From diabetestimes.co.uk
People who are struggling to manage their type 1 diabetes are set to be offered new technology to help them control their condition with little human input.
In draft guidance, an independent NICE committee has recommended the use of hybrid closed loop systems for managing blood glucose levels in type 1 diabetes – technology that has been described as a step towards an artificial pancreas.
The technology allows a person with type 1 diabetes to go about their day-to-day life without having to monitor if their blood glucose levels are too high or too low.
If type 1 diabetes is not well controlled, people are at risk of long-term complications of hyperglycaemia, including blindness, amputations, or kidney problems.
The hybrid closed loop system comprises of a continuous glucose monitor sensor attached to the body. This transmits data to a body worn insulin pump. This uses the data to run a mathematical calculation to work out how much insulin needs to be delivered into the body to keep blood glucose levels within a healthy range.
NICE has recommended people who are unable to control their condition despite using an insulin pump, or real-time or intermittently scanned continuous glucose monitoring, are offered the technology if their long-term average blood glucose levels are indicating they are at risk of long-term complications. That is, an average HbA1c reading of 8.0% or more when the NICE guideline recommends people should aim for a HbA1c level of 6.5% or lower to minimise the risk of long-term complications from diabetes.
People who are pregnant or planning a pregnancy are also eligible, because blood glucose levels are harder to manage during this time. In total, around 105,000 people in England are set to be offered the technology.
The draft recommendations also require NHS England to agree a cost-effective price for the systems on behalf of relevant health bodies. At present an average annual cost for the technology is £5,744, which is higher than what NICE considers a cost-effective use of NHS resources.
Mark Chapman, interim director of Medical Technology at NICE, said: “Some people living with type 1 diabetes struggle to manage their condition, even though they are doing everything asked of them by their diabetes team. This technology is the best intervention to help them control their diabetes, barring a cure.
“At a time when the number of people with diabetes is rising, we have to focus on what matters most to people who use NHS services by balancing recommending the best care with value for money.”
He added: “Our committee has reviewed the real-world data generated by the NHS and evidence generated by randomised controlled trials which show there are clear benefits of recommending the technology’s use.
“We look forward to working with NHS England and industry to ensure a cost-effective price can be reached which is fair to taxpayers.”
Professor Partha Kar OBE, national specialty advisor for diabetes at NHS England, said:“This technology has been proven to give the best control for managing type 1 diabetes and should make things like amputations, blindness, and kidney problems possibly a thing of the past.
“We have seen fantastic results from the real-world trials which have taken place and thank you to NICE for their review of the evidence and subsequent conclusions. The quality of life this technology gives to those using it is huge.”
Nikki Joule, Policy Manager at Diabetes UK, said:“Hybrid closed-loop technology has the potential to transform the lives of people with type 1 diabetes, improving both clinical outcomes and their quality of life.
“NICE’s draft guidance is a promising step towards ensuring people living with type 1 diabetes in England and Wales have access to the technologies they can benefit from most, helping them to manage their diabetes, avoid complications and live well with the condition.”
She added: “Type 1 diabetes can take a huge mental toll, with people manually calculating how much insulin they need regularly throughout the day.
“By automating these calculations, hybrid closed-loop technology can greatly alleviate the emotional burden of diabetes.”
She concluded: “We look forward to it being rolled out on the NHS and will work towards ensuring that everyone who could benefit from this life-changing technology has access to it.”
At present, the standard care for type 1 diabetes involves regularly measuring blood glucose levels by using finger-prick blood testing or by using a continuous glucose monitor (real-time or intermittently scanned).
Blood glucose levels are managed with multiple daily insulin injections or by using a pump to inject insulin under the skin.
It is estimated that approximately 278,000 people in England and Wales are living with type 1 diabetes.
In type 1 diabetes, a person’s blood glucose level becomes too high (hyperglycaemia) because there is no, or very little, production of insulin by the pancreas. Blood glucose levels can only be regulated by giving insulin to prevent hyperglycaemia which is when a person’s blood glucose level becomes too high and could result in blindness, amputations, or kidney problems.
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