Large group onboarding of Omnipod 5 automated insulin delivery system—Experience from a UK secondary care diabetes service

In December 2023, the National Institute for Health and Care Excellence (NICE) published technology appraisal guidance (TA943) recommending hybrid closed-loop (HCL) systems as an option for managing blood glucose levels for adults living with Type 1 diabetes (T1D).¹ NICE agreed to an NHS England request to extend the normal period of compliance to 5 years to allow specialist services time to develop education and training to support wider access. Diabetes services across England and Wales have been considering how to build the clinical capacity required to deliver equitable access to HCL systems in a safe and timely manner, while meeting the expectations of people living with the condition.

Our diabetes service is based at a large inner city hospital and supports over 2000 people living with T1D. We have a dedicated multidisciplinary team (MDT) consisting of diabetologists, insulin pump-trained diabetes specialist nurses (DSN), and specialist dieticians. The MDT, supported by a clinical psychologist, meets weekly virtually to discuss cases of significant clinical complexity, or where HCL is being considered. At the time of writing, 1145 of our cohort are benefitting from insulin pump therapy, with 989 established on HCL systems.

Here, we share our experience onboarding 56 people with T1D onto the Omnipod 5 automated insulin delivery (AID) system at a 1-day group event² (see Table 1 for baseline characteristics). To our knowledge, this is the largest 1-day HCL onboarding event to date in the UK. The proposal for this collaborative effort between the clinical and administrative teams and industry was presented to the hospital's outpatient services leadership team for approval, including financial planning. Based on our significant experience with diabetes technology, the proposal was deemed feasible and an opportunity to enhance productivity.^{3, 4}

The clinical and administrative teams held joint operational meetings prior to the event. This included participant identification, contact and invitation, ordering and shipment of devices, and consumables to each participant. Invited participants were existing users of Omnipod pumps (Eros or Dash) and had chosen to use Omnipod 5 with the Libre 2 Plus continuous glucose monitoring (CGM) device. A standardised letter was sent to the participant's GP for prescription of Libre 2 Plus CGM prior to the event. Written instructions were sent to each participant, providing guidance and instructions on how to prepare ahead of the onboarding event, including setting up individual Glooko and Omnipod 5 personal web accounts. This was supported by verbal communications with the DSN team where needed. Ahead of the event all participants were re-contacted by telephone and e-mail to confirm the location and timings, and ensure the pre-onboarding tasks had been completed.

The onboarding event was performed in a conference room on the hospital site. The 1-day event was split into a morning and an afternoon session. Each session was 3 hours in duration and facilitated by three insulin pump DSNs and two educators from the pump manufacturer (Insulet). Participants sat at tables with a large projector screen displaying the training content. Each table was provided with writing materials for participants and educational materials related to T1D self-management. During each session, the educator team from the manufacturer introduced the Omnipod 5 AID system, including instructions on transferring pump settings from their previous Omnipod devices to the Omnipod 5. The settings transfers were individually checked by the DSN team members. All participants then independently inserted their pod and CGM sensor and were instructed on how to link these devices by the educators, including how to navigate the Omnipod 5 handset menu. Once linked, the Omnipod 5 automated mode was initiated by each participant.

Throughout the 1-day event participants were encouraged to engage and share their experiences with each other and with the clinical team. Prior to leaving the event, all participants were provided with DSN clinical advice and manufacturer technical support contact details. Additional clinical time was allocated to ensure each participant could benefit from clinical review in the weeks after their onboarding event. At the follow-up visit, participants were provided a questionnaire to gather their feedback and experience from the event. Fifty of 56 attendees completed this questionnaire. The results showed that 96% felt the training event met their expectations. 94% reported they had received the training needed to benefit from the Omnipod 5 AID system, and 98% stated that they would recommend the event to others. Attendees also appreciated that a DSN was assigned to each table, allowing individualised care despite the size of the group, and the opportunity to share experiences with other people living with T1D. No incidents of severe hypoglycaemia or ketoacidosis were reported during follow-up. Participants spent an average of 93.9 ± 14.8% of the time in Auto Mode. Among participants with available paired data (pre- and post-AID, n = 48), the mean increase in time spent in range after 10 weeks was 13.5% (pre-AID: 51.5 ± 17.6% vs. post-AID: 65.1 ± 13.7%, p < 0.001). Additionally, the median time spent below range was minimal, at 2% (IQR: 1%–3%).

In conclusion, we have shown that large group AID onboarding can be feasibly delivered with appropriate planning and support, and is acceptable to patients and staff. With the current challenges faced by diabetes services, innovative approaches such as this are needed to enable improved access to diabetes technology.

J. Schofield and H Thabit conceived the idea for the work and analysis. A Chapman, S McGriskin, L Findlow, A Urwin, S Ohol, S Thomas and R Obsiye organised and delivered the device training. A Chapman collected the data. A Chapman, H Thabit and J Schofield supported data analyses and interpreted the results. A Chapman, H Thabit and J Schofield wrote the manuscript. All authors critically reviewed the report. No writing assistance was provided. H Thabit has full access to all of the data in the study and take responsibility for the integrity and accuracy of the data.

No funding was received for this manuscript.

H Thabit reports having received speaker honoraria from Eli Lilly and Dexcom Inc., having served on advisory panels for Medtronic, Sanofi and Roche and having received research support from Dexcom Inc. AC, S McGriskin, L Findlow, A Urwin, S Ohol, S Thomas, R Obsiye and J Schofield report no relevant conflict of interest.