The first-ever Diabetes Technology Network (DTN) Ireland meeting took place on May 23rd in Dublin and was hosted by Diabetes Ireland. Gráinne and Ken Barclay from Thriveabetes attended the event as Diabetes Ireland volunteers, and Ken was an invited speaker. This blog post is a brief overview of the day’s highlights.
Ken Barclay and Grainne Flynn from Thriveabetes attending DTN Ireland
What is DTN Ireland?
Like its UK counterpart (DTN UK) within the Association of British Clinical Diabetologists, DTN Ireland aims to support healthcare professionals by offering resources, best practices, and practical education on the latest diabetes technologies. The initiative is led by a dedicated team of experts, including Dr Tomás Griffin, University Hospital Galway, Dr Hannah Forde, Beaumont Hospital, and Dr Una Graham, Belfast Health and Social Care Trust.
Event Highlights
DTN Ireland Logo
The event opened with Dr. Tomás Griffin outlining DTN Ireland’s primary goals, including supporting healthcare professionals, advocating for better diabetes technology utilisation, and enhancing patient outcomes across Ireland.
The day proceeded with inspiring talks from several key figures in the field. Professor Partha Kar, the Type 1 Diabetes & Technology lead for NHS England, shared insights from the NHS's journey, from implementing access to the Freestyle Libre in 2018 to creating the pathway for access to Hybrid Closed Loop systems. His talk resonated particularly well, drawing parallels with Ireland’s own strides in diabetes care.
Interestingly, the 2017 NHS story looks a lot like the one we had in 2018, with CGM access and increased awareness of CGM increased uptake. However, the rest of the story is where we are now. In 2017 NHS, Type 1 diabetes was not a national focus (ahem), no freestyle libre, insulin pump uptake in children was 27%, and in adults was 8%, a lack of supporting evidence and no audits (diabetes registers). This is almost identical to Ireland in 2022.
The story of 2024 is that 95% of people with type 1 diabetes have CGM, 98% of pregnant women with type 1 have CGMs, paediatric and adult HbA1c levels are the best since records began, and type 1 diabetes pregnancy outcomes have improved.
Prof Kar credited the clinical champion buy-in from the beginning and all stakeholders but also mentioned how important it was to have the support of the diabetes community for pushing and leading the way.
In true Partha style, the advice to the room was delivered in the theme of Star Trek and the voyages of the Starship NHS Enterprise. I especially like the line about seeking out new leaders…and new initiatives and to boldly go where no one has gone before - this was very much what the event was about. I would also suggest that Prof P add one more line; “Make it so”.
* Photos of slides shared with permission from Prof. Kar
Development and Implementation of new Type 1 Diabetes Guidelines in Ireland, Dr Kevin Moore.
Dr Kevin Moore is no stranger to our Thriveabetes attendees as a guest speaker. He’s a Consultant Endocrinologist at Naas General, Tallaght University and Beacon Hospitals. His presentation discussed developing and implementing the updated National Clinical Guidelines (NCG) for Adults with Type 1 diabetes beyond the page, emphasising the expansion of Continuous Glucose Monitoring (CGM) systems and DAFNE education programs to more centres nationwide. You can read more about the NCGs from our previous post “HSE Recomends CGMs for All Adults with type 1 diabetes”.
The working group identified three priorities for implementation, and Dr Moore provided more information on these priorities:
#1 To provide access to CGM for all people with type 1 diabetes;
Most people are already using CGM, so further implementation involves looking at the reimbursement application processes. There was more than one, streamlining it into one system, and the Medicines Management Programme MMP will identify a preferred CGM.
#2 Every person with type 1 has access to DAFNE
This is a preexisting priority but is still incomplete however, there has been progress. There are now 19 public and 2 private DAFNE centres in Ireland, compared to the 7 in 2018. Most centres deliver between 2 and 10 courses online or hybrid per year. However, so far, less than 2,000 people are completing DAFNE per year and at the current rate it would take 10 years to ensure all 25,000 adults with type 1 completed it. To address this, Dr Moore stated that hospitals that are committed to providing DAFNE need more nurses and dietitians, need more awareness within the diabetes community, and hospitals need to work together to maximise resources. The lack of nurses and dietitians was a recurring theme in many of the following presentations.
#3 A minimum of two clinic appointments per year for all adults with type 1
In 2016 only 42% of adults with T1D were seen twice yearly. The barriers to accessing twice-yearly appointments included a lack of staff due to the chaos caused by the expansion of community services. He also highlighted a fear and unfamiliarity around diabetes technology that prevented twice-yearly visits. He continues that technology should not make diabetes consultations longer and make care better.
Some work for the National Clinical Programme going forward is to look at the provision of care across hospitals and look at the ratio of people with type 1 and type 2 diabetes, the number of visits per year for people with T1, the DKA and hypoglycaemia admission rates, and the numbers completing structured education.
* Photos of slides shared with permission from Dr. Moore
Exercising Guidelines with Hybrid Closed Loop Technology with Prof Rob Andrews
Prof Andrews is an associate professor at the University of Exeter and co-founder of EXTOD, a group that aims to provide evidence-based support for people with type 1 diabetes to undertake safe and effective exercise and enjoy its associated health benefits. Prof Andrews shared comprehensive guidelines for exercising with Hybrid closed-loop technology. His presentation had so much practical advice that I struggled to keep up. I am including photos of his slides, which reference studies and additional resources you may find useful if you want to learn more.
The EXTOD website looks to be under construction and none of the resources are uploaded. However, much of this information is available on the Glucose Never Lies website, including Exercise Carbohydrate Calculators to download for different CGM devices. This website was created by John Pemberton, a Paediatric Diabetes Dietitian and person with type 1 diabetes.
* Photos of slides shared with permission from Prof. Andrews.
Expansion of a diabetes technology service, The Beaumont Hospital Experience by Ms Sonya Browne
A standout session was delivered by Ms. Sonya Browne from Beaumont Hospital, detailing their transformative approach to insulin pump training—shifting from individual to group sessions, enhancing efficiency, and improving patient outcomes.
Ms Browne is a Candidate Advanced Nurse Practitioner for Diabetes Technology & the nurse lead for the insulin pump service in Beaumont Hospital. Ms Browne’s presentation on how Beaumont Hospital turned its insulin pump service around in one year was one of the most practical presentations for me.
Before 2022, insulin pump training in Beaumont involved people being placed on a long waiting list. Completing DAFNE was a requirement before starting on a pump.
The training involved a one-to-one session with a saline start taking 4 hours with a follow-up in one week for insulin start taking another four hours, and sending the pumper home with “homework” in the form of basal rate testing. It was estimated that one insulin pump start took 18 hours of a diabetes nurse’s time.
Once the pre-2022 process was mapped, areas where unnecessary steps could be removed were identified to improve efficiency, such as the DAFNE requirement, which was replaced with a dietitian review if necessary, the saine start was removed and one-to-one pump training was replaced with group training involving 10-15 people.
With hybrid closed-loop systems, there was no need for basal rate testing, and follow-up appointments were either via telephone or face-to-face, depending on what the pumper would prefer.
Some of the challenges the team encountered were in the planning and the paperwork; pump orders are incredibly time consuming because the system isn’t centralised. The lack of a suitable space on site was also an issue, but with support from industry, all the pump starts are now done off-site. Ms Browne also included clinical evidence for providing insulin pump starts virtually, including the DTN UK guideline for commencing insulin pump starts remotely. She also provided a list of educational opportunities for staff who were interested in upskilling in diabetes technology but were short on time.
This process has resulted in Beaumont going from providing 15 new pump starts in 2021, 48 in 2022, and 110 in 2023, with 2024 looking to continue this progress.
Key learnings shared were that buy-in for the diabetes team, the person with diabetes, and the industry partner is essential, and there is a need for dedicated admin support specific to diabetes technology.
Diabetes Technology Lived experience with Ken Barclay.
Ken has lived with type 1 diabetes for over 30 years and has been insulin pumping for 20. Ken gave a great presentation detailing his diabetes journey, particularly his journey with diabetes technology, but in the interest of not providing spoilers for his presentation at the next Dublin Adults with Type 1 support group online meeting, I will not go into detail here. If you are interested in joining the group at 7 pm on Wednesday, 5th June, email t1diabetic.dublin@gmail.com for the link to join.
* Photos of slides shared with permission from Ken Barclay
The remaining presentations took place after lunch, but, unfortunately, my ridiculously early morning start to travel from Clare to Dublin was beginning to catch up with me. I did not take as many photos of slides and lost much of my ability to retain information.
Tips & Tricks for using Diabetes Tech in Diabetes Transition Service with Prof Orla Neylon
Prof. Orla Neylon, a Consultant Paediatric Endocrinologist at University Hospital Limerick, addressed the challenges of diabetes transition services in Ireland. She highlighted the current state of transition care, noting significant inconsistencies in the standard of care across the country. Only half of the clinics offer a joint paediatric-adult clinic, and the estimated non-attendance rates range from 25% to 50%. Prof. Neylon emphasised how diabetes technology supports young adults in navigating these transitions more effectively, suggesting a potential area for improvement in standardising care.
Interpretation of Automated Insulin Delivery System Downloads with Dr Tomás Griffin
Dr. Tomás Griffin, a Consultant Diabetologist at Galway University Hospitals/CHO2, focused on using and interpreting Automated Insulin Delivery (AID) Systems, specifically Hybrid Closed Loop (HCL) systems. He advocated for widespread adoption of HCL systems, noting their suitability for nearly everyone with type 1 diabetes. He shared the Association of British Clinical Diabetologists' DTN Best practice guide for hybrid closed-loop therapy, which is open-access and can be viewed here. Dr Griffin provided insights into the resources available for interpreting HCL data and emphasised the importance of reviewing and working through HCL system data in clinical settings. His presentation included a practical, step-by-step guide to using these technologies in consultations and referenced the Type 1 Consultation Tool, which is useful for people attending clinics to have in advance of our appointments. This is the link to the consultation form.
* Photos of slides shared with permission from Dr Griffin.
Using diabetes technologies in Pregnancy with Dr Christine Newman
Dr Newman is a consultant endocrinologist at Galway University Hospital & lead clinical researcher in the Diabetes Collaborative Clinical Trials Network. She graduated from NUIG in 2012 with a Bachelor of Medicine (MB) of Surgery (BCh) and of Obstetrics (BAO) and completed her MD in the area of diabetes in pregnancy in 2022. The published research on HCL use in pregnancy is overwhelmingly positive. However, she mentioned that there are practical considerations for HCL in pregnancy, including the fact that there is only one commercially approved system for pregnancy, but some women will already be using other systems pre-pregnancy. As mentioned above in Prof Kar’s presentation, HCL and CGMs have improved all health outcomes for women with diabetes and their babies.
I love that Dr Newman included a nod to the #WeAreNotWaiting community.
* Photos of slides shared with permission from Dr Newman.
Challenges and Forward Movement
Despite the excitement of technological advancements, the conference did not shy away from discussing the challenges—such as staffing shortages and administrative hurdles—that continue to limit access to optimal diabetes care. Overall, the messages from the DTN Ireland conference were that pumps and sensors make managing diabetes easier for people with diabetes and for the people who are for them, and EVERYONE should be offered the opportunity to use them.
Conclusion
The launch of DTN Ireland offers the diabetes community a glimmer of hope that access to quality standards of care, insulin pumps, and improved healthcare practices is closer to becoming normal. There is now a collective effort from healthcare professionals to not only embrace innovation but also ensure that these advancements are accessible to all.