A qualitative study of clinician attitudes towards closed-loop systems in mainstream diabetes care in England

Clinicians mediate access to new technologies. Consequently, their views on specific devices may influence user access to diabetes technology in mainstream care. As yet, little is known about clinicians' views about closed-loop systems. This qualitative study explored clinicians' views on the likely impacts of future closed-loop systems in mainstream diabetes care in England.

We conducted interviews with 36 clinicians from a range of professional backgrounds in five hospital outpatient clinics (two adult, two pregnancy, one paediatric) in England to explore possible consequences of closed-loop systems for users and clinicians. Data analysis utilized a framework approach.

Clinicians reported a range of expected benefits for future users, including improved glucose control and quality of life. Expected burdens included continued need for manual input and the risk of losing basic self-care skills. In terms of future clinical workloads, three clinicians emphasized only positive impacts, seven emphasized both positive and negative impacts, and 17 mentioned only negative impacts. Our most prominent finding, expressed by 24 clinicians, was that closed-loop systems would generate initial challenges due to the need for staff training, user education and support, and new analytical capacities, alongside existing intra-clinic variations in technological experience.

Clinicians recognize the value of closed-loop systems in terms of health benefits, but also identify a range of concerns for both users and healthcare staff, which could impact negatively on user access. Future implementation efforts should address these concerns by providing training and support for healthcare teams, taking varied technological expertise into account.