Accelerating care, capacity and equity in automated insulin delivery systems for New Zealanders with type 1 diabetes: the ACCESS-AID study protocol

Purpose: Automated insulin delivery (AID) systems are the gold standard for managing type 1 diabetes (T1D), yet access remains inequitable due to funding disparities, workforce limitations, bias, and geographic barriers. The ACCESS-AID study aims to implement a new model of care by using a remote 'Hub' to deliver prioritised training and support to those most in need and to improve workforce capacity by working in partnership with New Zealand's National Public Health service. Methods: Eligible participants include all individuals with T1D and eligible people with pancreatogenic/Type 3c diabetes). Enrolment will use a prioritisation score. After informed consent and baseline assessments, participants receive one-day AID training (in-person or remote) by certified, industry provided trainers, followed by 12-weeks of structured support from Hub staff. The primary outcome is implementation effectiveness. Secondary outcomes: clinical and psychosocial impacts, safety, nutrition education effectiveness, and qualitative insights. CGM metrics and HbA1c will be assessed at baseline and 12-weeks, and CGM again at 24-weeks. Hub staff will receive training in AID management, complete self-efficacy assessments, and participate in interviews. Conclusion: This model offers a novel, scalable and equity-focused approach to diabetes technology care, which will enhance outcomes for people with diabetes and inform future service delivery for other long-term conditions.