op-Med Fellow.
Image by Kateryna Hermanchuk / Getty Images
