A controlled trial involving 847 adults aged 65-82 with type 2 diabetes found that participants using an AI-powered voice assistant for six months achieved 23% better glycemic control and 31% fewer emergency department visits compared to standard care. The system provided personalized medication reminders, dietary guidance, and real-time glucose monitoring feedback through daily conversations. This represents a significant advancement in remote diabetes management, particularly addressing the challenge of medication adherence among older adults who often struggle with complex regimens. The technology appears especially valuable for patients with limited family support or transportation barriers to frequent clinic visits. However, the study population was predominantly from higher-income households with existing smart home devices, raising questions about broader accessibility. The intervention's success likely stems from its conversational interface, which feels more natural to older adults than app-based solutions. While promising for reducing healthcare costs and improving quality of life, the approach requires validation across more diverse socioeconomic groups and longer follow-up periods to assess sustained behavioral changes and clinical outcomes.