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Can I Get a Hybrid Closed Loop System on the NHS?
Following the latest National Institute for Health and Care Excellence (NICE) technology appraisal, hybrid closed loop (HCL) systems are now available for reimbursement for many people with type 1 diabetes.1 Learn more about NICE, HCL systems and what their recommendations could mean for you.
Who are NICE?
The National Institute for Health and Care Excellence (NICE) offers guidance, advice, quality standards and information services for health, public health and social care.2 As an independent body established in 1999, it has become an authority to tackle variation in the access of healthcare through the National Health Service (NHS). NICE makes recommendations based on science and evidence with the aim of improving health and wellbeing within the UK.
What diabetes recommendations had NICE made?
Over the years, NICE has helped to make strides in the technology and services available to people with type 1 and type 2 diabetes. This includes access to continuous glucose monitoring (CGM) as an effective tool for managing diabetes and to reduce the burden of healthcare costs on the NHS associated with diabetes-related complications. Currently they recommend that:
- People with type 1 diabetes are offered a choice of a glucose sensor, including real-time CGM.3
- Children and young people with type 1 diabetes should be offered real-time CGM.4
- For people with type 2 diabetes, the recommendation is that real-time CGM can be considered an alternative to intermittent scanning (isCGM).5
More recently, NICE has participated in a technology appraisal highlighting hybrid closed loop (HCL) systems as an effective option for managing blood glucose levels for people with type 1 diabetes.1
What is a Hybrid Closed Loop (HCL) System?
A hybrid closed loop (HCL) system is a type of Automated Insulin Delivery (AID) system. A HCL system takes glucose readings from a continuous glucose monitor and uses an algorithm to let an insulin pump know how much insulin to deliver.6 It does this 24 hours a day and makes the process ‘more automated’ than it would be by using multiple daily injections or an insulin pen.
A HCL system will slow or stop the flow of insulin if your glucose levels are low or increase the flow if your levels are high.6 However, you’ll still need to deliver manual blouses from time to time. Examples include, before meals, and possibly before, during and after exercise (as well as a few other instances) to account for strong increases in blood sugar levels and to minimise fluctuations.
NICE’s HCL Technology Appraisal
Since 2020, NICE has participated in its recommendation of HCL systems for managing blood glucose levels for people with type 1 diabetes. The technical appraisal (TA) process has been ongoing and includes the following highlights:1
- April 2021: The topic began its diagnostic assessment
- July 2021: The assessment was paused while NHS collected real world data on the use of HCL systems for people with type 1 diabetes on the NHS
- June 2022: Evidence submission received
- October 2022: Assessment report sent for information
- November 2022: First committee meeting held
- January 2023: Draft guidance released
- March 2023: NHS reviewed the topic for further engagement. Scheduled second committee meeting
- May 2023: Second committee meeting held
- June 2023: The committee reached a conclusion to recommend HCL systems as an option for managing blood glucose levels in type 1 diabetes. Companies were invited to engage with NHS to offer cost-effective solutions
- July 2023: Declaration of interests submitted
- August 2023: NHS consulted on the case of extending the statutory 3-month period for funding of HCL systems for managing blood glucose levels in type 1 diabetes
- November 2023: Final Appraisal Document (FAD) published on the NICE website.
Can I get a HCL system on the NHS?
Via NICE recommendations, the NHS has recognised that hybrid closed loop (HCL) systems are an effective option for managing blood glucose levels for people with type 1 diabetes. HCL systems were previously available for funding for those who meet the criteria for a statutory 3-month period.1
Now that the FAD has been published, HCL systems are available for reimbursement on a longer-term basis for people:7
- Under the age of 18 years old with T1D
- Over the age of 18 years old with an HbA1c of 58 mmol/mol (7.5%) or above
- With T1D who suffer from disabling hypoglycaemia
- With T1D who are pregnant or trying to conceive a baby
How does a HCL integrate with Dexcom?
The Dexcom G6 Continuous Glucose Monitoring (CGM) System integrates with a range of insulin pumps to form a hybrid closed loop (HCL) system. In fact, Dexcom is the only CGM that connects with multiple pumps, such as Tandem t:slim X2, YpsoPump and Omnipod 5®, allowing you to choose your HCL system – the one that works best for you.
Your Dexcom G6 or Dexcom G7 takes real-time glucose measurements every 5 minutes without finger pricks* or scanning. It sends those numbers via an algorithm app†, such as Control-IQ TechnologyTM, to your insulin pump, such as the mylife Tandem t:slim X2, to adjust and administer insulin doses according to your needs. These three components work together seamlessly to ‘semi-automate’ insulin delivery so you can spend less time calculating doses and more time focusing on living your best life.
Get Dexcom funding on the NHS
On the heels of the latest NICE technology appraisal, HCL systems are now available for reimbursement (for those who meet the criteria) on the NHS1 – yet another triumph in making diabetes management easier, effective and more accessible than ever. You can also see if you qualify for a Dexcom CGM System on the NHS and learn more about what seamless connectivity can do for you.
Footnotes & References:
*Finger pricks required for diabetes treatment decision if symptoms or expectations do not match readings.
† Smart devices sold separately. For a list of compatible smart devices, please visit dexcom.com/compatibility.
1 Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes. NICE technical appraisal. TA10845.
2 About NICE. The National Institute for Health and Care Excellence. Accessed September 2023.
3 Type 1 diabetes in adults: diagnosis and management. NICE guideline [NG17].
4 Diabetes (type 1 and type 2) in children and young people: diagnosis and management. NICE guideline [NG18].
5 Type 2 diabetes in adults: management. NICE guideline [NG28].
6 Hybrid closed loop technology (artificial pancreas). JDRF. Accessed September 2023.
7 Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes. NICE.
† Smart devices sold separately. For a list of compatible smart devices, please visit dexcom.com/compatibility.
1 Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes. NICE technical appraisal. TA10845.
2 About NICE. The National Institute for Health and Care Excellence. Accessed September 2023.
3 Type 1 diabetes in adults: diagnosis and management. NICE guideline [NG17].
4 Diabetes (type 1 and type 2) in children and young people: diagnosis and management. NICE guideline [NG18].
5 Type 2 diabetes in adults: management. NICE guideline [NG28].
6 Hybrid closed loop technology (artificial pancreas). JDRF. Accessed September 2023.
7 Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes. NICE.