One year has now passed since the commencement of the rollout of hybrid closed-loop systems in England for individuals living with type 1 diabetes (NICE TA 943).

This period has been a rollercoaster of both significant advancements and considerable challenges for diabetes specialist nurse (DSN) teams. The introduction of hybrid closed-loop technology has yielded demonstrably positive outcomes for people living with diabetes (PWD) in the last 12 months. Feedback from PWD indicate improved glucose management, a reduction in the incidence of hypoglycaemic episodes, and an enhanced sense of autonomy for individuals navigating the complexities of type 1 diabetes. 

The ability of these systems to automate insulin delivery in response to real-time glucose monitoring has contributed to improved glycaemic stability and an overall improvement in the quality of life for many users, fostering greater confidence in daily activities and overnight glucose management.

However, the widespread implementation of this innovative technology has placed considerable strain on existing DSN services. Prior to the introduction of hybrid closed loops, many teams were already operating under significant pressure due to staff shortages and increasing patient caseloads. The specialised nature of these systems necessitates comprehensive patient education and ongoing support, requiring a substantial investment of time and expertise from DSNs.

The provision of thorough, individualised training on system operation, troubleshooting, and data interpretation is paramount for safe and effective utilisation. This personalised approach, while essential for optimal patient outcomes, significantly increases the workload for DSNs, particularly in the context of pre-existing staffing deficits. The capacity to deliver this intensive education, alongside routine clinical responsibilities, has become a critical concern. Furthermore, the need for continuous support for individuals using hybrid closed-loop systems cannot be understated. Patients require ongoing assistance with system adjustments, technical issues, and the interpretation of device-generated data. 

Ensuring the availability of timely and expert support is crucial for maintaining patient safety and maximising the benefits of this technology. However, the current staffing levels within many DSN teams pose a significant challenge to the provision of this sustained support without compromising the well-being and capacity of the workforce.In conclusion, while the positive impact of hybrid closed-loop systems on the lives of individuals with type 1 diabetes is undeniable and commendable, the rollout has exacerbated existing pressures on DSN teams. 

Addressing the critical issues of staff shortages and the provision of adequate resources for education and ongoing training is essential to ensure the sustainable and equitable delivery of this vital technology. Open dialogue and strategic investment are necessary to support both patients and the dedicated DSN workforce in navigating this evolving landscape of diabetes care.

Using the experiences and insights of colleagues within the diabetes nursing community are invaluable in informing the optimal path forward.