The National Institute of Health Care and Excellence (NICE) has made a landmark announcement for the treatment of Type 1 Diabetes which outlines details of who will be offered life changing hybrid closed-loop technology in England and Wales. Pending funding approval, the technology should be available to all those who meet the criteria in the coming 5-years. Who has hybrid closed-loop been recommended for? Under the new recommendations, hybrid closed-loop has been recommended for adults living with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or higher, or have disabling hypoglycaemia, despite best possible management with at least one of the following: Continuous subcutaneous insulin infusion (CSII) (i.e. an insulin pump) Real-time continuous glucose monitoring (CGM) Intermittently scanned continuous glucose monitoring (Flash) 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. Hypoglycaemia or a 'Hypo' as they are more commonly known, is a condition in which blood sugars are critically low, most often due to administering too much insulin. Low blood sugar can lead to coma and become fatal if untreated. Because Type 1 diabetics (and some Type 2) have to self administer insulin shots to maintain a healthy blood sugar level, hypoglycaemia is an ever present threat which hybrid loop systems have been shown to be able to help with. Unlike the more common Type 2 diabetes which is the result of insulin resistance and in most cases can be reversed by diet and exercise, Type 1 Diabetes is a result of through no fault of their own, the individuals own immune system attacking the beta cells on the pancreas which control insulin secretion. Once these cells have been destroyed insulin is always required. Type 1 is usually diagnosed early in life but can and does also affect adults. The most common treatment is via MDI or multiple daily injections using two different types of insulin, the first being Basal which slowly releases and controls the background levels in the body as well as Bolus which is fast acting and taken before eating. Some are already lucky enough to use insulin pumps which avoid the need for multiple injections by being semi permanently attached to the body with the injection site only having to be changed every 3-5 days depending on the brand and model of the pump. In almost all cases a level of manual input is still required. What are hybrid closed-loop systems? Sometimes known as an ‘artificial pancreas’ – hybrid closed-loop systems work by linking insulin pumps and continuous glucose monitors (CGM) so they can “talk” to each other. This is done by a computer algorithm that can calculate the amount of insulin someone needs based on blood sugar readings so the pump can automatically give accurate and timely doses. This allows the system to do some of the work to help manage blood sugar levels. Manual input is still needed to alert the system when eating or doing exercise. There’s lots of evidence to show that the technology can help people with type 1 diabetes to improve their blood sugar levels, have less hypos and make self-managing the condition easier. NICE is responsible for assessing medicines and medical technologies to see if they are beneficial and cost effective for use in the NHS in England and Wales. What happens next? As part of the NICE appraisal, the NHS in England and Wales have agreed to develop plans to offer hybrid closed-loop to eligible people in a phased programme over a period of five years. Plans are still being finalised for this but the rollout is expected to begin early next year in England, as local health systems decide on their plans to offer it to eligible people in their area. This latest news is life changing for those who suffer from the debilitating condition and can not come soon enough. Some of the symptoms of type 1 diabetes, include: feeling very thirsty. peeing more than usual, particularly at night. feeling very tired. losing weight without trying. thrush that keeps coming back. blurred vision. cuts and grazes that are not healing. fruity-smelling breath. If you are suffering from any of the above symptoms, you should contact your GP immediately and ask to be tested. If left unchecked it could lead to Diabetic Keto-Acidosis which is a condition in which the bodies glucose (sugar) levels are so high that it causes the blood to become acidic. This too can lead to coma and death unless immediately treated. Salford has some of the best diabetes treatment teams in the country, I know as I am Type 1 diabetic myself.
