Hybrid closed loops to be offered to people living with type 1 diabetes
National Institute for Health and Care Excellence (NICE) publish guidance for use of system for managing blood glucose levels.
Hybrid closed loop management system will now be available via the NHS – following a recommendation from NICE.
The hybrid closed loop system, also referred to as an artificial pancreas, can help people living with type 1 diabetes to improve management of their blood glucose levels.
The publication of the NICE final guidance means plans are now being agreed to begin rolling out the technology in 2024.
Following the consultation on the case for extending the statutory 3-month period for funding of hybrid closed loop systems for managing blood glucose levels in type 1 diabetes, the NICE guidance has been published (19th December), that could mean the system will soon be offered to around 150,000 people living with the condition in England.
Hybrid closed loop (HCL) systems work by linking an insulin pump and continuous glucose monitor (CGM) with a computer algorithm that can calculate the amount of insulin someone needs based on their blood glucose readings, helping people manage diabetes with minimal user interaction.
The NICE recommendations include that over the next five years hundreds of thousands of people living with type 1 diabetes should be offered this next-generation technology to help them manage their condition.
The NICE guidance applies to England and Wales but can also be formally adopted in Northern Ireland, with work underway to start that process. Scotland already has guidance for hybrid closed loop systems and will continue to implement this.
Those eligible to be offered HCL as part of the recommendation will include people living with type 1 diabetes who are under the age of 18 or those who are over 18 with either an HbA1c of 7.5% or who are experiencing disabling hypoglycaemia (low blood glucose levels. This includes people using a continuous subcutaneous insulin infusion (CSII) (i.e. an insulin pump); real-time continuous glucose monitoring (CGM); and intermittently scanned continuous glucose monitoring (Flash).
The system is also recommended for women who are pregnant or planning a pregnancy, and people already using an insulin pump.
The guidance adds that hybrid closed-loop systems should only be used with the support of a trained multidisciplinary team experienced in insulin pumps and continuous glucose monitoring in type 1 diabetes.
According to the guidance eligible people and their carers should be able to use them safely and either be offered an approved structured education programme or know how to manage insulin dosing and adjustments.
Partha Kar, National Specialty Advisor, Diabetes with NHS England, said: “This is amazing news for people living with type 1 diabetes and this announcement can be made possible thanks to the hard work of the NHS, once again trialling and testing the best and latest innovations for the benefit of our patients.
“This tech might sound sci-fi like but it will have a dramatic impact on the quality of people’s lives, not to mention outcomes – it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication.”
HCL manufacturers Dexcom recently published the results of a new study around the perceptions of HCL among patients with type 1 diabetes and healthcare providers involved in their care.
The research found that 79% people struggle with time in range, but 45% do not know what a HCL is or understand how the system could benefit them.
According to HCL users participating in the study there were numerous benefits to HCL, including improvements in quality of life (52%), time in range (46%), productivity at work (44%), sleep (42%) and reduced stress related to diabetes (40%).
All HCL users surveyed said it was important to them that they had a choice of insulin pump, with more than half indicating it was very important (55%), and the rest noting it was somewhat important (45%).
Healthcare providers were also in agreement at the potential of HCL to change lives for people living with type 1 diabetes for the better (99%), while 98% said they would want all people with the condition to have access to HCL.
Karen Baxter, Vice President for UK Ireland Benelux Spain and France for Dexcom, said: “It is clear from our research that so many more people could benefit from HCL. Every single person (100%) surveyed with type 1 diabetes said that being on an HCL system has reduced the burden of managing their diabetes and 98% of healthcare practitioners say they would want all people with type 1 diabetes to have access to HCL. The newly announced technology appraisal from NICE is a great advancement in access to diabetes technology.
“As such, to support healthcare professionals with their understanding of the benefits of HCL systems for patients with diabetes, Dexcom has worked with the clinical experts at the Diabetes Technology Network (DTN) to launch a series of education modules encompassing everything they need to know about the technology, we are excited to play a key role in widening access to HCL as a result.”
Jeremy Irvine, actor and HCL user, said: “I can honestly say using the Dexcom G6 continuous glucose monitoring device to power my HCL system has changed my life. I can’t imagine going back to finger pricks and blood glucose monitoring, and I certainly couldn’t do the intense filming I’ve been doing without my HCL system.”
Read the NICE guidance on Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes
Read more about type 1 diabetes
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