Hybrid closed loop technology for patients with Type 1 diabetes

NICE have recommended that hybrid closed loop (HCL) technology should be offered as an option for managing blood glucose in type 1 diabetes if other methods have not achieved the desired results. This means that if a diabetes specialist feels that you would benefit from a HCL, this will be discussed with you at a routine appointment. NICE guidance also comes with a 5-year national implementation strategy. It will take time to implement this strategy and incorporate it into local services. Clinical risk and individual circumstances will be taken into consideration.

It is likely it will take up to a few years for some people who are eligible to be offered hybrid closed loop technology. The rollout will be over 5 years. Clinicians require time to do this safely and effectively.

We plan to provide this to those in most clinical need first, starting with; those with an urgent need, children and young people, those who are pregnant or planning to become pregnant, and those already on standalone Continuous Glucose Monitoring (CGM) and insulin pumps that require an upgrade to a hybrid closed loop. We are following the national approach to guard against inequities in access.

No, your specialist knows who you are and will either contact you or review your eligibility at your next appointment.

Additional recruitment and training of specialist staff is required to establish a diabetes workforce sufficiently trained to manage a rollout of this scale.

As healthcare teams would be unable to offer hybrid closed loop to everyone eligible straight away, steps need to be taken to start the rollout whilst allowing for more time to recruit to diabetes teams and equip them with skills to help people to use the technology effectively.

Doing so will also help tackle health inequalities, which is another important part of the strategy. An unplanned rollout which does not address these foundational issues around staff capacity and variation in what services can offer would have a greater risk of creating gaps in access to the technology.

No, these recommendations don’t include everyone with Type 1 diabetes and there are additional criteria for adults over 18 years old who aren’t pregnant or planning to become pregnant will have to meet before being offered the hybrid closed loop system.

NICE and NHS England have negotiated a national deal to provide cost effective hybrid closed loop systems. This process was able to identify a small selection of systems that we are able to select from. As new devices come to market, technology progresses and if prices change, the cost effectiveness point may change. As such, the range of devices will be under constant review with patients offered the most cost-effective device that needs their individual needs. This means that the devices/systems available for us, to offer you, may change over time. We will review our selection locally based on the needs of our population and the devices made available by the above process.

You do not need to take any action. Your usual clinical team will contact you or discuss this with you at your next planned review. If you are contacted again by the company, you can ask them to stop contacting you. If eligible, you should not have to pay for any of your pump therapy costs, the NHS cover this, so please do not agree to buy direct from the company before checking with your clinical team.

Your diabetes team will support you in selecting a hybrid closed loop system that best meets your clinical needs.

Each area has varying levels of pump clinician staffing, expertise and capacity. Part of the plan is to equalise this in line with local demands.

Locally, we have set up a steering and implementation group to work together across mid and south Essex to support each other so the eligible patients are able to access hybrid closed loop systems as soon as possible.

Please be patient with your diabetes team.