Closed loop systems are devices that can make it easier for people living with type 1 diabetes to manage the condition.
They can help to make blood sugar levels more stable and you do not need to inject insulin, unless you have a problem with an insulin pump. Closed loop systems also reduce the amount of finger prick tests you need to do.
Current closed loop systems that are available on the NHS or to buy are called hybrid closed loop systems. They combine automated insulin delivery with information manually inputted by the user.
Hybrid closed loop systems are now being rolled out by NHS England to certain people living with type 1 diabetes.
In this guide you’ll find what you need to know about the eligibility criteria and availability for hybrid closed loop systems in England, Scotland, Wales and Northern Ireland.
Who is eligible for hybrid closed loop systems on the NHS?
The National Institute for Health and Care Excellence, or NICE for short, shared its final guidance on hybrid closed loop systems in 2023 which recommended certain people living with type 1 diabetes in England and Wales become eligible for this technology.
The NICE guidance has also been adopted for Northern Ireland.
NICE guidance recommends hybrid closed loop systems for adults living with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or higher, or have disabling hypoglycaemia (low blood sugar), despite best possible management with an insulin pump or a continuous glucose monitor (CGM).
Disabling hypos are defined by NICE as the repeated and unpredictable occurrence of hypoglycaemia that results in persistent anxiety about recurrence and is associated with a significant adverse effect on quality of life.
Hybrid closed loop has also been recommended for:
- children and young people (under 18 years old) living with type 1 diabetes
- people living with type 1 diabetes who are pregnant or planning to become pregnant.
In Scotland, separate guidance for hybrid closed loop systems was published in 2022. This recommends that hybrid closed loop should be pro-actively discussed with all people with type 1 diabetes, and made available to those who:
- are struggling to meet their blood glucose management targets
- have a high risk of severe hypos
- have impaired awareness of hypos
- experience diabetes-related distress that adversely affects quality of life or their ability to manage diabetes, which is likely to be improved by moving to a closed loop system.
What about people with other types of diabetes?
Hybrid closed loop systems are currently recommended for routine use in the UK for people with type 1 diabetes based on strong research evidence, but they would also likely benefit other groups of people who need to regularly administer insulin such as those with type 3c diabetes.
There is potential for people with other types of diabetes to be considered for the tech as more evidence becomes available and systems evolve, but this will take more time.
If you don’t have type 1 diabetes but think you may benefit from hybrid closed loop you can discuss it with your healthcare team at your next appointment, but access would be considered on a case-by-case basis rather than under current guidance and implementation plans.
We support research on technology to understand it’s impact for different groups of people in different settings.
For example, in 2023 a world-first trial testing the use of closed loop systems for people with type 2 diabetes who use insulin reported increased time-in-range compared to injections, which helps to build our knowledge of how it can be used safely and effectively in this cohort.
How hybrid closed loop will be rolled out in England, Scotland, Wales and Northern Ireland
England
NHS England have planned a phased five-year implementation of the guidance that began in April 2024, to assist in delivering the tech in a way that provides access to people who could benefit from it most first.
This strategy recommends that priority should initially be given to:
- children and young people under 18 years old
- people who are pregnant or planning to become pregnant
- and other adults who already use insulin pumps where it could be easier to move over to hybrid closed loop with less intensive training requirements.
However, there will be some differences in the approaches local areas take. You can read more about NHS England's implementation plan.
Wales
NHS Wales have, similarly to NHS England, agreed a five-year period to roll out hybrid closed loop systems, and we await further details of this.
Northern Ireland
The NICE guidance has also been adopted in Northern Ireland and there is work underway to plan the implementation process.
Scotland
The Scottish Government has recently funded plans to accelerate implementation, including funding a dedicated innovation team to support roll out.
Which hybrid closed loop systems are available on the NHS?
The recommendations in the NICE guidance apply to hybrid closed loop systems as a whole and not particular models, but they say any systems made available must meet a cost-effective price for the NHS.
As part of their implementation plan, NHS England have negotiated with tech manufacturers to agree which systems meet the cost-effective price set by NICE, and prices have been agreed for a wide range of hybrid closed loop systems.
Which system you are offered can depend on your situation, and your location. You can speak to your healthcare team for advice on which hybrid closed loop system you could use.
Some hybrid closed loop systems have been shown to be most effective at managing blood sugar levels during pregnancy. As part of the roll out in England, steps have been taken to ensure these pregnancy specific systems are offered to people during pregnancy.
What if I'm not eligible for a hybrid closed loop system on the NHS?
If you don’t qualify for tech
We know it can be frustrating if you don’t meet the criteria set out by NICE to access tech. But there are steps you can take to try and address this.
Firstly, you can make your case to your healthcare professional, explaining how and why using hybrid closed loop will help you to manage your condition.
It may be that making certain changes to your management could help you without using hybrid closed loop, and you can work with your diabetes team on making these changes.
If you live in England or Wales and you have been told that you will need to wait before you can get a hybrid closed loop system, this is because a five-year rollout is underway in these countries. You could ask your diabetes team for advice on when you may be able to access one of these systems.
Individual funding requests
Sometimes local policies mean you may not get access to the technology you need.
You can ask your healthcare professional if they can help you submit a request for individual funding – an approach used to ask local decision-makers to fund technology outside of their normal policies.
Your healthcare professional should know what the process is for your part of the UK and whether this is the right approach for you.
Write to your ICB or health trust or board
If this doesn’t help, you can also write to or email your Integrated Care Board (ICB), Health Trust or Board and outline why you should be provided with the tech you want.
When making your case for any type of tech, include answers to the questions below if they’re relevant, giving as much detail as possible.
- If you’ve been self-funding your tech, what did you notice about your diabetes management before, during and after using the device?
- What are the challenges you’re currently facing with your diabetes management?
- How do you think using the tech would help you with your blood sugar levels?
- Do you test as often as you have been advised or would like to? If not, why is that?
- Do you experience regular hypos and what are the effects of this on your day-to-day life?
- How does your lifestyle make it hard to monitor your diabetes without tech?
- Do you struggle to perform finger prick tests regularly as part of your everyday routine?
- Do you work in an environment where it is difficult to perform finger prick tests regularly? Can you explain why?
- How would tech benefit you if you regularly play sport?
Find your ICB or health board
England
Integrated care boards (ICBs) replaced clinical commissioning groups (CCGs) in the NHS in England in July 2022.
You can use the ICB finder on the NHS England website, which will list your local services and their contact details.
Wales
There are seven Local Health Boards across Wales. Find out which Board covers your region on the NHS Wales website, along with more information and contact details.
Scotland
There are 14 Health Boards covering all of Scotland. Find the full list and contact details on the NHS Scotland website.
Northern Ireland
In Northern Ireland, there is a Health and Social Care Board (HSC) and five Local Commissioning Groups (LCGs). Find your local group and their contact details.
What happens to my hybrid closed loop system if I move area?
If you move areas and you’re registering with a different hospital, you may be under a new ICB or local health board.
ICBs and health boards are responsible for local NHS services and budgets. Each has its own guidelines on diabetes tech, so your new hospital might offer different tech to your previous one.
If you want to continue using the hybrid closed loop system you currently have, or there’s a specific model you’d like to use, you can ask your GP to refer you to a clinic where that system is used. You can also ask the manufacturer which hospitals their hybrid closed loop systems are used in.
If there aren’t any hospitals in your new area that offer the hybrid closed loop you’d like, or there’s a lack of choice of other systems ask why this is the case. It might be that the staff have only been trained on one type of system so they might be willing to get training on the model you want. It might take some time for this training to happen.
If the lack of choice is because of the ICB or health board’s policies, you might be able to submit an Individual Funding Request through your diabetes team. This is when an application for the funding will be sent to a panel for review.
Self-funding a hybrid closed loop system
If you don’t meet the eligibility criteria for a hybrid closed loop system on the NHS, it is possible to fund one of these systems yourself.
If you’re choosing to self-fund, it’s important you tell a healthcare professional who has expertise in hybrid closed loop systems. They’ll be able to offer guidance and support.
How much does a hybrid closed loop system cost?
A hybrid closed loop insulin pump can cost between £2,000 and £3,000 plus around £1,500 per year for the cannulas, reservoirs and tubing required for its use.
A CGM can cost about £2,000 a year. You'll also need to change the sensor on your CGM about every 10 to 15 days, depending on which CGM you're using.
If you already have a CGM, you may just be able to buy an insulin pump that is ‘loopable’ and can be used for a hybrid closed loop system. If you have a standalone 'non loopable' insulin pump, you’d need to buy a ‘looping’ pump and the CGM system that works with it.
Do get advice from your healthcare team first. You can also check which pump or CGM may work with what you have.
Get support from our helpline or online forum
Please give our confidential helpline a call if you’re looking for more information, advice or just someone to chat to. Whether you’ve got specific questions about the different types of tech available, or just want to talk through your options with someone, our highly trained advisors are ready to help.
Or head over to our online forum to join hundreds of members talking about their experience with diabetes tech. You can ask questions, read conversations between existing members, or share your own knowledge and help others.
What we’re doing to help everyone get the tech they need
Everyone with diabetes should be able to get the tech they need to live well with diabetes and we won’t rest until that happens. But nearly half of those who have tried to get diabetes tech have been refused it at some point.
We know that the emotional impact of not being able to access the tech you want and need can be difficult. That’s why we want you to know we’re here for you.
Improving access to diabetes tech has the potential to impact many millions of people with diabetes. That’s why our strategy focuses on working towards a system where both existing diabetes tech, and the new innovations that become available, are accessible to all those who could benefit from their use.
