In January, NICE released draft guidance on the use of hybrid closed-loop (HCL) systems for managing blood glucose levels in some people with type 1 diabetes in the NHS in England and Wales. HCL technology allows the user to go about daily life without the burden of monitoring whether their blood glucose levels are too high or too low.
Hybrid closed-loop systems employ a continuous glucose monitor (CGM) sensor to transmit real-time data to a body-worn insulin pump. The pump uses a mathematical algorithm to calculate how much insulin to deliver into the body to keep blood glucose levels within range, thereby reducing the risk of long-term complications of hyperglycaemia.
NICE has recommended HCL systems as an option for managing blood glucose levels in type 1 diabetes for people who are finding it difficult to manage their condition (i.e. they have an average HbA1c ≥64 mmol/mol), despite the use of continuous subcutaneous insulin infusion, real-time CGM or intermittently scanned CGM.
The draft guidance also recommends that women with type 1 diabetes who are pregnant or planning a pregnancy should be offered the technology, as blood glucose levels are harder to manage during this time. An HCL system may only be used with the support of a trained multidisciplinary team, and if the person or their carer understands how to use it and attends a type 1 diabetes structured education programme.
The systems are only recommended if the companies that supply them and NHS England agree a cost-effective price on behalf of the relevant health bodies. Currently, an average annual cost is estimated at £5744, which is higher than what NICE considers to be cost-effective.
Professor Partha Kar, National Specialty Advisor for Diabetes at NHS England, has thanked NICE for its recommendations and the benefits that they would bring to people with type 1 diabetes, noting that “the quality of life this technology gives to those using it is huge.”
A consultation on the draft is underway, and consultees can comment until 31 January 2023. Click here to read the draft document.