Closed Loop - DAFNE HCP

Free access to the DAFNE Closed Loop Essentials course

For all publicly funded diabetes services in the UK, ROI and Crown Dependencies

Access to closed loop therapy in England

NICE published guidelines in December 2023 to increase access to hybrid closed loop therapy to around 152,000 people with type 1 diabetes according to specific eligibility criteria. The was supported by NHS England’s 5-year implantation plan published in January 2024. The high adoption scenario estimating that 60,000 people would move to closed loops in the 5-year implementation period, approximately 10,000 adults per year.

This represents a huge logistical task for diabetes services. In addition, some people expect closed loop systems to function perfectly all the time, which is unrealistic.

DAFNE’s response

We have developed the online DAFNE Closed Loop Essentials (DAFNE-CLE) course for people with type 1 diabetes to prepare them for using a closed loop system.

The course will support diabetes services to transition large numbers of adults to closed loops, by helping them to establish which adults eligible for a closed loop can be onboarded safely with minimal support and which individuals will require more support. This will help teams to establish and focus resources on those on those that will require more intensive input.

We collaborated with the Diabetes Technology Network UK (DTN-UK) to ensure the content of the course is aligned to the essential skills identified by DTN-UK to manage closed loop systems safely.

Who can access the free DAFNE-CLE course?

Ordinarily DAFNE courses are only available to diabetes teams (and the people they provide care to) that are part of the DAFNE consortium.

However, in line with our vision to improve the lives of all people living with type 1 diabetes we have secured funding from industry partners to enable us to widen access to the DAFNE-CLE course, free of charge, to all publicly funded diabetes services and the people they provide a service to in the UK, Republic of Ireland and Crown Dependencies.

The funding will enable us to provide free access for up to 10,000 people eligible to transition to a closed loop system, receiving their care from non-DAFNE diabetes services over the next 2 years until the end of March 2026.

We see this approach as consistent with principles 3 and 4 of NHS England’s hybrid closed loop implementation strategy by helping to provide education through partnership between clinicians and industry and helping to offer closed loops in an equitable manner.

Helping diabetes services to focus their clinic resource

The course includes a 20-question end of course knowledge with randomly generated questions focused on the main safety messages of the course.

Those that pass the knowledge check will receive a digital badge is emailed by the online platform directly to the participant, which they can share with their diabetes team to demonstrate they have the required level of training to understand what’s involved in using a closed loop system without further input from their diabetes team at the time.

If participant’s do not pass the knowledge check, there is a checklist whereby they can record the topics they would like more support with from their diabetes team.

The knowledge check is not a barrier to accessing a closed loop system, just a way for individuals and their diabetes teams to identify where further support may be helpful, so clinical teams can target clinical input where needed.

The course also aligns with the NICE recommendation to only use systems if the person or their carer:

is able to use them, and

is offered approved face-to-face or digital structured education programmes,

Or is competent in insulin dosing and adjustments.

What does the course involve?

The focus of the course is keeping safe using closed loop, so people are aware of what closed loop can and can’t do, and the user input required to use closed loop effectively.

This is a standalone online course which involves 4-6 hours of self-directed online learning including the end of course knowledge check. Participants can dip in and out of the course as many times as they like and revisit the course for reminders.

There is no requirement for educator or healthcare professional input before or during the course, although some local admin is required.

When participants are given access, they are also sent the DAFNE-CLE start checklist which outlines the course content and encourages participants to note topics they would like further support with from their team.

The check list also includes the essential glucose sensor and pump skills outlined by DTN-UK as a reminder of what will be covered as part of their closed loop start, and a prompt to ask about topics they are not familiar with.

People are encouraged throughout the course to think about how closed loop will work for them and generate questions to bring to their closed loop start to discuss with their diabetes team.

The course content is not system specific and is not designed to cover system functions other than the basics.

Participants will require access to a computer, laptop or tablet and a WIFI connection in order to complete the course.

What does the course cover?

Participants will be given access to:

The online DAFNE-CLE course.

A DAFNE-CLE start checklist.

Tips for success including keeping safe toolkit.

Carb counting basics booklet.

The course is split into sessions making use of audio-visual resources to increase accessibility and reduce health literacy barriers.

DAFNE-CLE course content (key skills)

How a closed loop pump gives insulin to keep Glucose in range more often.Pump Glucose target.Time in Range targets (no DAFNE specific glucose targets).Action profile of quick acting insulin.How the algorithm gives and adjusts insulin.

When you, as the closed loop manager, give insulin using the bolus calculator.Giving bolus insulin for meals and snacks (importance of pre-bolusing).Giving bolus corrections in some situations.

Checking and changing your mealtime ratios.Identifying glucose patterns over 2 days or more that indicate a ratio change is required.Changing a ratio by adjusting the carb number in the bolus calculator up or down by 1 or 2 grams.

Carb awareness and carb counting.Estimating carbs by eye.Counting carbs using carb factors.Counting carbs using the carb formula.

Avoiding and treating hypos.Closed loop will suspend insulin delivery when glucose is predicted to fall below range.Using low alert alarms.Giving less rapid acting carbs to treat a hypo (10 g).

What to do if there is a problem with your pump or you are ill. Glucose over 15.0 mmol/L for 2 hours or more indicates pump failure.Problems with insulin, cannula, pod or pump.Signs and symptoms of high glucose and ketones.If in doubt change it out.

Ketone checking and ketone management plans.How to check for ketones.Trace ketone management plan.Large ketones management plan.Keeping safe toolkit (what you need to hand at all times in case of pump failure).

Going back to insulin injections.Keeping background insulin, quick acting insulin, pens and needles on prescription.How to work out an insulin dose and when to give it.

End of course knowledge check.20 randomly generated questions on key skills topics3 attempts to complete and get the digital badge.Those who are unsuccessful are encouraged to contact their centre for tailored individual support on topics they would like support with.