NICE has recommended the use of ‘game changer’ wearable technology to help patients manage type 1 diabetes.
Hybrid closed loop systems allow insulin to be delivered automatically to the body, keeping blood glucose at a healthy level. This technology includes a continuous glucose monitor sensor which transmits data to an insulin pump, both of which are worn on the body.
Final draft guidance, published by NICE today, said hybrid closed loop systems should be offered to people whose current device is not controlling their diabetes.
NICE and NHS England have agreed that this technology will be rolled out over a five-year period in order to allow for trusts to employ the extra staff needed.
The technology will be offered first to all children and young people, women who are pregnant or planning a pregnancy, and those who already have an insulin pump. It is also recommended more widely for adults with an average HbA1c reading of 7.5% or more.
NICE’s draft guidance, due to be published as final in December, evaluated clinical trial evidence showing that hybrid closed loop systems are ‘more effective than standard care at maintaining blood glucose levels within a healthy range’.
The wearable technology also allows patients to continue daily life without needing to regularly conduct finger prick testing or insulin injections.
There are around 270,000 people in England and 16,000 people in Wales living with type 1 diabetes, according to NHS data.
Patients will only be able to access this technology with the support of a trained multidisciplinary team experienced in continuous subcutaneous insulin infusion.
NICE recommendations
1.1. Hybrid closed loop (HCL) systems are recommended as an option for managing blood glucose levels in type 1 diabetes for adults who have an HbA1c of 58 mmol/mol (7.5%) or more, or have disabling hypoglycaemia, despite best possible management with at least 1 of the following:
continuous subcutaneous insulin infusion (CSII)
real-time continuous glucose monitoring
intermittently scanned continuous glucose monitoring.
1.2 HCL systems are recommended as an option for managing blood glucose levels in type 1 diabetes for children and young people.
1.3 HCL systems are recommended as an option for managing blood glucose levels in type 1 diabetes for people who are pregnant or planning a pregnancy.
Professor Jonathan Benger, chief medical officer at NICE, said it is important to focus on ensuring best value for money for diabetes technology since the disease takes up around 10% of the NHS budget.
He said: ‘Using hybrid closed loop systems will be a game changer for people with type 1 diabetes.
‘By ensuring their blood glucose levels are within the recommended range, people are less likely to have complications such as disabling hypoglycaemia, strokes and heart attacks, which lead to costly NHS care.
‘This technology will improve the health and wellbeing of patients, and save the NHS money in the long term.’
Dr Patrick Holmes, a GP and diabetes network primary care lead at North East and North Cumbria ICB, agreed that the technology is ‘truly a game changer’ because it functions as an ‘automatic pancreas’.
He said: ‘This is really what AI should be giving us. These are the tools to make people live longer and healthier lives in a way we’ve not had.
‘And so it is a game changer, it is the best way to manage people’s diabetes. It’s not for everybody – not everybody wants wearable devices. But I think for those who can and want it, they should be given the opportunity.’
From a general practice perspective, Dr Holmes said it is important that primary care teams engage with patients who are living with type 1 diabetes and who are not under specialist care in order to ‘repatriate them to secondary care’ wherever possible.
He added: ‘Patients with type 1 diabetes don’t achieve QOF glycemic targets, HbA1c, so this is a win for [GPs] if they can identify these people and refer them on to specialist teams.’
NHS England’s national specialty advisor for diabetes Professor Partha Kar said the NICE’s recommendation is ‘amazing news’ for people living with type 1 diabetes.
He said: ‘This tech might sound sci-fi like but it will have a dramatic impact on the quality of peoples’ 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.’
Dr Becky Haines, a GP in Gateshead with a special interest in diabetes, said use of technology to manage the condition has increased over recent years but this approval takes it ‘to the next level’ and will be ‘life-changing’ for eligible patients.
She said: ‘As well as reducing some of the burden of living with type 1 diabetes day to day, the improvement in blood glucose levels will reduce the risk of complications developing in the long term.’
‘There is still much work to do to enable all regions to have staff trained and able to initiate hybrid closed loop systems, so patients should not expect this to be immediately available from their diabetes clinic, but can discuss what is happening in their area at their next review,’ she added.
Last year, NICE recommended ‘flash’ glucose monitors for all type 1 diabetes patients, with devices prescribed by their GP or local diabetes team.
On type 2 diabetes, NICE recommended tirzepatide in September for people whose condition is difficult to manage, overturning a previous decision on the drug.
The Government is expected to publish a ‘major conditions strategy’ next year which will include diabetes and will focus on improving population health through ‘lifestyle drivers’ and early diagnosis.
A version of this story first appeared on our sister title Pulse.
