Summary
Increased access to closed loop technology will significantly improve the lives of many people with type 1 diabetes. However, transitioning to this technology poses a challenge for both the person with diabetes and diabetes services. The DAFNE Closed Loop Essentials Course was developed to support people with type 1 diabetes to use a closed loop safely and effectively, as well as diabetes services to efficiently onboard large numbers of adults onto closed loops. A total of 5,440 people have accessed the course. Course graduates report significant increases in confidence in using a closed loop on course completion.
Innovation/Novel approach to an existing problem
People with diabetes require knowledge and skills to be able to operate a closed loop safely. It is not feasible for health care professionals (HCPs) to deliver the education in one-to-one consultations. Therefore the DAFNE Closed Loop Essentials (CLE) course was developed. It is an online course that participants can complete in their own time at their own pace. The DAFNE team collaborated with Diabetes Technology Network UK (DTN-UK) to ensure the course content is suitable. The course includes: introductory information on closed loops; insulin and how it works in a closed loop; when to give additional insulin; carbohydrate counting; ratios; how to manage a hypo; problems with a closed loop; and going back to pens. HCPs in publicly funded services in the UK and Republic of Ireland can refer people with diabetes to the course free of charge. The course helps people with diabetes to develop the skills to manage closed loops safely and incorporates activities and case studies. Participants complete knowledge checks to assess their understanding of the content.
Equality, Diversity and Variation
The course is inclusive in several ways: it is accessible to people with low health literacy; multiple methods are used to convey information, suiting different learning styles and needs; case studies include people of different genders, ages and ethnicities; food examples are from a range of cultures; it can be accessed via mobile phone, laptop or PC in the person’s own time. Data show that people from the most deprived as well as the least deprived sectors are successfully completing the course. It is free to people with diabetes in the UK and Republic or Ireland whether or not they receive their care from a DAFNE centre. A total of 62% of participants described their gender as female and 37% male. Participants comprise 43% aged 36–55, 28% aged 17-35, 27% aged 56–75 age range, with no upper age limit. Regarding ethnicity, 94% described themselves as White, 1.5% as Asian, and 1.25% as Black. The Race Equality Foundation is helping with ways to increase the number of ethnic minority groups. Data shows course graduates access the course via a laptop (49%), mobile phone (21%), PC (19%) and tablet/iPad (11%). English postcode data shows the course is being accessed by people from all deciles, but more people in higher deciles have completed it. The team is promoting the course through its networks and social media to reduce variation in access. A face-to-face version is being introduced to reduce digital exclusion.
Impact to Patient Care
Since its launch in April 2024, 3,536 people with diabetes have completed and passed the course. An additional 1,746 people with diabetes are accessing the course. Feedback describes the positive impact of the course on patient care. Participants can revisit sections multiple times, and can refresh their learning at a future point. After the course graduates reported significant increases in confidence about moving onto closed loop therapy. Several described learning from the course despite having diabetes for a long time. HCPs have also completed the course. This is important as those not working in diabetes need to to understand how a closed loop works to ensure safe care and to prevent conflicting advice. In addition, the course frees up specialist diabetes dietician and nurse time.
Results
Since the course was launched in April 2024: 5,440 people have accessed it; 3,536 people with diabetes have completed and passed the course; only 11 people have failed the course assessment; 158 HCPs have also completed the course. Most people (46%) completed it in 4-6 hours. A total of 91% of course graduates rated themselves 7,8,9 or 10 out of 10 in confidence after completing the course, compared to just 39% beforehand. Some centres have incorporated the CLE course into their access to closed loop pathway. The course was developed by the central DAFNE team using industry sponsorship and educational grants and is available free of charge to up to 10,000 people eligible to transition to a closed loop system receiving their care from any publicly funded diabetes services in the UK, Republic of Ireland and Crown Dependencies until the end of March 2026. The knowledge check designed to ensure participants have understood safety aspects of closed loop technology was passed by 99.7% of participants. Therefore, the course allows more people to be trained to use a closed loop in a shorter time span than traditional methods, meaning more people should benefit from improved glycaemic control and have fewer short-, medium- and long-term diabetes-related complications.
User Feedback
The course has received overwhelmingly positive reviews from users. Of 1,093 (31%) of course graduates, 91% rated it as good or excellent and 91% said they would recommend the course to others. Feedback was obtained by inviting all course graduates to complete a set of person reported outcome measures. Participants could complete the form anonymously, feedback was self-reported and a standard online form containing neutrally phrased Likert scale and open-ended questions was used. HCPs from referring centres receive information on which of their patients have completed the course and passed the knowledge check. Professionals report this is beneficial as it means they can target individual support more effectively and efficiently. The DAFNE team is responsive to feedback suggesting improvements, such as a request for a face-to-face version of the course. The team has developed this course option, and two centres are piloting this format in July 2025. This will also benefit people with diabetes who are digitally excluded.
