NICE recommends "artificial pancreas" for 100,000 T1s

[EllieM]

NHS in England to offer artificial pancreas to help manage type 1 diabetes

Successful trial of groundbreaking device, now approved by Nice, uses algorithm to determine amount of insulin needed

www.theguardian.com

So as far as I can make out this is an insulin pump that loops?

The first thing that comes to mind to me is what sensors are they using? Not sure if I trust automated insulin delivery if it relies on a (possibly) dodgy sensor.

 

[Hopeful34]

Yes, it's a hybrid closed loop pump. There was a lady on Channel 5 news tonight talking about it. She was using Dexcom 6 and a Tandem tslim x2 pump.

 

[EllieM]

Yes, it's a hybrid closed loop pump. There was a lady on Channel 5 news tonight talking about it. She was using Dexcom 6 and a Tandem tslim x2 pump.

Was she still manually bolusing for carbs?
And what happens when the dexcom misreads?

 

[Hopeful34]

Yes she was manually bolusing for carbs.
She didn't say anything about when the Dexcom misreads. Maybe @Juicyj can answer that better than I can, as she uses this pump.

 

[Juicyj]

Yes she was manually bolusing for carbs.
She didn't say anything about when the Dexcom misreads. Maybe @Juicyj can answer that better than I can, as she uses this pump.

Dexcom gives accurate readings, been using for around 4 years now and the only times i've had inaccurate readings are from decompression on the sensor which hasn't caused an issue and when levels have been moving too quickly for the sensor to catch up, so exercise/too much insulin, so has been a rare occasion to cross check with a meter, but that's very rare, you only bolus for food eaten and that's it.

 

[Rokaab]

The BBC article showed a medtronic pump and its sensors in their image - admittedly they didn't actually state which pump and sensors they were taking about

 

[Hopeful34]

Channel 5 didn't either, I just recognised them!

 

[suk]

It seems to be good news but I doubt all of us will be eligible to get it on the NHS. Depending on whether the Trust in your area is prepared to fund it.
I’ve been told that as I am fairly well controlled I probably won’t be considered. Expected that

 

[oldgreymare]

I've just raised a post in the Type 1 Pump forum, as this appears to be the only category under consideration to move to NHS funded "closed loop systems"

 

[Codythechef]

It seems to be good news but I doubt all of us will be eligible to get it on the NHS. Depending on whether the Trust in your area is prepared to fund it.
I’ve been told that as I am fairly well controlled I probably won’t be considered. Expected that

Not so true where I am, I didn’t expect to be offered this new tech so quickly. I run on average 80-90% time in range on DEXCOM and Ypsomed pump. I start my camaps tomorrow morning.

 

[Hopeful34]

That's brilliant @Codythechef

 

[urbanracer]

In the news again in today's Guardian

 

[In Response]

I am pleased but not excited yet.
At my last diabetes review, my consultant explained that the NHS has to consider Return on Investment. Therefore, those of us who do well without closed loop are going to be de-prioritised for the new technology because there is no value to the NHS.
Unfortunately, quality of life (time and effort taken to achieve good results) is rarely taken into consideration.

I feel I am being penalised for doing a good job and the risk of complications that comes with relaxing my management is too great.
HCL would be awesome ... but I am not holding my breath for it to be funded by the NHS.

 

[Jaylee]

Personally.

It would be great to see it prioritised for the youngsters.
My colleague has had the L3 & YpsoPump combo for a few months now for his 4YO. (after certain reservations on the offer.)
They love the system…

Oddly, they were seriously struggling with the Dexy & MDI.. (That’s another saga..)

 

[Finnlee]

I feel I am being penalised for doing a good job and the risk of complications that comes with relaxing my management is too great.

This is the thought I have when I read the pump or HCL criteria in other countries. Either you need to have a 'good' HbA1c or a 'bad' HbA1c to be offered a pump or a HCL system.

I'm in Germany and a pump was offered to me (without me bringing it up at all) 1.5 years after diagnosis. I had HbA1cs running regularly around 6.1% (42 mmol/mol) and I don't think that was taken into account.

There were four pumps to pick from, two or three of which could loop. My chosen pump (Tandem t:slim) and CGM (Dexcom G6) are both fully covered by insurance. By contrast, when I was on MDI, I paid €5 a sensor for Freestyle Libre 2 and 3.

Within two weeks of choosing my pump, I was trained and moved onto the pump, even with a few nights' stay at the clinic for basal testing. It was a bit over the top as I know I can figure this stuff out on my own, but I'll admit it was easier having the diabetes clinic team there to suggest adjustments since it was my first pump and it was good to start off on the right foot.

I'm in Germany, so my experience of getting a pump will certainly be different to those in the UK, but I'm really happy with my HCL system.

 

[oldgreymare]

I am pleased but not excited yet.
At my last diabetes review, my consultant explained that the NHS has to consider Return on Investment. Therefore, those of us who do well without closed loop are going to be de-prioritised for the new technology because there is no value to the NHS.
Unfortunately, quality of life (time and effort taken to achieve good results) is rarely taken into consideration.

I feel I am being penalised for doing a good job and the risk of complications that comes with relaxing my management is too great.
HCL would be awesome ... but I am not holding my breath for it to be funded by the NHS.

Sadly, I have to totally agree. Plus, if I read all the NICE documents correctly, this latest directive includes that NO new pumps should be prescribed until all existing pump users that qualify for HCL ( remember this is a 5 year rollout) are dealt with first. I would just like a standalone pump...I'm borderline hypo unaware and suffer massive sleep deprivation due to ongoing nighttime hypos regardless of tweaking my basal.

 

[oldgreymare]

Not so true where I am, I didn’t expect to be offered this new tech so quickly. I run on average 80-90% time in range on DEXCOM and Ypsomed pump. I start my camaps tomorrow morning.

Just a guess - are you in Scotland? HCL already approved there since 2022.

 

[Richard1984]

NHS in England to offer artificial pancreas to help manage type 1 diabetes

Successful trial of groundbreaking device, now approved by Nice, uses algorithm to determine amount of insulin needed

www.theguardian.com

So as far as I can make out this is an insulin pump that loops?

The first thing that comes to mind to me is what sensors are they using? Not sure if I trust automated insulin delivery if it relies on a (possibly) dodgy sensor.

The headline was a bit misleading. I pay for the medtronic closed loop system and it is good there is no doubt but it is not the panacea to forgetting you have T1DM (hopefully this will come). You still need to carb count and do the basics. What the machine does is help when levels are dropping or rising. It does this by stopping basal delivery or increasing basal delivery. The number of hypos ive had has fallen significantly. For example, say when you BG is 6 and dropping the machine cuts outs delivery of basal. Its impressive the impact this has on steadying BG levels (i call it 'putting the brakes on') and for sure one can worry a bit less about dropping low unexpectantly.

So in summary its good kit, its expensive if you self-fund, it still needs much user input, its more stuff stuck into your body so your abdo takes a battering but for sure it takes some of the pressure of T1DM management.

 

[Deleted member 99312]

And this new technology does that automatically, virtually mimicking the function of a pancreas - although it still requires information on food intake to be inputted at mealtimes to work accurately.

Diabetes patients to be offered artificial-pancreas technology

The rollout of new devices for thousands in England with type 1 diabetes is hailed as a landmark moment.

www.bbc.co.uk

So who is this for, really? People who are currently not very capable or disciplined enough to count their carbs and inject insulin accordingly? But they will still have to count their carbs accurately and input them into some device whenever they eat?

I think if the NHS gave simpler instructions to people then few diabetics would have bad control in the first place. Controlling our blood sugar is not rocket science, and the fact so many struggle with it and seem baffled by it is not because it is inherently difficult, but because the NHS does a woeful job in explaining it to people.

 

[Martinaustin]

The closed loop systems are a good idea. But are only at an early stage. Like Libre sensors they are time limited and even worse with cannula changes every 2 or 3 days. This is much too frequent. When such changes and associated insulin reservoir sizes increase to cope with 1 week minimum then I’ll be on. At last a partial artificial pancreas but a weekly change would be even better. Martin (Type 1 for nearly 60 years)