The UK-based institute recommended offering automated insulin delivery (AID) for people whose type 1 diabetes is not controlled with their current device despite best possible management with an insulin pump or real-time or intermittently scanned continuous glucose monitoring (CGM).
Hybrid closed-loop systems utilize a CGM attached to the body that sends data to a body-worn insulin pump. They calculate the necessary insulin delivery to the body to keep blood glucose levels within a healthy range.
NICE, with NHS England, agreed to first offer hybrid closed-loop systems to certain people who already have an insulin pump. These include all children, young people, and women who are pregnant or planning a pregnancy. It comprises part of a five-year rollout plan.
Others eligible include adults with an average HbA1c reading of 7.5% or more and adults who suffer disabling hypoglycemia. Mark Chapman, NICE interim director of medical technology, says the technology represents “the best intervention” to control diabetes, barring a cure. NICE expects to publish its final guidance in December 2023.
“Using hybrid closed loop systems will be a game changer for people with type 1 diabetes,” said Jonathan Benger, NICE chief medical officer. “By ensuring their blood glucose levels are within the recommended range, people are less likely to have complications such as disabling hypoglycemia, 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.”
Diabetes and insulin delivery tech leaders applaud the NICE recommendation
Que Dallara, EVP & President, Medtronic Diabetes, wrote a LinkedIn post titled “Bravo, NICE! Yes, AID should be available for all.” In it, she called the recommendation an “exciting move” that reinforces the need to look beyond just CGM to manage diabetes. Medtronic develops the MiniMed 780G, its latest-generation automated insulin delivery system.
Dallara said AID systems are “one of the most remarkable medical achievements of the 21st century.” She believes people from all walks of life can “almost effortlessly harness [AID’s] potential for better health.”
“Providing a glucose number tells you where your sugars are, but not how to manage them,” Dallara wrote. “Like other areas of our life, automation can help to simplify diabetes management, and it’s difficult to match the efficiency and accuracy of automated technology. Outcomes are better. Quality of life is better.”
In a news release, Dexcom, which provides CGM for closed-loop insulin delivery systems, provided market research supporting the use of hybrid closed-loop systems. The company says 79% of people struggle to keep glucose levels in range and 45% don’t understand what a hybrid closed-loop system is.
Dexcom also noted that 99% of healthcare providers expect the NICE decision to “somewhat or significantly” change lives for the better.
“It is clear from our research that so many more people could benefit from HCL,” said Karen Baxter, VP for UK, Ireland, Benelux, Spain and France for Dexcom. “Every single person (100%) surveyed with type 1 diabetes said that being on an HCL system has reduced the burden of managing their diabetes and 98% of healthcare practitioners say they would want all people with type 1 diabetes to have access to HCL. The newly announced TA from NICE is a great advancement in access to diabetes technology.
