When technology meets teamwork: transforming complex diabetes care with hybrid closed-loop systems

BACKGROUND: Individuals who meet the eligibility criteria for hybrid closed loop technology may not all have equal access, especially those outside conventional acute care pathways. This is particularly the case for people with type 1 diabetes, supported by district nursing services. AIMS: This case study discusses the implementation of hybrid closed loop systems for managing blood glucose levels in type 1 diabetes according to the National Institute for Health and Care Excellence TA 943 guideline. CASE DESCRIPTION: The patient was a 59-year-old man with a long history of type 1 diabetes. He had experienced a traumatic brain injury in 1997 that had a significant impact on his cognitive abilities and resulted in a significant loss of decision-making capacity regarding his diabetes management. This necessitated daily visits from district nurses for insulin administration and capillary blood glucose level checks. Although eligible for a hybrid closed loop system, he was unable to access it because the district nursing team delivered his insulin. OUTCOMES: Glycaemic control and quality of life improved significantly, demonstrating the feasibility of implementing hybrid closed loop systems for patients with complex needs. CONCLUSIONS: The successful implementation of hybrid closed loop system indicates the potential of this approach in enhancing diabetes care. This case study presents a unique collaborative model between acute and district nursing teams, which can broaden access to hybrid closed loop systems and improve outcomes in diabetes management, even in the face of existing inequalities driven by workforce limitations and knowledge gaps. IMPLICATIONS FOR PRACTICE: The success of initiating hybrid closed loop systems in a community setting, supported by a diversified acute diabetes service and an upskilled district nursing team, demonstrates that access can be broadened with targeted efforts. This implies that the integration and collaboration of community and acute care teams are not only feasible but also crucial in bridging care gaps.