More than 150,000 adults and children with type 1 diabetes in England and Wales are to be offered an artificial pancreas on the NHS, which experts are hailing as a “gamechanger” that will “save lives and heartbreak”.
The groundbreaking device, also called a hybrid closed-loop system, uses a hi-tech algorithm to determine the amount of insulin that should be administered and reads blood sugar levels to keep them steady. A world-first trial on the NHS showed it was more effective at managing diabetes than current devices and required far less input from patients.
Final draft guidance from the National Institute for Health and Care Excellence (Nice) recommends that people in England and Wales should benefit from the wearable device if their diabetes is not adequately controlled by their current pump or glucose monitor. The decision to give the go-ahead for widespread use of the artificial pancreas was announced on Tuesday at Nice’s annual conference in Manchester by Dr Sam Roberts, its chief executive.
There are about 290,000 people living with type 1 diabetes in England and Wales. More than half of them will now become eligible because their diabetes is not controlled with their current device.
The artificial pancreas has been found to be better at keeping blood sugar levels within a healthy range, cutting the risk of people suffering complications from diabetes. It works via a continuous glucose monitor sensor attached to the body which transmits data to a body-worn insulin pump.
This pump then calculates how much insulin is needed and delivers the precise amount to the body. Hybrid closed-loop systems mean people do not need to rely on finger-prick blood tests or injecting insulin to control their blood sugar levels.
Living with type 1 diabetes can be relentless, health experts say, and requires intense management 24 hours a day. Hundreds of individual treatment decisions must be made around the clock as extreme blood glucose highs and lows can be fatal. By automating what is currently a manual process, the artificial pancreas could lift the relentless burden and risk of burnout.
Nice said it had agreed with NHS England that all children and young people, women who are pregnant or planning a pregnancy, and people who already have an insulin pump will be first to be offered a hybrid closed-loop system as part of a five-year rollout plan.
The technology will then be rolled out to those adults with an average HbA1c reading of 7.5% or more and those who suffer abnormally low blood sugar levels. Nice guidelines recommend people should aim for an HbA1c level of 6.5% or lower.
Prof Jonathan Benger, the chief medical officer at Nice, said: “With around 10% of the entire NHS budget being spent on diabetes, it is important for Nice to focus on what matters most by ensuring the best value for money technologies are available to healthcare professionals and patients.
“Using hybrid closed-loop systems will be a gamechanger 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.”
Nice said that, due to the need for extra staff alongside specialist training for patients and staff, it had accepted a request from NHS England for a rollout over five years.
Karen Addington, the chief executive of JDRF UK, a type 1 diabetes charity, hailed the announcement, saying it would transform the lives of children and adults. “Hybrid closed-loop defines a new era for medicine,” she said.
“It’s a beautiful algorithm, which will save lives and heartbreak, as well as in the long term saving NHS the cost of cardiovascular and retinal surgery, kidney dialysis and transplantation.”
She added: “Today’s announcement makes Great Britain the first country in the world to make hybrid closed-loop widely available, as England and Wales follow the lead of Scotland, who approved the use of HCL earlier in 2022.”
Colette Marshall, the chief executive of Diabetes UK, said the artificial pancreas had the potential “to transform the lives of many people with type 1 diabetes”, improving both health and quality of life.
Yasmin Hopkins, who took part in trials of the artificial pancreas, said: “From day one it was amazing. Before the closed-loop system, I would experience a lot of highs, which I’d then overcorrect, go low and eat a lot of sugar. All of that has been eradicated.
“This technology gives me the freedom to get on with my life and live without fear of what might happen in a few hours, days or years.”
