Abstract
In Aotearoa New Zealand, the landscape of care for youth with type 1 diabetes (T1D) is evolving rapidly with the introduction of public funding for diabetes technologies such as continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery (AiD) systems(1). Previously, one of the requirements for youth with T1D to meet the Pharmac criteria for funded insulin pumps and consumables was participation in carbohydrate counting education delivered by a multidisciplinary team. However, with universal access now available, there is limited research on how diabetes teams across Aotearoa NZ are now providing nutrition and carbohydrate counting education to meet the needs of youth using diabetes technology. This qualitative study aimed to explore the perspectives of dietitians and diabetes nurses on the evolving role of carbohydrate counting and nutrition education in supporting youth (aged 12 to 24 years) with T1D to optimise their glucose outcomes, particularly in the context of increasing use of newer diabetes technologies. Semi-structured interviews were conducted with 13 participants, including dietitians (n = 8) and diabetes nurses (n = 5), who were purposively sampled to capture experiences from regional diabetes services and rural-based teams across diverse geographical regions of Aotearoa NZ. All participants took part in the study voluntarily and interviews were recorded, transcribed and coded using NVivo. Data were analysed thematically to generate insights relevant to clinical practice, guided by interpretive description methodology(2). Participants acknowledged that advances in diabetes technology, along with the universal funding of diabetes technology for T1D from October 2024, have enabled carbohydrate counting education to become more flexible and accessible for youth living with T1D. Importantly, many emphasised that dietitian input remains critical to achieving optimal diabetes outcomes and supporting overall health. In addition, while increased access to CGM and AiD data enables healthcare professionals to provide tailored follow-up and support, participants described a substantial increase in workload, making it challenging to manage within already limited resources. To address these challenges and improve access to carbohydrate-counting information, some regions reported an increase in the use of group nutrition education sessions as part of their pre-pump training programme. Of note, participants reported mixed results when using this approach (compared to individualised nutrition education), with low attendance to group sessions being a frequent challenge. Participants suggested that flexibility in the way education is provided - via one-on-one consultations, phone, email, and online webinars - has helped enhance access, particularly for vulnerable populations. In conclusion, this qualitative study suggests that healthcare professionals believe that providing carbohydrate counting and nutrition education remains vital to optimising the use of diabetes technology in youth with T1D in Aotearoa New Zealand.