Box 4.
Summary of Recommendations
| The recommendations presented below are ordered according to the priority attached to them by workshop participants. |
| • Ensure that healthcare professionals providing training and support to pregnant HCL users are proficient in the use of insulin pumps, CGM and HCL technology. |
| • Provide inexperienced centers/staff with support from device manufacturers to learn about insulin pump and CGM (if required) and train women transitioning onto a HCL. |
| • Provide healthcare professionals seeking to develop and/or refresh their skills with access to online webinars, videos, training resources, and succinct checklists, which are regularly updated and specific for using each closed-loop system. |
| • Support inexperienced sites/staff to review/interpret data by establishing regularly updated intra- and/or intersite meetings or ‘masterclasses' led by experienced healthcare professionals. |
| o Ensure that staff attending such meetings receive refresher training to take account of rapid developments in HCL technology. |
| • Provide 24 h technical support for healthcare professionals via a telephone helpline. |
| • Develop and implement a mentorship/peer support model to assist inexperienced centers/staff to review and interpret HCL users' glycemic and insulin data. |
| • Ensure that general hospital staff receive guidance to support pregnant HCL users who present acutely at emergency departments and maternity units. This could be provided by updating mandatory professional training modules (e.g., on Insulin Safety) to include: |
| o Information about HCL components (insulin pump, cannula, and CGM sensor) and where these might be located on a woman's body. |
| o Contact details and guidance on when to seek clinical input from local diabetes and obstetric specialists (e.g., during administration of corticosteroids, labor, and birth). |
| o Advice to follow local management protocols with expedited diabetes and obstetric review if a pregnant woman presents with ketones, with explicit guidance that HCL should not be used for management of DKA during pregnancy. |