**Background:** Older adults with type 1 diabetes (T1D) represent a unique population who have managed a complex disease for many decades. As they age, they face additional challenges including age-related decline in physical and cognitive status, comorbidities, acute illnesses, hospitalizations, caregiver burdens, financial difficulties, and changing support systems. The COVID-19 pandemic lockdown created a natural experiment to understand how these individuals cope when their support system is suddenly disrupted. This study aimed to understand the impact of isolation and a fractured social network on diabetes self-care and quality of life in older adults with T1D.
**Methods:** Semi-structured interviews were conducted with a convenience sample of 34 older adults from the ongoing TANGO study (Technological Advances in Glucose Management in Older Adults, NCT03078491) at Joslin Diabetes Center. Data were collected between May 2020 and August 2020. Eligibility required participation in the TANGO study and willingness to participate. The interviews included four broad questions with probes and 23 survey questions, developed with guidance from a psychologist with extensive qualitative research experience. Each interview was conducted by a research assistant via phone, digitally audio-recorded, and lasted 30–60 minutes. Interviews were transcribed, coded using NVivo12, and analyzed using qualitative content analysis. A multidisciplinary team of eight individuals (geriatricians, endocrinologists, a psychologist, a health informaticist, and research assistants) individually coded the interviews via bi-weekly meetings over a 6-month period, with majority agreement required for coding decisions.
**Key Results:** Thirty-four older adults were interviewed (mean age 71±5 years, T1D duration 38±17 years, mean A1C 7.4±0.9% [57.3±10.1 mmol/mol], 53% women, 97% White, 94% with some college or higher education, 30% with history of depression, 56% with cognitive dysfunction [MoCA<26]). Three themes emerged: (1) Impact on diabetes management and self-care behaviors — participants were nearly equally divided on positive versus negative impacts. Some improved diet by cooking at home and increased outdoor walking, while others struggled with loss of gym access (76% reported changed physical activity levels, 88% followed usual dietary patterns). (2) Emotional stress and anxiety — separation from family and friends was a major stressor, with 38% connecting with loved ones more than usual, 18% less than usual, and 41% the same as usual. Those with better family support reported less stress. Some participants reported increased anxiety and depression medication needs. (3) Concerns regarding the COVID-19 pandemic — 56% reported media as their most helpful information source, 21% trusted health officials, and 24% felt they needed more information. Delays in other medical care (surgeries, dental, eye care) were reported by 11 participants. Economic insecurity was not a common stressor in this cohort, with many reporting retirement income and investments as protective.
**Clinical Implications:** This study demonstrates the overall resilience of older adults with T1D during periods of isolation, likely stemming from decades of disciplined self-care routines. However, disruption of exercise routines, loss of caregiver support, and separation from loved ones can increase anxiety and negatively impact self-care. Clinicians should routinely assess for signs of isolation, help patients maintain structured routines during disruptions, and facilitate connections with mental health professionals and community resources. The homogeneous, White, highly-educated, financially stable study population limits generalizability to more diverse populations. These findings can help clinicians develop coping strategies for older adults with T1D facing isolation from various causes beyond pandemics, such as loss of spousal support or declining functional status.