Tens of thousands of children and adults living with type 1 diabetes across England are set to receive an ‘artificial pancreas’ in a world-first initiative being rolled out by the NHS.
What is an artificial pancreas?
An artificial pancreas – also known as a hybrid closed loop system - continually monitors a person’s blood glucose, then automatically adjusts the amount of insulin given to them through a pump.
Over the next five years, local NHS systems will start identifying eligible people living with type 1 diabetes who health chiefs believe could benefit from the hybrid closed loop system today. There are currently 269,095 people living in England with type 1 diabetes.
The technology will mean some people with type 1 diabetes will no longer need to inject insulin but use technology instead. The hybrid closed loop can also help prevent people having hypos (hypoglycaemia) and hypers (hyperglycaemia).
Colette Marshall, Chief Executive of Diabetes UK, said:
“It is incredibly exciting to see hybrid closed-loop technology being rolled out on the NHS in England for people with type 1 diabetes.
“Diabetes is a tough and relentless condition, but these systems make a significant, life-changing difference – improving both the overall health and quality of life for people with diabetes.
“This really is a landmark moment and we’ll be working with the NHS and others to ensure a fair rollout that reaches people as quickly as possible.”
How will the roll out work?
NHS England has provided local health systems with £2.5 million so they are ready to start identifying people who can benefit.
The mass rollout of the artificial pancreas builds on a successful pilot of the technology by NHS England, which saw 835 adults and children with type 1 diabetes given devices to improve the management of their condition.
Dr Clare Hambling, National Clinical Director Diabetes & Obesity at NHS England, said:
"This is another example of the NHS leading the way in healthcare, rolling out these groundbreaking devices across England over the next five years.
“This transformative technology holds the power to redefine the lives of those with type 1 diabetes, promising a better quality of life as well as clinical outcomes.
“Type 1 diabetes is an easily missed diagnosis so if you are concerned about symptoms - the 4Ts - going to the Toilet, passing urine more frequently, with Thirst, feeling Tired and getting Thinner (loosing weight), please come forward for support.”
Professor Partha Kar, NHS national speciality advisor for diabetes, said:
“The national roll out of Hybrid Closed Loop systems is great news for everyone with type 1 diabetes.
“The device detects your glucose levels, transmits the readings to the delivery system, known as the pump, which then initiates the process of determining the required insulin dosage.
“This futuristic technology not only improves medical care but also enhances the quality of life for those affected."
How do I know if I’m eligible?
The National Institute of Health Care and Excellence (NICE) approved the NHS’s roll-out of the technology in December 2023.
Since the NICE announcement, NHS England has published a 5-year implementation strategy, which sets out a timeline for how local systems will provide hybrid closed loop systems to people who are eligible from 1 April 2024.
NICE recommends the devices should be rolled out to children and young people under 18 with type 1 diabetes, pregnant women with type 1 diabetes, and adults with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or higher.
How has a hybrid closed loop system helped people?
The hybrid closed loop system has dramatically changed the everyday life of Gemma Lavery, 38, from Plymouth. She received an artificial pancreas as part of the NHS pilot and calls the technology a “game changer” that allowed her to find a sense of normality.
Gemma said:
“I no longer have to worry about work related stress affecting my blood glucose levels as the closed loop helps to sort this out before it becomes a problem.
“I can have a full night sleep without worrying about regular low glucose levels hindering my morning routine and I have found that my diabetes is more stable.”
Another person who has received an artificial pancreas from the NHS is 64-year-old Les Watson, from West Devon. Les has been living with type one diabetes for nearly 44 years, and experienced all of the technological changes in treatment first hand over that period.
Les said:
“The user interface is clean, clear and straightforward to grasp, the information that is required by a pump user is readily available and not tucked away somewhere deep in a stacked menu.
“The system is not overloaded with complicated options making its day-to-day use quick and easy. As a user I now spend hardly any time interacting with the system other than at mealtimes or telling it I’m heading out to exercise.
From research to roll out
Our research was there at the very beginning. We funded the UK’s first ever insulin and glucose delivery system – called the biostator – in 1977. And ever since we’ve been supporting research to drive forward the development of closed loop tech and build the evidence to make its roll out a reality.
What about Northern Ireland, Scotland and Wales?
This NICE guidance also applies to Wales and NHS Wales have similarly agreed a five-year period to roll out hybrid closed loop following the appraisal, though we don't yet have further details of this.
The guidance has also been adopted in Northern Ireland and there is work underway to agree on how it can be implemented there.
Scotland has separate guidance for hybrid closed-loop systems which was published in 2022 and the Scottish Government has recently funded plans to accelerate implementation, including funding a dedicated innovation team to support roll out.
In Scotland, they are recommended for people with type 1 diabetes who are struggling to manage their blood sugars, are at a high risk of hypos, have impaired hypo awareness, or are experiencing diabetes-related distress.
