Hybrid closed loop system seen as step toward artificial pancreas

In draft guidance, an independent NICE (National Institute for Health Care Excellence) committee has recommended the use of hybrid closed loop systems for managing blood glucose levels in type 1 diabetes.

NHS trials have provided the data which has allowed NICE to consider wider use of the technology which allows a person with type 1 diabetes to go about their day-to-day life without having to monitor their blood glucose levels.

In a statement, Mark Chapman, interim director of Medical Technology at NICE, said: “Some people living with type 1 diabetes struggle to manage their condition, even though they are doing everything asked of them by their diabetes team. This technology is the best intervention to help them control their diabetes, barring a cure.”

If type 1 diabetes is not well controlled, people are at risk of long-term complications of hyperglycaemia, including blindness, amputations, or kidney problems.

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The hybrid closed loop system is comprised of a continuous glucose monitor sensor attached to the body. This transmits data to a body worn insulin pump which uses the data to run a mathematical calculation to work out how much insulin needs to be delivered to keep blood glucose levels within a healthy range.

NICE has recommended people who are unable to control their condition despite using an insulin pump, or real-time or intermittently scanned continuous glucose monitoring, are offered the technology if their long-term average blood glucose levels are indicating they are at risk of long-term complications.

In total, around 105,000 people in England and Wales could be offered the technology.

The draft recommendations also require NHS England to agree a cost-effective price for the systems on behalf of relevant health bodies. At present an average annual cost for the technology is £5,744, which is higher than what NICE considers a cost-effective use of NHS resources.

The standard care for type 1 diabetes involves regularly measuring blood glucose levels by using finger-prick blood testing or by using a continuous real-time or intermittently scanned glucose monitor. Blood glucose levels are managed with multiple daily insulin injections or by using a pump to inject insulin under the skin.

Professor Partha Kar OBE, national specialty advisor for diabetes at NHS England, said: “This technology has been proven to give the best control for managing type 1 diabetes and should make things like amputations, blindness, and kidney problems possibly a thing of the past. The quality of life this technology gives to those using it is huge.”