Any update from NICE on closed loop?

[SamJB]

Hi everyone,
NICE met this week to discuss feedback on their initial statement on who qualifies for closed loop on prescription. In January they said only people with an HbA1c over 8 will get it. Does anyone know if they have changed this stance?

 

[mansingh01]

Hi everyone,
NICE met this week to discuss feedback on their initial statement on who qualifies for closed loop on prescription. In January they said only people with an HbA1c I’ve 8 will get it. Does anyone know if they have changed this stance?

First I heard of that. People won’t be able to afford all the drugs you have to take for diabetes. People will just stop taking them.

 

[Nicola M]

Whilst it is frustrating I do understand their thinking behind it. I was part of the group of people who got to trial it and give real world data which helped to start the ball rolling on these guidelines. Before starting my HbA1c was slightly over 9% even with already using a pump and CGM. It’s the same as why they won’t always give insulin pumps to people who have good control with MDI because they don’t want to spend hundreds of thousands on people who already have good control and are unlikely to cost the NHS thousands more from complications. Do I agree with it? Not particularly but it’s all about cost for them and saving money where they can. It’s a great system for everyone and I would love for it to be offered to everyone.

 

[SamJB]

Whilst it is frustrating I do understand their thinking behind it. I was part of the group of people who got to trial it and give real world data which helped to start the ball rolling on these guidelines. Before starting my HbA1c was slightly over 9% even with already using a pump and CGM. It’s the same as why they won’t always give insulin pumps to people who have good control with MDI because they don’t want to spend hundreds of thousands on people who already have good control and are unlikely to cost the NHS thousands more from complications. Do I agree with it? Not particularly but it’s all about cost for them and saving money where they can. It’s a great system for everyone and I would love for it to be offered to everyone.

I understand their decision, but don’t want to get into a debate about it Just want to know whether I’ll get one for free, or will have to buy one

 

[Ipodlistener]

I understand their decision, but don’t want to get into a debate about it Just want to know whether I’ll get one for free, or will have to buy one

New info on this. Best bet is to follow Partha Kar on Twitter. My DSN said it wasn't always a case of worst first. But small steps like when Libre was first prescribed. My DC said two pumps would be available Ypso or omnipod 5. Ypso is good but only for low insulin usage is my understanding of it

 

[SamJB]

New info on this. Best bet is to follow Partha Kar on Twitter. My DSN said it wasn't always a case of worst first. But small steps like when Libre was first prescribed. My DC said two pumps would be available Ypso or omnipod 5. Ypso is good but only for low insulin usage is my understanding of it

Awesome, thanks!

 

[LongtermIDD]

NICE move at a snail's pace. Don't expect any meaningful announcements for a while.

 

[SamJB]

I reached out to Partha Kar on twitter and an announcement will be made soon. I get the feeling it’s not going to be universal access, but we’ll find out soon

 

[Ipodlistener]

I reached out to Partha Kar on twitter and an announcement will be made soon. I get the feeling it’s not going to be universal access, but we’ll find out soon

Think I'm right in saying. The guidelines are to get 100k people on to pumps. Which sounds like a lot. But isn't really. It's a good start thou.

 

[FatCatAnna]

New info on this. Best bet is to follow Partha Kar on Twitter. My DSN said it wasn't always a case of worst first. But small steps like when Libre was first prescribed. My DC said two pumps would be available Ypso or omnipod 5. Ypso is good but only for low insulin usage is my understanding of it

Ypsopump is good for anyone using insulin - whether it's low amount or more. The changing of the glass vials is very simple to do, if you run out of insulin inbetween your infusion changes. I think in the EU (I'm in Canada - where we have refillable glass vials for the Ypsomed rather than prefilled ones that are easily plunked into the pump). I tested the pump out here last year, and if it hadn't been for technical issues during the trial, where Ypsomed decided I was a pain in the **** (my words - but how I read their scribbles when the requested the pump back before the end of the trial) - I might still be on it.

Interesting about having an A1c above 8% to be eligible for closed looping. I'm in the same boat, where I self fund the CGM here in Canada - even though I am hypo unaware - and reason I have been self funding since 2016 ... sadly my endo refuses to sign paper work to allow help. The joys of countries like Canada and UK that have socialised health care - doesn't always mean that you can get onto some of the technology, etc. that you admire from afar.

 

[LongtermIDD]

Type 1's with extremely good Hba1c control (e. g. regularly at or below 42) are prone to hypos, but generally suffer far less diabetes related conditions. As such they save the NHS money, but the acute risk of hypos is still of concern.

Given the above IMO it seems rather discriminatory for the likes of NICE to focus solely on helping patients with very high Hba1c's. Although some can do little to reduce their levels, many may well just not be disciplined enough to take care of themselves.

Apologies for being direct, but I'd like to see high Hba1c's patients being made to fully exhaust alternative means of reducing Hba1c's (e. g. diet changes etc) before being put on to a closed loop system. Such a system may mask underlying issues and do little to help some to change their ways in the medium to long term.