The Diabetes Technology Network UK (DTN-UK) launched in 2016. Led by Dr Emma Wilmot, the team has delivered initiatives to improve access to diabetes technology, 11 educational meetings (2016-19), three national clinical best practice guides, three online webinars (953 registrations, >1500 views) and 13 online modules for people living with diabetes and their health care professionals (HCPs). DTN-UK has over 500 members and 1,384 followers on Twitter. It campaigned for better access to flash glucose monitoring, developed the FreeStyle Libre national audit and the 2018 national Type 1 diabetes service level audit. It also played an integral role in the development of the NHSE/Diabetes UK technology pathway.
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Diabetes technology is an evolving field; while insulin pumps and continuous glucose monitoring (CGM) are evidence-based effective interventions, uptake has been limited in the NHS. DTN-UK aimed to tackle this by supporting greater, and more optimal, use of technology to deliver higher quality care. Dr Wilmot has been DTN-UK chair since 2016, supported by a committee of 16 multi-disciplinary HCPs and four user representatives. It operates under the auspices of the Association of British Clinical Diabetologists (ABCD). Close collaboration of the DTN-UK committee with key stakeholders (Diabetes UK, NHS England, JDRF, Input diabetes, National Diabetes Audit, ABCD) has improved outcomes. It has enabled a greater proportion of people with Type 1 diabetes to use insulin pump therapy, supported campaigns to improve access to flash glucose monitoring, co-authored the Diabetes UK flash glucose monitoring position statement and provided input into national eligibility criteria for the FreeStyle Libre. The successful campaign means central funding is now available for ~20% of the Type 1 population. DTN-UK developed the national ABCD FreeStyle Libre audit, with data for >5,000 users to date. If the results are positive, this will support the case for wider access. It has brought access to CGM for pregnant women with Type 1 diabetes, and a more standardised approach to insulin pump therapy through national best practice guides. Online educational modules are available for people living with diabetes and HCPs. DTN-UK states that it is the only national organisation specifically focusing on diabetes technology HCP education. It provides educational meetings for over 500 HCPs/year. It developed the first national best practice guides for: insulin pump optimisation, insulin pump services, inpatients on insulin pumps, diabetes technology in pregnancy, CGM and diabetes technology in primary care. Its online modules for flash glucose monitoring offer HCPs and patients high-quality education when they need it. DTN-UK has played a pivotal role in the development of the Diabetes UK Technology pathway, providing access for diabetes technologies in the NHS. It has provided expertise for, and promoted, the national insulin pump audit, improving the number and quality of submissions. The network led the development of the national Type 1 diabetes service level audit and had a key role in highlighting the barriers to accessing technology, including a Freedom of Information request to assess access to CGM.
In 2015 Dr Wilmot and Dr Peter Hammond approached Dr Rob Gregory, ABCD chair, who agreed to host and support DTN-UK. National experts in diabetes technology and four patient representatives joined the committee. HCPs could join DTN-UK free and there are now over 500 members. DTN-UK brings clinicians the latest developments in diabetes technology. It is a platform to share best practice and maintain continuing professional development. Its inaugural event for 100 HCPs sold out, demonstrating need. DTN-UK now runs two or three ‘team days’ for up to 60 insulin pump team members, plus the larger annual meeting. Recognising that not all HCPs can attend meetings, online resources were developed. Twenty clinicians from across the UK contributed to the national insulin pump best practice guides. In 2017 DTN-UK campaigned with Diabetes UK for better access to flash glucose monitoring. Responding to the concern about adequate education to support access, it co-produced online education modules on the FreeStyle Libre with users.
DTN-UK membership has grown to >500 members between 2016-2019. Educational events include 11 face-to-face educational events, four annual meetings (each for >100 HCPs), seven team day events (each for >60 HCPs), and an educator event. Online educational resources include three DTN-UK flash glucose webinars: >1500 YouTube views, three CSII best practice guides with 1,994 unique downloads. The FreeStyle Libre is now available to 20% of people with Type 1 diabetes in England and >20% in the rest of the UK. The FreeStyle Libre national audit was developed and >5,400 users’ data has been entered, with initial data showing 8mmol/l reduction in HbA1c, which should support wider future access. The DTN-UK expert reference group supports and promotes the national diabetes insulin pump audit. The number of patients entered into the audit has increased from 9,770 to 14,007. Insulin pump uptake has also increased from 15% to 18% in England (2015-2018). CGM in pregnancy will be available from April 2020 and DTN-UK is part of the NHS England implementation group, developing online and face-to-face education to support the rollout. DTN-UK developed a national Type 1 diabetes service audit to understand barriers to technology. Data from 115 centres in 2018 will be presented in due course. The Diabetes Technology Pathway was published in Diabetic Medicine.
Sustainability and Spread
There has been funding available from technology companies since inception in 2016. As the technologies available increase and the role of DTN-UK widens a further expansion in funding is likely. The HCPs on the DTN-UK committee are volunteers. The role of DTN-UK chair has expanded significantly and since 2018 this role has been reimbursed for four hours of work a week, making the role more sustainable. DTN-UK disseminates outputs through e-newsletters, face- to-face DTN-UK educational meetings, and the committee presents at educational events. DTN-UK best practice guides and online education modules are all freely available on the DTN website. People living with diabetes can access webinars and modules on flash glucose monitoring via the website, with additional modules on CGM planned.
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