We welcome new draft guidance from the National Institute for Health and Care Excellence (NICE) that recommend specific hybrid closed loop systems should be offered to women with type 1 diabetes who are pregnant or trying for a baby.
Why is NICE recommending a pregnancy specific HCL system?
Managing diabetes during pregnancy is difficult and critical. Blood sugar that is too high or too low can cause serious harm to the parent and child and baby. Risks include miscarriage, premature birth, and complications during labour.
A hybrid closed loop system automatically monitors blood sugar and delivers insulin through a small pump worn on the body. It removes the need for frequent finger prick tests and manual insulin injections.
NICE says clinical guidelines have shown that ‘pregnancy specific’ hybrid closed loop systems, rather than standard hybrid closed loop systems, help people maintain safer blood sugar levels throughout pregnancy and reduce risks to parent and baby.
What qualifies as a pregnancy-specific HCL system?
To qualify as a pregnancy specific hybrid closed system, the device must be:
- licensed for pregnancy
- allow blood sugar levels to be set within the ranges recommended for pregnancy (allows target blood sugar level to be set below 5 mmol/L)
- and has evidence showing it increases time in the safe blood sugar range by at least 5% compared with standard HCL systems.
The updated guidance also sets out that:
- People should be able to continue using their pregnancy-specific HCL system during labour and birth, if this has been discussed and agreed in advance and it is safe.
- People can choose to continue using pregnancy-specific HCL systems for at least six months after birth.
- Training and support for women using pregnancy-specific HCL systems should be provided by specialist multidisciplinary teams.
- Clinicians should regularly revisit the option of a pregnancy-specific HCL system with women who initially declined an HCL.
This recommendation goes a step further than NICE guidelines in 2023 that people with type 1 diabetes in England and Wales should be offered a hybrid closed loop system in pregnancy and pregnancy planning. This guidance was also adopted by Northern Ireland, for which the update also applies.
NICE are now consulting on the draft guidance, which we will respond to as stakeholders for the update.
Colette Marshall, Chief Executive of Diabetes UK said:
"Hybrid closed loop technology is highly effective in helping people with type 1 diabetes manage their condition, improving their health, wellbeing, and quality of life.
"It can be particularly important during pregnancy, when keeping blood glucose levels in target range reduces the risk of harm to both parent and child.
"We welcome this new guidance as it will greatly improve the experiences of people with type 1 diabetes during pregnancy."
Our research funding has been instrumental in pioneering closed loop technology, including a decade of world-first studies to develop and test the technology for pregnancy.
For more information on the NICE draft recommendations for pregnant-specific hybrid closed loop systems, go to the NICE website.
Find out how the updated draft guidance on hybrid closed loop systems guidance applies to your part of the UK, on our type 1 and pregnancy page. If you have type 1 diabetes and are pregnant or planning a pregnancy, if you have any concerns, speak to your healthcare team. You can also speak to our helpline on 0345 123 2399.
