Smart blood glucose management experience and needs in community-dwelling older adults with type 2 diabetes mellitus and excess adiposity: A qualitative study

Background To explore the experiences and needs of community-dwelling older adults with type 2 diabetes mellitus and excess adiposity regarding smart blood glucose management tools, and to understand their challenges and support needs in community-based digital health management. Methods A descriptive qualitative study was conducted using purposive sampling. From October 2025 to February 2026, 19 eligible older adults were recruited from a community in Hangzhou, China. Data were collected through face-to-face semi-structured interviews and analyzed using a thematic analysis approach with NVivo 15.0 software until data saturation was achieved. Smart blood glucose management tools included home blood glucose monitoring devices and digital platforms or applications used for blood glucose tracking and diabetes management. Results Thematic analysis generated five core themes and 15 subthemes: (1) dynamic motivation in disease risk perception; (2) digital health information: empowerment and cognitive burden; (3) use of digital monitoring tools: convenience, barriers, and trust; (4) community healthcare context: support and selective engagement; and (5) emotional–behavioral responses to monitoring results. Blood glucose monitoring was characterized as a dynamic process shaped by the interaction of cognitive, technological, contextual, and emotional factors. While risk perception and abnormal monitoring results may enhance short-term engagement, long-term adherence was constrained by limited disease understanding, information overload, usability challenges, trust issues, and gaps between healthcare accessibility and effective utilization. Conclusions Smart blood glucose management among community-dwelling older adults with T2DM and excess adiposity is shaped by interacting cognitive, technological, contextual, and emotional factors. Future interventions should consider these multifaceted factors to better support sustained self-management among older adults with T2DM and excess adiposity.