The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. Design:A descriptive qualitative research using content analysis of interviews.Methods: Participants were invited through the National DiNPs' Forum. Semistructured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. Findings: Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles;and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. Conclusions:The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth.Clinical relevance: Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.

Background: Treatment of type 1 diabetes (T1D) is complex, requires therapeutic intensity and understanding patient needs. The COVID-19 pandemic has led to a rapid and dramatic increase in the use of telemedicine to maintain treatment continuum and response to patients. Dedicated software, developed to transfer data from patients’ glucose sensors and insulin pumps to the treating team, facilitates personalized therapeutic interventions. Diabetes Nurse Practitioners (DNPs) have the knowledge, treatment skills and expertise for analyzing patient data transferred by the software; hence, they are an essential resource for managing diabetes treatment in these patients. The lack of suitable infrastructure and staff members who specialize in T1D has led to the establishment of a dedicated DNP unit within a diabetes clinic in Israel. The unit’s services are provided by frontal and telemedicine sessions to patients aged 18-40 with T1D. Its aims include continuous and regular monitoring of patients, achieving glycemic control according to patients’ personal targets, and preventing acute and late complications. The DNP provides comprehensive advice and training, assesses, and evaluates the patients' conditions, adjusts their therapy and refers them to appropriate care providers based on their medical and emotional conditions. Each session lasts 30-45 minutes. The summary of each session is sent to the diabetes doctor and to the primary clinic’s team. Methods: Analysis of patient data treated by the dedicated DPN unit between January and July 2022. Results: A total of 143 patients underwent 537 sessions; 55% were frontal visits and 44.4% were telemedicine visits (online or by phone). improved glycosylated hemoglobin was noted in 61% of patients. One patient was hospitalized. Conclusions: DNPs are an important factor for improving the quality of care of patients with T1D by providing personalized care, continuous contact and better access to services through remote consultation. Disclosure O.Waizinger: None.

There are 70,942 people with diabetes in Haifa- Galil District of Clalit Health services, most are treated in primary care clinics. 10.7% have an HbA1c above 9% and 14.7% of the Arab patients. The HMO is in a process of reallocating and redistributing personnel to better meet the needs. The nursing staff and specifically the graduates of the advanced diabetes course (GADC) are an important asset that needs to be maximally utilized to meet this end. There are 24 nurses who are GADC, 19 work in primary care setting. Aims: Improvement of metabolic control by enhancing intervention by the GADC. Positioning the role of the GADC in primary care clinics. Methods: Initiating a quality forum for the graduates led by the diabetes nurse specialist (DNS) coordinator and the head of nursing services to launch a targeted plan of intervention in the 18 community clinics in which they work. The 19 nurses make the intervention in their clinics - 7,800 patient with diabetes in total: invite them for assessment of adherence to therapy, patient education, intensification of therapy and follow-up until getting to target. Support, empowerment, supervision and ongoing assessment of the process by the District DNS. Results: Improvement in the implementation of performance measures in the clinic from 81.7 to 88.4 (6.6) % in the total population and from 74.9 to 83.5 (8.6) % in the Arab sector. Improvement in the overall metabolic control from 77.9 to 86 (8) % and from 68.9 to 79 (10.1) % respectively. Decrease in HbA1c in those above 9% by -2.3% and -3.3% respectively. Conclusions: A DNS led structured intervention by GADC as part of the policy of the District nursing administration, maximizes their abilities and professional authority of the graduates. The knowledge and skills provided by the GADC significantly improves performance measures as well as metabolic control. Continue the integration of future graduates into the framework at the community clinic level. Disclosure O. Waizinger: None.