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Type 1 technology

Hybrid closed loop likely to be recommended for over 100,000 people with type 1 diabetes

Draft guidance has been published which recommends that the NHS fund hybrid closed loop (HCL) systems, following years of dedicated research and campaigning by JDRF.
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Kate Lawton 13 January 2023

Illustration of the hybrid closed loop technology system, funded as part of treatment research for type 1 diabetes by Breakthrough T1D UK.

Draft guidance has been published which recommends that the NHS fund hybrid closed loop (HCL) systems, following years of dedicated research and campaigning by JDRF. The guidance will help more people access HCL, which helps relieve the burden of type 1 diabetes by automating insulin delivery.

The National Institute for Health and Care Excellence (NICE, the body which advises the NHS on treatments and technologies) has opened a public consultation on the draft guidance before it comes into force later this year.

If approved, it would mean over 100,000 people in England and Wales would qualify for NHS funding of HCL technology.

Hybrid closed loop is a sophisticated technology which uses an algorithm to link a user’s continuous glucose monitor (CGM) with their insulin pump to automatically deliver insulin.

Our Policy and Communications Director, Hilary Nathan, said, “Hybrid closed loop technology is a game-changing treatment at the forefront of health technology and artificial intelligence. HCL will transform the lives of people living with type 1 in England and Wales, reducing potentially fatal glucose highs and lows, lifting the relentless burden and reducing the risk of long-term complications such as sight loss, cardiovascular disease and kidney failure.”

This intelligent HCL technology was developed thanks to rigorous JDRF-funded research and clinical trials over almost 20 years, along with tireless campaigning and advocacy work by Breakthrough T1D UK to make it available on the NHS.

Who would hybrid closed loop be offered to?

The draft proposal recommends that the NHS offer HCL systems as an option for managing blood glucose levels for people with type 1 who are pregnant, planning a pregnancy, or have difficulty managing their condition (shown by an average HbA1c of around 8% (64 mmol/mol) or above).

The proposed guidelines say that anyone eligible for HCL will need the support of a trained team who have experience with insulin pumps and CGMs to receive an HCL system. People with type 1 must also attend a structured type 1 diabetes education programme to be eligible to receive HCL on the NHS.

Will hybrid closed loop be available in other UK nations?

This proposal document by NICE covers England and Wales. Scotland is already providing HCL systems to people with type 1 who need support managing their condition. We are pushing for people in Northern Ireland to have access to this crucial technology as soon as possible.

What’s the next step for the draft guidance and consultation?

Once the consultation closes on 31st January, NICE will review the feedback and finalise the guidance. In the meantime, the NHS need to negotiate a cost-effective price before HCL is offered to patients.

How is JDRF responding?

Our passionate policy team and type 1 technology experts are drafting a comprehensive response to the proposed guidelines from NICE. In this feedback, we will include concerns and praise from the type 1 community as well as our own evidence-based comments.

Have your say on the proposal

NICE welcome comments from the public about their proposed guidelines. If you would like to contribute, add your views to this version of the hybrid closed loop proposal document by 5pm 31 January 2023.

What feedback is NICE seeking?

The guidance committee would particularly like comments addressing these areas:

  • Has all of the relevant evidence been taken into account?
  • Are the summaries of clinical and cost effectiveness reasonable interpretations of the evidence
  • Are the recommendations sound and a suitable basis for guidance to the NHS?
  • Are there any aspects of the recommendations that need particular consideration to ensure the avoidance of unlawful discrimination against any group of people? This includes potential barriers due to race, sex, disability, religion or belief, sexual orientation, age, gender reassignment, pregnancy and maternity.

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