In recent years, health plans have invested heavily in improving diabetes care, with expanded access to medications, continuous glucose monitoring (CGM), and digitally enabled care management programs. Yet despite these advances, only around 40% of adults with diabetes achieve recommended glycemic targets, highlighting that important gaps remain despite substantial advances in diabetes care.
If the clinical infrastructure for diabetes care is so much better, but real-world experiences and outcomes are declining, it’s time to consider that there are other powerful factors influencing the ability of people with diabetes to effectively manage their care.
One important factor may be human connection — or the lack thereof.
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There’s no question that modern society is struggling with increasing isolation. Nearly one in three adults reports experiencing loneliness, and one in four say they don’t have social or emotional support in their lives.
This includes over 3 in 10 adults with diabetes, who often find that loneliness increases the challenges of completing daily self-care activities, including monitoring glucose levels, taking medications, and making positive choices around diet and exercise.
With emerging research suggesting that loneliness may influence how successfully individuals can manage their chronic conditions, health plans need to consider more comprehensive strategies for identifying and addressing members who could benefit most from additional education and engagement.
How loneliness provides the missing context behind diabetes outcomes
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Healthcare organizations have become increasingly sophisticated in identifying clinical risk. Claims data, utilization patterns, medication adherence metrics, and biometric indicators all provide valuable insights into which members may be struggling.
However, those data points do not always explain why two individuals with similar diagnoses, treatment plans, clinical profiles, and access to clinical resources can experience dramatically different outcomes.
Loneliness may help explain part of that difference.
Unlike social isolation, which refers to limited social contact, loneliness reflects a person’s perception of connection. An individual can be surrounded by family members, coworkers, and community networks while still feeling alone in managing a chronic condition.
Loneliness can influence motivation, confidence, resilience, and engagement. Together, these factors shape diabetes self-management. Because the vast majority of diabetes care occurs outside the healthcare setting, people must make dozens of health-related decisions every day, often without immediate clinical support.
For example, a recent poster presented at the American Diabetes Association Scientific Sessions examined adults with diabetes who initiated CGM as part of a structured education and coaching program. The findings provided important insights into the relationship between loneliness and diabetes outcomes.
At baseline, individuals reporting loneliness demonstrated significantly poorer glycemic profiles than those who did not.
Average blood glucose levels were nearly 185 mg/dL among lonely participants compared with approximately 162 mg/dL among non-lonely participants. Glucose management indicator (GMI), an estimate of A1C derived from CGM data, was also significantly higher, while time in range was substantially lower.
In short, participants experiencing loneliness entered the program at a clear disadvantage. What happened next suggests that individuals experiencing loneliness may have the greatest opportunity to benefit from structured education, coaching, and ongoing human support.
When participants received structured diabetes education and ongoing coaching from certified diabetes care and education specialists, those experiencing loneliness demonstrated some of the most substantial improvements observed in the study.
Within three months, average glucose levels declined by more than 34 mg/dL, GMI improved by nearly one percentage point, and time in range increased by more than 17 percentage points.
While some variation occurred over the remainder of the nine-month study period, outcomes remained improved relative to baseline and narrowed many of the initial differences between lonely and non-lonely participants.
These findings suggest that loneliness is not simply a marker of poor outcomes, but also a valuable data point that can pinpoint individuals who have the most to gain from meaningful support and engagement.
The research shows a promising opportunity for health plans to connect with members who may benefit the most from more personalized engagement with experienced diabetes coaches, educators, and clinicians and therefore reduce the delta in outcomes for people with loneliness in their lives.
Recalibrating how health plans investigate poorly controlled diabetes
The study highlights the need for a more comprehensive understanding of the underlying reasons a person may be experiencing poor control of their chronic disease.
When looking at a member who is having trouble maintaining their health, the first questions usually revolve around how to connect a member with medications, CGM devices, and clinical care management resources.
But if all those are in place and the member isn’t experiencing improvement, it should trigger a deeper dive into the member’s nonclinical circumstances.
Who helps this person manage their diabetes? Do they have a caregiver, or are they trying to juggle being a caregiver for someone else? Are they socially connected outside of the home? Are they struggling with depression, anxiety, or other mental health conditions? Do they have the health literacy and confidence to participate in decision-making around their own health needs?
Asking the right questions about community support, caregiving responsibilities, emotional well-being, and the availability of trusted social networks can establish important context for a person’s outcomes — and spark conversations about social needs that might never otherwise take place.
As healthcare continues moving toward more personalized and holistic models of care, it is important to consider that “success” with diabetes care isn’t just about achieving glycemic control, but also about improving the quality of life for the whole person in multiple dimensions.
Photo: FrankyDeMeyer, Getty Images
Coni Dennis DNP, RN, NE-BC, is SVP and Chief Clinical Officer at CCS, where she leads evidence-based chronic care strategies focused on improving outcomes for health plans, providers, and individuals living with chronic conditions. Prior to CCS, she spent 16 years at Humana leading clinical strategy and population health initiatives at scale, providing deep experience across care delivery, quality improvement, and value-based healthcare operations.
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