Posted on 24 November 2023

​Type 1 Diabetes is a congenital condition which means a person can’t make insulin – often because of a defect in beta cells in the pancreas. This autoimmune condition means that in Diabetes Mellitus, the pancreatic cells responsible for secreting insulin are not recognised as belonging to the body. This means the immune system destroys these cells, but not neighbouring alpha cells which produce glucagon (a hormone telling your body to release more blood sugar). The beta cells, releasing insulin, are responsible for ensuring the uptake of glucose into body cells and out of the blood through different mechanisms – storing as glycogen, direct uptake into cells or storing as fat. Breakthrough research might be about to transform the quality of life of 150,000 people with type 1 diabetes who are being offered an artificial pancreas on the NHS.

Living with type 1 diabetes can be unrelenting due to the intense management required around the clock. Hundreds of individual treatment decisions must be made to ensure that one’s blood sugar is at the correct level and to not cause undue symptoms to a daily life. Automating what is currently a very manual endeavour, the artificial pancreas could lift the relentless burden and risk of burnout. The groundbreaking device, which is a hyrbid closed-loop system, uses algorithms to determine the amount of insulin that should be administered in real time and reads blood sugar levels to keep them steady. A world-first trial on the NHS showed it was more effective at managing diabetes than current devices and required far less input from patients. The idea of closed loop means that decisions are made within the device algorithm, not a patient responding to reading a blood measurement, deciding it’s too high, then having to take action. Action will be taken automatically – this is how your brain decides temperature, sweating, breathing and hormone release, for example.

Prof Jonathan Benger, chief medical officer at NICE, said: “With around 10% of the entire NHS budget being spent on diabetes, it is important for NICE to focus on what matters most by ensuring the best value for money technologies are available to healthcare professionals and patients. Using hybrid closed-loop systems will be a gamechanger for people with type 1 diabetes. By ensuring their blood glucose levels are within the recommended range, people are less likely to have complications such as disabling hypoglycaemia, strokes and heart attacks, which lead to costly NHS care. This technology will improve the health and wellbeing of patients, and save the NHS money in the long term.”

Type 1 diabetes is controlled with injections of insulin at times of high blood sugar which is often measured through a finger prick blood monitor. Hyperglycaemia (too high blood sugar) will inevitably result in individuals who do not have metformin or insulin to control their diabetes, and it’s known that high blood sugar levels cause life-threatening complications, such as:

  • Diabetic Ketoacidosis (DKA) – a condition caused by the body needing to break down fat as a source of energy.

  • Organ damage

  • Coma

Karen Addington, chief executive of a type 1 diabetes charity called JDRF UK, hailed the announcement, “Hybrid closed-loop defines a new era for medicine - It’s a beautiful algorithm, which will save lives and heartbreak, as well as in the long term saving NHS the cost of cardiovascular and retinal surgery, kidney dialysis and transplantation. Today’s announcement makes Great Britain the first country in the world to make hybrid closed-loop widely available, as England and Wales follow the lead of Scotland, who approved the use of HCL earlier in 2022.”

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