In a landmark development for diabetes care in England and Wales, over 150,000 individuals could soon have access to a transformative ‘artificial pancreas‘ system, known as a hybrid closed-loop system.

This hybrid closed-loop system is a cutting-edge technology which has the potential to revolutionise the management of type 1 diabetes by automating blood glucose control, thus eliminating the need for frequent insulin injections.

What are the recommendations?

The National Institute for Health and Care Excellence (NICE) has put forth new recommendations, suggesting that adults with type 1 diabetes who have an HbA1c level of 58 mmol/mol (7.5%) or higher, or who suffer from disabling hypoglycaemia despite optimal management with an insulin pump, real-time continuous glucose monitoring (CGM), or intermittently scanned continuous glucose monitoring (Flash), should be offered the hybrid closed-loop system.

Additionally, the system is recommended for children and young people under 18, as well as for individuals who are pregnant or planning to become pregnant.

The guidance from NICE also specifies that the use of hybrid closed-loop systems should be supported by a multidisciplinary team experienced in managing insulin pumps and continuous glucose monitoring in type 1 diabetes.

Furthermore, it is essential that eligible individuals and their carers are capable of using the system safely, having either completed an approved structured education programme or possessing the knowledge to manage insulin dosing and adjustments.

These inclusive recommendations have expanded from the initial draft shared in January, now offering the technology to all children and young people, lowering the HbA1c criteria, and providing greater flexibility in the training for using the technology.

The guidance issued by NICE applies to England and Wales and may also be formally adopted in Northern Ireland, where processes are already in motion to do so.

Scotland has its own guidance for hybrid closed-loop systems which was approved in 2022, and is continuing with its implementation.

What is a hybrid closed-loop system?

Hybrid closed-loop systems, sometimes referred to as ‘artificial pancreases’, integrate insulin pumps and continuous glucose monitors (CGM) with a computer algorithm that calculates the required insulin dosage based on glucose readings.

The Juvenile Diabetes Research Foundation called it “the biggest treatment breakthrough for type 1 diabetes since the discovery of insulin”.

Hybrid closed-loop technology partially automates blood sugar management, although manual input is still necessary for activities such as eating or exercising.

Evidence strongly indicates that hybrid closed-loop systems can significantly improve blood sugar control, reduce hypoglycaemic events, and simplify the self-management of type 1 diabetes.

The consultation on this recommendation will continue until December, marking a potential milestone in diabetes care and offering hope for a more manageable future for those living with type 1 diabetes.

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