Study highlights impact of CGM and HCL technologies on UK nurses and midwives
New research has identified a growing confidence among UK nurses and midwives in supporting people with diabetes using continuous glucose monitoring (CGM) technologies, but not so much hybrid closed-loop (HCL) systems.
While the widespread adoption of CGM is now underpinned by relatively high staff confidence and training access, HCL implementation remains inconsistent, particularly outside of specialist diabetes teams, a national online survey has revealed.
Conducted by the DSN Forum UK team, the findings underscore a critical gap between the NHS’s ambitions for digital transformation in diabetes care and the preparedness of the nursing and midwifery workforce tasked to deliver it.
This service evaluation aimed to explore the confidence levels of registered nurses and midwives in the UK in the use of CGM and HCL technologies within their clinical practice.
An anonymous online questionnaire was distributed in May 2025 via professional social media channels, targeting registered nurses and midwives involved in diabetes care in the UK.
The survey was developed by diabetes specialist nurses (DSNs), reviewed by peers, and piloted with 10 multidisciplinary team (MDT) professionals for clarity and relevance.
It included multiple-choice, Likert-scale and open-ended questions covering:
- Confidence in CGM and HCL
- Education and training received
- Perceived safety and workload impact
- Organisational support.
A total of 434 responses were received across the four home nations. The result highlight a clear role-based divide, with confidence linked to exposure to diabetes technology.
CGM is more established in both primary care and secondary care practice, whereas HCL remains less familiar despite national policy support.
These findings emphasise the need for targeted training, especially in non-specialist and maternity settings, to ensure safe and equitable technology-supported care.
Nurse consultants reported the highest confidence, reflecting their advanced expertise and leadership roles
Paediatric DSNs also reported very high confidence, attributed to early adoption of technology and structured training embedded in paediatric care pathways.
Confidence in HCL was lowest among midwives and those working in primary care. These groups often lack structured training, protocols and access to escalation pathways, despite being at the frontline of patient care. These respondents described anxiety, limited training and a lack of antenatal protocols.
Workforce strain was a major concern, with many professionals reporting increased workload, limited administrative support and a lack of time and funding to deliver the education and follow-up required for safe HCL use.
This pressure, coupled with disparities in training access and regional funding models, risks undermining the equitable implementation.
The DSN Forum UK said: “We are acutely aware from stories of DSNs working in diabetes, that the workforce of registered nurses and midwives are coming to diabetes technologies, in particular the HCL rollout with varying levels of competence and confidence.
“With the NICE TA now in year two and diabetes tech becoming more widespread in all environments from schools to labour wards to operating theatres, we wanted to assess the competence of registered nurses and midwives delivering this tech to people living with diabetes.
“This survey has identified some stark differences between specialists working in diabetes to nurses working in general settings such as primary care.
“We hope that by highlighting this deficit across the workforce, trusts, organisations, industry and charity partners can look at how this can be remedied to keep patient safety at the heart of diabetes care.”
The results are available here.