WIREDGOV

Almost 1,000 adults and children with type 1 diabetes have been given a potentially life-altering ‘artificial pancreas’ by the NHS in England as part of the first nationwide test into the effectiveness of this technology in the world.  

One century after the first diabetes patient was given insulin, around 35 NHS diabetes centres across the country are piloting the revolutionary hybrid closed loop system – also known as an ‘artificial pancreas’ – with 875 people benefiting for a year so far.

The innovative ‘hybrid closed loop technology’, continually monitors blood glucose and automatically adjusts the amount of insulin given through a pump.

It can eliminate finger prick tests and prevent life-threatening hypoglycaemic and hyperglycaemia attacks, which can lead to seizures, coma or even death for people living with type 1 diabetes.

NHS experts want to discover whether the tech can help people with diabetes, of all ages, to safely and effectively control their condition, in a real-world setting, in the first nationwide test of its kind in the world.

The NHS has already exceeded some of the goals in the Long Term Plan for delivering better diabetes care, such as ensuring that one fifth of people with type 1 diabetes had access to a flash monitor device, so they can check their glucose levels more easily and regularly.

NHS data shows that three in five people living with type 1 diabetes – around 175,000 – have been given a glucose monitoring device to help control their condition, through the NHS. Just yesterday, new guidance was announced that will see everyone living with type 1 diabetes eligible for a lifechanging flash glucose monitor on the NHS.

The NHS in England currently spends around £10 billion a year on diabetes – around 10% of its entire budget.

The NHS is taking radical action to tackle and treat diabetes, including through the world leading NHS Diabetes Prevention Programme with new research showing thousands of people are being spared type 2 diabetes thanks to the scheme.

Professor Partha Kar, NHS national speciality advisor for diabetes, said: “Having machines monitor and deliver medication for diabetes patients sounds quite sci-fi like, but when you think of it, technology and machines are part and parcel of how we live our lives every day.

“A device picks up your glucose levels, sends the reading across to the delivery system – aka the pump – and then the system kicks in to assess how much insulin is needed.

“It is not very far away from the holy grail of a fully automated system, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication”.

Estimations show that only a third of children with type 1 diabetes are currently able to achieve good control of their blood glucose level, which is needed to avoid serious consequences to their long-term health and quality of life.

Figures also show that a five-year-old child diagnosed with type 1 diabetes faces up to 23,000 insulin injections and 52,000 finger prick blood tests by the time they are 18 years old.

As well as the physical benefits, using this system can also help relieve some of the mental burden on people with type 1 diabetes or their carers who otherwise must remain constantly vigilant to blood sugar levels.

One of the children who has received an artificial pancreas from the NHS is six -year-old Charlotte Abbott-Pierce. Just over a year ago, Charlotte was diagnosed with type 1 diabetes when she was five years old after having to attend Ormskirk Paediatric A&E department because of a significant increase in thirst and need to urinate.

Ange Abbott-Pierce, Charlotte’s mum, has type 1 diabetes so had recognised the symptoms, and this prevented her daughter from being extremely unwell upon diagnosis.

Charlotte was initially started on insulin injections then progressed to an insulin pump and a continuous glucose monitor. Now, as part of the pilot these systems work together as an HCL system.

Due to Charlotte being so young, having no awareness of what can happen when blood sugar levels become dangerously low and her glucose levels being so variable, her clinician recommended her as part of the HCL pilot. This was done with the aim of improving Charlotte’s glycaemic control, supporting her parents with her diabetes management and potentially improving her long-term health outcomes.

Now Charlotte has fewer blood glucose highs, and her parents know the pump is doing work in the background, so they don’t have to set alarms every two hours to check how she is.

Ange said: “Before the HCL was fitted, my husband and I would be up every two hours every night having to check Charlotte’s blood sugars and most times giving insulin, sometimes doing finger pricks or dealing with ketones due to quick rises in blood sugar. This was really hard as we both work full time.

“The HCL has given us tighter control as the CGM is monitoring Charlotte’s blood sugars and the pump is reacting before we even know there’s a problem. Hormones are a big factor at the moment, so interventions are still needed but this system is a god send to us as we were at our wits’ end with worry, not being able to catch the highs before they got dangerous.”

The NHS’s pilot has been designed to include a representative mix of adults and children living with type 1 diabetes from all backgrounds, to ensure this pilot considers the potential effectiveness of HCL.

Under the NHS’s pilot, all of the closed loop systems that are licenced for use within the UK are available to participants. Clinicians and patients or their carer discuss which is the best option for them and choose the HCL system they want.

Yasmin Hopkins, 27, from London has also received an artificial pancreas as part of the NHS pilot.

Yasmin has been living with Type 1 diabetes for 16 years.  She started pump therapy six years ago, which helped her control her diabetes. However, diabetes is never straightforward, and Yasmin still suffered from peaks and troughs, diabetes burnout and general fluctuations of glucose levels.

Yasmin, said: “I became aware of the emerging research into artificial pancreases, and fortunately for myself, my amazing diabetes team are part of the NHS pilot study. From here, I instantly contacted the team, and I was eligible to enrol. Since then, I haven’t looked back”.

Yasmin’s continuous glucose monitor has been able to communicate with her insulin pump and reduce the fluctuations that were taking over her life. This has not only brought Yasmin physical benefits but has also supported her mental health.

“The connection between the monitor and insulin pump means that I can enjoy my life, whilst limiting the highs and lows, changing my life for the better. This amazing innovative technology hasn’t just benefitted me, it has also benefitted my family and friends – my boyfriend constantly emphasises that this technology will change lives the way that it has changed mine – even if it does beep extremely loud at 4am”, said Yasmin.

Chris Askew OBE, Chief Executive of Diabetes UK, said: “This technology has the potential to transform the lives of people with type 1 diabetes, improving both their quality of life and clinical outcomes.

“The trial will generate real-world data which will hopefully support the case for more people having access to this life-changing tech in the future. And while widening access to diabetes tech remains a priority for Diabetes UK, the NHS’ rollout of this scheme is a very significant and positive step in the right direction.

“We are proud of our legacy of artificial pancreas research and will continue to support NHS England as the pilot progresses”.

The data collected from the pilot, along with other evidence, will be considered by the National Institute for Health and Care Excellence (NICE) as part of a technology assessment. NICE will make a recommendation about wider adoption within the NHS following a review of the evidence.