Who is level 4 training for?
This training is aimed at senior or expert healthcare professionals including diabetes specialist nurses, consultant medics, GPs with a special interest in diabetes and consultant pharmacist.
Before starting level 4 training, learners must be able to evidence they have undertaken learning to meet the aims at levels 1 to 3. If a learner can demonstrate this, they do not need to do the learning again. This information can be recorded on the competency guides and checklists for learners and managers or supervisors.
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Aims of level 4 training
Level 4 training covers all the aims listed at levels 1 to 3, plus the following:
- Help develop local guidance or strategy to enable more access to isCGM and rtCGM
- Demonstrate an in-depth knowledge regarding the use of different insulin therapies in conjunction with advanced technologies to support individuals in the management of their diabetes (e.g. insulin pump therapy in hybrid closed loop system, smart meters and smart pens connected to CGM)
- Be able to advise and initiate procured CGM both as standalone and as part of a hybrid closed loop system considering the functionality of the devices and the needs of the individual.
Level 4 aims for specialist diabetes services only:
- Co-ordinate assessment processes relating to potential service users
- Assess the person with diabetes regarding self-management skills
- Provide structured education to support informed decision-making, regarding how this therapy differs when controlling and monitoring their diabetes, including: specific insulin pump devices, specific hybrid closed loop devices follow-up requirements, risk versus benefit and additional functions associated with pump devices
- Demonstrate understanding and provide education supporting nutritional requirements, glycaemic effects of different foods, weight management and concepts of carbohydrate counting
- Review carbohydrate counting skills and insulin ratios
- Develop and ensure delivery of educational materials, supportive networks and models of diabetes care that foster empowerment and lifelong learning about diabetes
- Work with the person with diabetes to facilitate lifestyle adjustment in response to changes in their diabetes or circumstances
- Review blood glucose monitoring results to ensure effective use of insulin pump or HCL system
- Provide education for other healthcare professionals and care workers in diabetes self-care skills in using insulin pump or hybrid closed loop therapy
- Demonstrate in-depth knowledge regarding the use of different insulin therapies and advanced technology to support these individuals in the management of their diabetes (e.g. smart meters, CGM).
Level 4 training resources
Before starting level 4 training, learners must be able to evidence they have undertaken learning to meet the aims at levels 1 to 3. If a learner can demonstrate this, they do not need to do the learning again. This information can be recorded on the competency guides and checklists for learners and managers or supervisors. In addition to the resources detailed in the table at level 1 and listed at level 2 and level 3, the following resources offer further knowledge and skills to progress to level 4.
Glooko Academy is an education platform for diabetes technology, certified by the Association of British Clinical Diabetologists (ABCD). Modules you may find beneficial include:
- Diabetes technology in pregnancy
- Sensor augmented pumps (SAP)
- Continuous subcutaneous insulin infusion (CSII)
- Pumps for CSII
The CDEP is developing a training module to help diabetes experts identify when hybrid closed loop should be used with caution or discontinued and be able to troubleshoot issues. This module is expected to be available from November 2024.
Please note that a CDEP licence is required to access CDEP training modules. See the contact details on the main page to get your CDEP licence.
Online DAFNE closed loop essentials course for adults with type 1 diabetes that may not previously completed a DAFNE course or other structured education and need upskilling in intensive insulin management, carbohydrate counting, pump therapy and the fundamentals of closed loop therapy. This course provides basic knowledge and has been designed in collaboration with the Diabetes Technology Network UK, aligning to the essential skills identified by DTN-UK to manage closed loops safely.
Further information about the course and the benefits to diabetes services can be found on the website DAFNE Closed Loop Essentials - DAFNE
- DTN (2018) Best practice guide: Continuous subcutaneous insulin infusion (CSII) - a clinical guide for adult diabetes services
- DTN (2018) Clinical guideline: Guidelines for managing CSII (or ‘insulin pump’) therapy in hospitalised patients
- DTN has developed a suite of training materials to support the adoption, uptake and optimal use of CGM in diabetes in pregnancy, freely available to all healthcare providers and to pregnant women with diabetes. To access the DTN-UK education platform - The Academy – register here
- Teams are encouraged to follow the DTN best practice guide on using diabetes technology during pregnancy.
Dexcom G6
Dexcom has a comprehensive program to ensure healthcare professionals can access any training materials for them and their teams online and in-person. Part of this training informs the healthcare professional to the different patient onboarding routes and resources. Once a Dexcom device has been identified as the most appropriate choice Dexcom can provided the materials and training to help establish the level of support needed, including:
- Dedicated website for healthcare professionals containing training and education videos, education modules and webinars
- Train the trainer sessions provided by Dexcom field support teams
- Helpful frequently asked questions to support healthcare professionals
- Training slide decks for use with patients using a receiver or app to allow healthcare professionals to help patients get the best out of their Dexcom device
- Dexcom has also partnered with third party education providers to offer CGM education.
Getting started with DEXCOM
- Self-guided training programme
- Details on pump upgrades from Dexcom G6 to Dexcom G7
- ‘In the loop’ webinars.
Dexcom G7
- Information about Dexcom G7 which is designed for people with type 1 diabetes who need extra support.
Healthcare professionals should contact the local Abbott representative for demonstration and sampling of the FreeStyle Libre 3 sensor. If you need contact details for the local representative, call the helpline number: 0800 032 1016 - 8am to 8pm Monday to Friday (excluding bank holidays) and 9am to 5pm on Saturdays. Or you can email Abbott at: ADChelpuk
The FreeStyle Libre 3 web page has further information about the system including key product details, a compatibility list, accuracy data, FreeStyle Libre 3 App and videos.
Medtronic holds local and national events, and uses its Facebook, Instagram and YouTube channels to support patients. Please see this document Medtronic training and education overview for further details.
Please see this booklet Omnipod 5 automated insulin delivery system - considerations for healthcare practitioners for more information.
The CamAPS training portal has a section for healthcare professionals who will be supporting people living with type 1 diabetes to safely use the CamAPS FX system. There is also this leaflet: Starting the mylife CamAPS FX app.