Updated 12 November 2023
A hybrid closed loop system (HCL) - also referred to as an artificial pancreas or automated insulin delivery (AID) - is the use of a combination of medtech to adjust glucose levels through automated-means. A T1D would use real-time glucose monitoring from a continuous glucose monitor (CGM) which links to a control algorithm (on an app, usually a smartphone) to direct insulin delivery through an insulin pump.
Users of HCL do not need to inject but still need to carb count to adjust insulin flow for meals.
Following a pilot study of the use of hybrid closed loops, the National Institute for Health and Care Excellence (NICE) have put forward guidelines for their use by persons with type 1 diabetes. The Guidelines are currently going through the approval process.
This is a brief overview of the latest information regarding hybrid closed loops including information from Prof. Partha Kar, NHS National Diabetes Specialist, who recently spoke via Twitter on Diabetes Chat, a community support group (@diabetes_chat).
Additional information following draft guidance released August 2023.
Following a 3 month consultation period, NICE (National Institute for Health and Care Excellence) have published their draft guidelines for the use of hybrid closed loops (also referred to as an artificial pancreas) by Type 1s, through the NHS in England.
✅ All children aged 0-18 years with Type 1 will be eligible for a hybrid closed loop.
✅ Persons with Type 1 diabetes aged 18 years and older will be eligible if the following apply:
- HbA1c greater that 7.5%
- planning a pregnancy
- experience disabling hypos
Who do the NICE Guidelines apply to?
It is thought that over 150,000 type 1s in England and Wales could benefit if NHS funding is approved for use of HCLs.
HCL systems are already available in Scotland, however, there are no formal plans for Northern Ireland yet as insulin pump therapy and CGM are not widely available.
What is the timeline?
Draft NICE Guidelines published - January 2023
Public consultation - now closed
NICE decision - expected 24th May 2023
Industry consultation - 3 month period
Expected rollout - from October 2023
The case for Hybrid Closed Loop
The potential benefits of using a HCL rather than solely MDI or MDI and sensor use include the following:
Improved quality of life and psychological well being
Improvements in terms of time spent managing the condition, time spent off work or school, ability to participate in daily life, time spent at clinics, impact on sleep)
Reduced anxiety about hypos
Dependent on price, all options (from a range of manufacturers) should be available to those meeting criteria (yet to be determined). Current pump users should be able to upgrade and users shouldn't be held back by having to use pumps that can't loop.
Current usage of pumps by children is around 42-48%.
For adults, the uptake is around 10% - largely due to restrictive criteria and some ICS not following the Guidelines.
What Hybrid Closed Loops are available?
The following HCL have been licensed, however many more options are likely to be available if/when updated NICE Guidelines are approve and formally in place.
- CamAPS FX (on Android phone) with a Dana or mylife YpsoPump and Dexcom G6 CGM or Abbott Libre 3 CGM with YpsoPump. It is licenced for PWD age 1+
- Medtronic 670G with Guardian sensors. It is licenced for PWD age 7+
- Medtronic 780G with Guardian sensors. It is licenced for PWD age 7+
- Control IQ hybrid closed loop uses Tandem t:slim insulin pump and Dexcom CGM. It is licenced for PWD age 4+
Note, Omnipod 5 (a tubeless option) has not yet been approved for use in the UK.
Cost of Hybrid Closed Loop
Sources of information
Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes Click here.
Assessment Document by Warwick University, published October 2022
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