Nurses Reach Landmark Consensus on Guiding Patients Through Diabetes Tech

Nurses who specialize in helping people manage diabetes with advanced technology now have a clearer professional identity, thanks to a Spanish consensus study published in the journal Diabetes Therapy. The research, led by Núria Alonso-Carril and colleagues, brought together 21 expert Diabetes Self-Management Education and Support (DSMES) nurses from 18 locations across Spain and then tested their conclusions against a much larger group of 306 healthcare professionals, including 176 nurses and 130 endocrinologists. The result was agreement on all nine consensus statements, both among the expert panel and across the external groups, with agreement levels in the external assessment generally exceeding those of the panel itself.

The study addressed a gap that has grown as diabetes care has become more technologically complex. Automated insulin delivery systems, among the most significant developments in type 1 diabetes management, have been shown to improve glycemic outcomes, reduce hypoglycemia and glycemic variability, and enhance quality of life for people with diabetes. Current international evidence supports these systems as an effective technology-based treatment option for many people with type 1 diabetes, and their use is increasingly backed by major clinical guidelines and professional organizations, including the International Society for Pediatric and Adolescent Diabetes and the National Institute for Health and Care Excellence. Yet the benefits of such devices depend heavily on effective education and sustained engagement with treatment, and the researchers noted that limited evidence existed on the specific role, competencies, and training requirements of nurses specializing in advanced diabetes technologies.

To build that evidence, the team ran a structured consensus process. An initial virtual meeting in December 2024 identified the key domains requiring agreement: professional role and responsibilities, technology-related competencies and expertise, educational and leadership responsibilities, and training and organizational support. A questionnaire with nine consensus statements was then distributed electronically in February 2025 through the Medallia CheckMarket platform and remained open for two weeks. Statements were rated on a 5-point Likert scale from strongly disagree to strongly agree, and consensus was predefined as at least 70 percent of participants selecting agree or strongly agree for a given statement. The panel also answered complementary closed- and open-ended questions exploring their responses in greater depth.

The expert panel was not a random sample of the nursing workforce. All 21 participants were members of a national expert working group established by Medtronic, with clinical experience in diabetes care, active involvement in the care and education of people with type 1 diabetes, and experience with diabetes technologies. Twelve nurses, or 57.1 percent, cared for adults with type 1 diabetes, six, or 28.6 percent, cared for pediatric patients, and three, or 14.3 percent, cared for both populations. Fifteen participants, or 71.4 percent, reported that their center followed more than 500 people with type 1 diabetes. Medtronic supported the organization and logistical coordination of the working group and provided the online questionnaire platform, but its representatives attended meetings without participating in scientific discussions or formulating the consensus statements, and the sponsor did not define objectives, analyze data, or draft the manuscript.

When the quantitative results arrived, every one of the nine statements cleared the 70 percent threshold within the expert panel. The lowest level of agreement was observed for Question 5, at 76 percent. The follow-up questions revealed a profession caught between recognition and structure. Some 71 percent of participants reported that the role of the DSMES nurse is formally defined in their workplace, and among those reporting an undefined role, the main barriers were lack of recognition, insufficient training, absence of role standardization, and excessive workload. Most participants, 91 percent, reported feeling valued within their multidisciplinary teams, though qualitative responses highlighted limited recognition at the institutional or management level. Only 48 percent reported full leadership of DSMES nurses in technology education, with a further 14 percent indicating equal distribution with industry and 38 percent reporting partial industry involvement of between 10 and 50 percent.

Questions about what defines expertise in advanced diabetes technology exposed both unity and disagreement. Agreement on the need for specialized training was unanimous at 100 percent, and the panel reached consensus that proficiency across advanced diabetes technologies is a defining characteristic of expertise. Every participant selected minimum exposure time as a requirement, with no responses below 50 percent, and 36 percent selected more than three years of professional experience as a minimum. Yet only 62 percent considered that DSMES nurses currently meet the minimum requirements to be recognized as technology experts. The barriers they reported included lack of regulation, unequal access to training, role adaptation without formal preparation, reliance on individual initiative, and workforce instability. Most participants, 81 percent, reported the absence of institutional policies and the absence of dedicated resources to support specialized training, describing training that depends on individual initiative, industry support, peer learning, or prior experience. Some 76 percent reported having structured therapeutic education programs at their centers.

The external professional assessment then tested whether these views were shared beyond the expert group. The questionnaire was distributed by email through professional networks, working groups, and scientific societies, and participation was voluntary and open to nurses working in diabetes care and endocrinologists. The 306 respondents included 176 nurses, or 57.5 percent, and 130 endocrinologists, or 42.5 percent. Most worked in public healthcare centers, at 96.1 percent, and 77.8 percent primarily cared for adults with type 1 diabetes. Because the number of professionals who received the invitation was not recorded, a response rate could not be calculated, and the authors acknowledged that this recruitment approach may have introduced selection bias, since professionals with greater interest in diabetes care or technology may have been more likely to participate.

Agreement with the consensus statements was high across both external professional groups, with all statements reaching at least 70 percent agreement and the overall sample exceeding 90 percent for every statement except Question 5, where the lowest level was recorded among external nurses at 86 percent. The comparisons with the expert panel were revealing. Agreement that the DSMES nurse role is formally defined was higher among external groups, at 82 percent for external nurses and 96 percent for endocrinologists, compared with 71 percent for the panel. External groups more frequently attributed full educational leadership to DSMES nurses, at 52 percent of external nurses and 70 percent of endocrinologists, compared with 48 percent of the panel. External groups also more frequently considered that DSMES nurses meet minimum requirements, at 68 and 86 percent respectively, against the panel’s 62 percent. Availability of structured DSMES programs was reported more frequently by endocrinologists, at 90 percent, than by external nurses at 70 percent or the expert panel at 76 percent. Differences also emerged in how expertise was defined: external nurses placed greater emphasis on professional experience, endocrinologists prioritized performance-related criteria, and minimum exposure time did not reach 70 percent agreement within either external group.

The authors argue that the findings expose a gap between professional recognition and structural implementation. Although regulatory and competency frameworks exist in Spain, including the national competency framework for diabetes care nursing and Royal Decree 639/2015, alongside the Spanish Diabetes Society position statement, participants reported a lack of consistent implementation across healthcare settings. The study’s conclusions state that there is strong consensus on the essential role of DSMES nurses in the context of advanced diabetes technologies, but that the lack of standardized training and formal recognition highlights the need for competency-based educational frameworks and institutional support to ensure consistent and equitable practice. Structural barriers identified included the lack of standardized training pathways, insufficient institutional policies, and the absence of formal accreditation frameworks. The discussion notes that the challenges identified were closely related to insufficient organizational definition and variability in institutional support rather than being attributable solely to individual professional competence, and that training pathways often rely on individual initiative, peer learning, or external support, potentially contributing to variability in access to professional development.

The study has limitations the authors themselves emphasize. The selection of the expert panel may have introduced selection bias, as participants were highly engaged in diabetes care, education, and advanced diabetes technologies, and variability in organizational contexts across participating centers may have influenced responses. Although the initial quantitative rating was followed by a facilitated discussion in March 2025, no subsequent quantitative re-rating was performed, so changes in individual ratings and quantitative convergence across iterations could not be assessed. The study was conducted exclusively in Spain and reflects the specific regulatory, organizational, and professional context of the Spanish healthcare system, so the findings should not be assumed to directly reflect the organization or professional roles of DSMES nurses in other healthcare systems. There was no patient or public contribution to the work. Even so, the overall pattern of agreement across the expert panel and the external groups supports the consistency of the identified priorities, and the authors conclude that advancing toward formal recognition of the DSMES nursing role, alongside standardized competency-based training pathways and institutional frameworks, may help reduce variability in professional practice and promote more equitable and consistent care for people with diabetes using advanced diabetes technologies.

Subject of Research: Expert consensus on the professional role, competencies, and training of diabetes self-management education and support nurses in advanced diabetes technology care

Article Title: Defining the Role of DSMES Nurses in Advanced Diabetes Technologies: An Expert Consensus Study with External Professional Assessment

Article References: Alonso-Carril, N., Aizpeolea, L., Burillo, E., Civitani, E., Díez, M., Espinosa, J., Fernández, A., Gómez, A. M., López, E., López, R., Lorenzo, M., Lucas, F., Navarro, C., Nieto, M. D. L. O., Palacio, M., Penalba, M., Pueyo, I., Real, P., Rodríguez, M., … Roldán, M. J. (2026). Defining the Role of DSMES Nurses in Advanced Diabetes Technologies: An Expert Consensus Study with External Professional Assessment. Diabetes Therapy. https://doi.org/10.1007/s13300-026-01932-x

Image Credits: AI Generated

DOI: 10.1007/s13300-026-01932-x

Keywords: DSMES nurses, diabetes technology, expert consensus, type 1 diabetes, automated insulin delivery, nursing competencies, healthcare professionals, training pathways, institutional support, Spain, Diabetes Therapy, professional accreditation