In April 2023 Diabetes UK declared a “rapidly escalating” public health crisis.

Now, there is an urgent need to understand the uptake and social impact of digital technologies that are increasingly advocated for patient self-management.

Changing the conversation

This move towards digital healthcare has accompanied a shift in how healthcare responsibility is discussed and described – from an emphasis on the role of public providers, including doctors and other healthcare professionals, to the responsibility of private citizens for self-management.

In this context, we have developed a multi-dimensional method for the assessment of access and use of glucose monitoring devices and sensors amongst Type 1 diabetes (T1D) patients. Drawing from critical social science, our approach builds on in-depth narrative interview data and suggests three key consequences.

Firstly, the use of continuous glucose monitoring technologies and the associated shift in public health discourse towards self-management, underpins a new emphasis on individual patient responsibility which has had direct consequences for patient experiences of stigma and “diabetic burnout”.

This was further exacerbated by the physical design and visibility of the continuous glucose monitoring technology that contributed to patient perception of being identified as diabetics rather than individuals.

Secondly, we identify how technology for self-management of disease has the potential to cast patients in the role of ‘data-producing subjects’, sustaining and reinforcing unhelpful expert/non-expert binaries in the relationship between clinicians and patients.

Lastly, we found that T1D patients are both disciplined (by required patterns of monitoring behaviour) and empowered (by enhanced information and control) through digital technologies, but in the process become increasingly ambivalent towards clinical forms of expertise. This ambivalence has come to underpin a collective - rather than simply individual - sense of responsibility that emphasises peer support, mutual aid, and social care.

Better healthcare management

By reconsidering the role of digital technologies within wider discursive shifts towards patient self-management, this work has revealed the significance of social-technical complexity for patient outcomes. In turn, this opens up questions of how technology is designed, translated and delivered.

Technology development has the potential to integrate the histories and everyday contexts of a diversity of patients and clinicians in a design process that is simultaneously attentive to the technical and social, delivering socio-technical healthcare solutions that are better able to respond to patient experiences of living with disease.

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