Results from a pilot roll-out of hybrid closed loop technology for up to 1,000 children and adults living with type 1 diabetes have been presented this week at our professional conference (DUKPC).
In 2021, NHS England announced they were piloting this roll-out of hybrid closed loop technology, which will give the NHS important real-world evidence about the benefits of this life-changing technology.
Hybrid closed loop systems allow a continuous glucose monitor (CGM) to ‘talk’ to an insulin pump. An algorithm calculates the amount of background insulin required to keep blood sugars in target range, and automatically delivers this.
Some of the CGMS systems can also correct for high blood sugars by delivering extra insulin. But users still need to tell the device when they’re eating to receive insulin at mealtimes.
We’re now starting to hear the results from this pilot, some of which were presented at our professional conference (DUKPC).
Gains for all ages
Dr Tom Crabtree presented findings investigating whether age influences blood sugar levels when using hybrid closed loops. They looked at data from 448 people between the ages of 17- and 78-years taking part in the pilot.
They tracked how their HbA1c (a measure of average blood sugar levels) and the time they spent with their blood sugar levels in a target range (3.9-10mmol/mol) changed over five months.
Researchers found that HbA1c reduced by an average of 17.4mmol/mol (or 1.7%), and time in range increased by an average of 28.3%. Encouragingly, they also found that these improvements happened across all ages, with little difference between age groups.
These findings importantly show that age shouldn’t be a barrier to being offered a hybrid closed loop and the benefits to blood sugar levels could be huge, no matter your age.
How do people feel about the tech?
As well as the impact on blood sugar levels, it’s also critically important to understand the impact using hybrid closed loops can have on people’s daily life, and any pros and cons of the tech.
Researchers asked 120 people from the pilot to complete a series of questionnaires to capture their experiences. This included information on their satisfaction with using hybrid closed loops, their quality of life, and questions tailored for each person.
More than 70% of people reported that using a hybrid closed loop improved not just their blood sugar levels, but also their quality of life.
But 54% also said that they found the alarms (which go off when blood sugar levels are too high or too low) somewhat got in the way of their day-to-day lives. And 22% felt overwhelmed by dealing with the amount of information coming from the hybrid closed loop system.
These findings suggest that although hybrid closed loops can have life-changing benefits and offer some freedom from the everyday burden of type 1 diabetes, they aren’t a magic solution. This kind of technology might not be for everyone.
The researchers highlighted the importance of listening to the experiences and concerns of people with type 1, to be able to address these and provide the right care and support.
Keeping an eye on eyes
People with diabetes are at a higher risk of an eye complication called retinopathy. Keeping blood sugar levels within a target range is really important to reduce this risk.
But some research suggests that rapidly improvements in blood sugar levels over a short period can make retinopathy worse. This led to some concerns about the effect a hybrid closed loop could have.
A team at the University Hospitals of Derby and Burton studied information from 62 people from the pilot to investigate more. Everyone was screened for retinopathy at the start of the study, and some were screened again three months later.
Of the 32 people who were followed up, after an average of nine months four people’s retinopathy had progressed, but no one developed the severest form of retinopathy.
People whose retinopathy had progressed didn’t have much change in their HbA1c or time in range. The researchers also found that everyone whose retinopathy got worse had already had some retinopathy at the beginning.
Overall, the team’s findings agreed with previous findings on rapid improvements in blood sugar levels and retinopathy, with no added concern from using hybrid closed loop systems. However, it’s still vital for all people with diabetes to be offered retinopathy screening, to spot problems early and avoid preventable sight loss.
Real-world evidence
Results from clinical trials have previously shown how transformative this tech can be. But the NHS hybrid closed loop pilot is building crucial real-world evidence that’s further showing the drastic improvements to lives that the tech can bring.
Earlier this year, NICE (National Institute of Clinical Excellence) released draft guidance recommending the use of hybrid closed loop systems for some people with type 1 diabetes in England and Wales.
NICE will be looking closely at data from the NHS pilot to make their decisions and we’re looking forward to hearing more on their final recommendations in the coming months.
We’ll continue working to make sure that everyone with type 1 diabetes who could benefit can access the tech they deserve, as well as the right support to get the most out of it.
