Pharmacists Help Resolve Barriers in Automated Insulin Delivery for Patients With Type 1 Diabetes

In a new study published in the Journal of Diabetes and Metabolic Disorders, investigators aimed to dismantle the systemic barriers that have long prevented equitable access to the gold standard of type 1 diabetes management, automated insulin delivery (AID) systems. Following the expansion of public funding in October 2024 in New Zealand for continuous glucose monitors (CGM) and insulin pumps for type 1 and related forms of diabetes, a new implementation study known as ACCESS-AID is seeking to solve the resulting workforce and capacity crisis.¹

This study protocol introduces a novel remote hub model designed to provide prioritized training and support to those in greatest need while simultaneously upskilling health care professionals, including pharmacists, to manage these advanced technologies.¹

“This approach aims to efficiently and safely speed up training and access to AID and has been used previously by our research team to successfully train high-risk and priority populations across the lifespan onto AID systems,” the study authors said.¹ “Furthermore, evidence from our research group indicates that access to modern diabetes technologies is an effective equalizer of ethnicity-based disparities in diabetes outcomes and thereby is an effective equity tool.”

AID systems represent a significant leap forward by linking an insulin pump, a CGM, and a computer algorithm to semi-automate insulin dosing. These systems have demonstrated the ability to dramatically improve glycemic outcomes, with some trials showing a 2.5% decrease in HbA1c and a 35% increase in time in range (TIR) for younger patients.¹

Despite these clear benefits, access in Aotearoa, New Zealand, has historically been slow and inequitable, particularly for Māori, Pacific peoples, and those living in rural areas. Workforce constraints and overly complicated training pathways have remained persistent hurdles, with a recognized shortage of practitioners who feel confident supporting patients through the transition to this new technology.¹

For the pharmacy profession, the ACCESS-AID study offers a strategic opportunity to integrate into a multidisciplinary team that includes registered nurses, physicians, and dietitians. Prescribing pharmacists and other clinical staff can be seconded to the remote hub, where they receive specialized mentoring and training to build self-efficacy in preparing and managing patients on AID systems. This train-the-trainer approach is intended to increase capacity throughout the entire public health system, ensuring that once the study period concludes, these skills are disseminated back into local districts and primary care settings.¹

The study specifically targets the historical gatekeeping of technology, where providers often prioritized patients who already demonstrated high levels of diabetes management skills. Instead, the hub utilizes a prioritization score to favor individuals who stand to gain the most from automation, such as those with high hemoglobin A_1c levels, known complications, or those facing geographic barriers. Research indicates that providing advanced technologies to priority populations is an effective tool for negating ethnicity-based disparities in health outcomes.^1,2

Pharmacists must also be aware of the individual-level barriers that can lead to technology discontinuation, such as alarm fatigue, skin irritation from adhesives, or the perceived burden of wearing multiple devices on the body. Furthermore, patients often experience a bureaucracy nightmare when navigating insurance and supply chains, though the New Zealand funding model aims to simplify these hurdles.²

By participating in the hub model, pharmacists can help address these practical challenges through daily remote data reviews and structured support during the critical first 12 weeks of technology adoption.¹

The impact of this research extends beyond immediate clinical metrics. By exploring the acceptability of a remote health care team, the study investigates whether telehealth can safely and effectively initiate complex new technologies rather than just providing ongoing management. This decentralization of care is vital for rural equity, allowing patients to start on AID systems in their own communities with support from a national center of expertise.¹

“This study leverages our research group specialist knowledge in advanced diabetes technology to propose a solution to an identified problem in the current diabetes health care provision,” the study authors said.¹ “By decentralizing training and support, this novel remote hub aims to overcome workforce capacity limitations and methodological and geographical barriers.”

Ultimately, the goal of the ACCESS-AID study is to create a scalable framework that can be adapted for other long-term chronic conditions. As the health system moves toward more automated and data-driven models of care, the role of the pharmacist is evolving from traditional dispensing to a more clinical, technology-focused partnership with patients.¹

By building professional confidence in AID management, the pharmacy workforce can ensure that the recent expansion of funding translates into real-world health improvements for all New Zealanders living with type 1 diabetes.¹

READ MORE: Insulin Management Resource Center

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REFERENCES

1. Gale JT, Boucsein A, Williman J, et al. Accelerating care, capacity and equity in automated insulin delivery systems for New Zealanders with type 1 diabetes: the ACCESS-AID study protocol. J Diabetes Metab Disord. 2026;25(1):96. Published 2026 Mar 2. doi:10.1007/s40200-026-01864-0

2. Tanenbaum ML, Commissariat PV. Barriers and Facilitators to Diabetes Device Adoption for People with Type 1 Diabetes. Curr Diab Rep. 2022;22(7):291-299. doi:10.1007/s11892-022-01469-w