What training, support and resourcing do health professionals need to support people using a closed-loop system? A qualitative interview study with health professionals involved in the Closed Loop from Onset in type 1 Diabetes (CLOuD) trial

Background We explored health professionals' views about the training, support and resourcing needed to support people using closed-loop technology in routine clinical care to help inform the development of formal guidance. Methods Interviews with health professionals (n=22) delivering the Closed Loop from Onset in type 1 Diabetes (CLOuD) trial after they had ≥6 months experience of supporting participants using a closed-loop system. Data were analysed descriptively. Results Interviewees described how, compared to other insulin regimens, teaching and supporting individuals to use a closed-loop system could be initially more time-consuming. However, they also noted that, after an initial adjustment period, users had less need for initiating contact with the clinical team compared with people using pumps or multiple daily injections. Interviewees highlighted how a lessened need for ad-hoc clinical input could result in new challenges; specifically, they had fewer opportunities to reinforce users' diabetes knowledge and skills and detect potential psychosocial problems. They also observed heightened anxiety amongst some parents due to the constant availability of data and unrealistic expectations about the system's capabilities. Interviewees noted that all local diabetes teams should be empowered to deliver closed-loop system care, but stressed that health professionals supporting closed-loop users in routine care will need comprehensive technology training and standardised clinical guidance. Conclusion These findings constitute an important starting point for the development of formal guidance to support the rollout of closed-loop technology. Our recommendations, if actioned, will help limit the potential additional burden of introducing closed-loop systems in routine clinical care and help inform appropriate user education and support.