Abstract
Background: In Aotearoa New Zealand (NZ), care for youth with type 1 diabetes (T1D) has undergone substantial change following the introduction of universal funding in October 2024 for diabetes technologies, including continuous glucose monitors (CGMs), insulin pumps, and automated insulin delivery (AID) systems. Prior to this reform, inequities in both technology access and uptake, as well as in diabetes outcomes, were well documented. While universal funding aims to improve equity, international evidence suggests policy change alone may not ensure equitable uptake, particularly amid workforce capacity constraints. The funding changes also removed the requirement for participation in carbohydrate counting education before accessing insulin pump therapy. Therefore, little is known about how nutrition education is currently being delivered alongside expanding technology use, or how technology may influence eating behaviours in NZ youth with T1D.
Aim: This study aimed to explore healthcare professionals’ (HCPs’) perspectives on how access to diabetes technologies is prioritised across regions of Aotearoa NZ, to identify barriers to equitable use, and to examine how nutrition education and support are delivered, including perceived influences of increasing technology use on eating behaviours among youth with T1D.
Methods: This qualitative study used semi-structured interviews with 15 HCPs, including dietitians (n = 9) and diabetes nurses (n = 6), who were recruited via clinical networks and professional associations using a study advertisement distributed by email, and purposively sampled to capture experiences from regional diabetes services and rural-based teams across Aotearoa NZ. Interviews were conducted between May and October 2025, then recorded, transcribed and coded using NVivo 15 software. Data were analysed thematically to generate insights relevant to clinical practice, guided by interpretive description methodology.
Results: HCPs reported that while CGM use has expanded rapidly, insulin pump access varied widely across regions and services due to the training, support required, and workforce limitations. Access was prioritised using an equity-driven, multi-factor approach, considering age, ethnicity, clinical need, social circumstances, and patient engagement. Despite universal funding, barriers to equitable access persisted, including systemic inequities, geographic isolation, disengagement, and limited staffing for individualised support. Participants emphasised that culturally responsive care, consideration of young people’s circumstances, ongoing education, and innovative, flexible service delivery models are central to enhancing engagement and reducing inequities in technology use. Dietitian input was also identified as essential for optimal diabetes outcomes, though workforce constraints restricted support in some centres. Nutrition education remained central to care but has adapted alongside advancing technology, with carbohydrate counting education delivered flexibly and tailored to individual needs. HCPs noted that the ways technology use shapes nutrition and food choices vary between individuals and highlighted the need for standardised, culturally responsive nutrition resources to support youth with T1D in the context of increasing technology use.
Conclusion: From the perspectives of HCPs, universal funding has improved access to diabetes technologies for youth, although insulin pump access remains inconsistent due to high demand and local workforce capacity, with systemic, social, and geographic barriers to access and uptake persisting. Nutrition remains central to T1D management, with dietitian involvement regarded as essential for achieving optimal diabetes outcomes, alongside the increasing use of technology. These findings highlight that achieving equitable outcomes for youth with T1D requires culturally responsive, individualised care, ongoing education, and innovative, flexible service delivery models, alongside strengthened workforce capacity and standardised nutrition resources.