NICE publish new guidance on hybrid closed loop systems for pregnancy

An independent NICE committee has recommended that a pregnancy-specific version of hybrid closed loop (HCL) technology should be offered when planning a pregnancy or at the earliest stages of pregnancy. The device, known as a hybrid closed loop (HCL) system, automatically monitors blood sugar and delivers insulin through a small pump worn on the body. It reduces the need for frequent finger prick tests and manual insulin injections. 

Why this matters

Managing blood sugar during pregnancy is difficult and critical. Blood sugar that is too high or too low can cause serious harm to the mother and baby. However, clinical trials show pregnancy-specific HCL systems can help women maintain safer blood sugar levels throughout pregnancy. 

What the guidance says

The updated guidelines set out that: 

• Everyone who is planning a pregnancy should be offered a pregnancy-specific HCL system from the point of pregnancy planning 

• Training and support should be provided by specialist multidisciplinary teams 

• Women should be able to continue using their HCL system during labour and birth, if this has been discussed and agreed in advance and it is safe to do so 

• Women can choose to continue using pregnancy-specific HCL systems for at least six months after birth 

• Clinicians should regularly revisit the option with anyone who initially declined 

Pioneering technology 

Manisha Vadgama, 39, used a hybrid closed loop system throughout her pregnancy. 

Manisha said: “I was diagnosed with type 1 diabetes at 20 and for a long time I told myself having a baby wasn’t something I could do. The fear felt overwhelming. But this is genuinely the best time to get pregnant if you have type 1 diabetes, because the technology is pioneering. Using a hybrid closed loop system during my pregnancy meant I could focus on being pregnant rather than constantly worrying about my blood sugar. During my c-section I kept my devices on. I was in control, and that meant everything to me. 

I now have a beautiful, healthy boy called Dillan, and I am living a reality I never imagined for myself. To any woman with type 1 diabetes who is thinking about starting a family, please don’t let fear hold you back. I just want to shout it from the rooftops: do it. This technology will be there for you.” 

Better outcomes for parent and baby 

Hilary Nathan, Director of Policy and Community Engagement at Breakthrough T1D, said: “Pregnancy with type 1 diabetes can be complex and demanding, so it’s vital that people have access to technology that supports their individual needs and circumstances. Hybrid closed loop systems can help manage glucose levels more effectively while reducing the day to day burden of decision-making. During pregnancy, this support is especially important, as it contributes to better outcomes for both parent and baby. 

No two pregnancies with type 1 diabetes are the same, which is why choice and access to the right technology are essential. Ensuring people can use the tools that work best for them will help support safer pregnancies and healthier families.” 

Eric Power, interim director of the centre for guidelines at NICE, said: ”Thousands of women with type 1 diabetes give birth in England and Wales every year. Every one of them faces the challenge of maintaining safe blood sugar levels for themselves and their baby, from the moment they start planning a pregnancy. 

These draft recommendations would mean that pregnancy-specific hybrid closed loop technology should be offered to all of them. The evidence shows these systems help people spend significantly more time within safe blood sugar ranges. That is a meaningful improvement in care, and it is what NICE guidance is here to deliver.”