Recommendation for NHSScotland 

To minimise inequalities in accessing diabetes technologies, clinicians should pro-actively initiate meaningful discussions with all patients with type 1 diabetes about the suitability of a closed loop system for their individual circumstances. 

Single hormone closed loop systems should be available to people with type 1 diabetes (paediatric and adult) who:  

• under their current diabetes care plan, continue to have suboptimal glycaemic control, a high risk of severe hypoglycaemia, or impaired awareness of hypoglycaemia, or 

• experience diabetes-related distress, measured using a validated tool, that adversely affects quality of life or their ability to manage diabetes, and which is likely to be improved by moving to a closed loop system. 

People who can achieve the desired glycaemic targets using finger prick testing, flash glucose monitoring or continuous glucose monitoring plus multiple daily insulin injections, or flash glucose monitoring plus an insulin pump, should be supported to remain on their current diabetes care plan subject to their circumstances and quality of life. People who are currently using continuous glucose monitoring in combination with an insulin pump (non-integrated) should be offered a closed loop system, which may provide them with additional clinical benefits at lower costs. 

In their discussions, people with type 1 diabetes and clinicians must consider the day-to-day requirements of managing closed loop systems, for example, responding to alerts or replacing sensors when required. Support on how to use the closed loop system effectively should be provided to everyone offered the technology. 

The Scottish Care Information (SCI)-Diabetes database should be used to collect clinical and person-reported outcomes data from people with type 1 diabetes using closed loop systems. These data will be used to inform quality of care improvements and future advice for NHSScotland. 

NHSScotland is required to consider Scottish Health Technologies Group (SHTG) advice. 

What were we asked to look at? 

We were asked to examine the evidence on using closed loop systems and the artificial pancreas for the management of type 1 diabetes. We were asked to consider the cost-effectiveness of these technologies compared with current diabetes management options, and to consider clinical effectiveness, safety and patient aspects. 

Why is this important? 

Access to technologies to support people with managing diabetes is a key priority of the Scottish Government’s Diabetes Improvement Plan. The 2019 Scottish diabetes survey found that there were 33,452 people living with type 1 diabetes in Scotland. Living with type 1 diabetes is associated with a significant physical and mental health burden caused by the demands of managing the condition every day and worrying about future complications. Poorly controlled diabetes is associated with complications such as leg, toe or foot amputation, nephropathy, neuropathy and retinopathy resulting in sight loss. People with type 1 diabetes are also at increased risk of cardiovascular disease and premature mortality. Approximately 80% of the £10 billion annual spending on diabetes in the UK is used to fund the treatment of complications. Rapidly advancing diabetes technologies, such as closed loop systems and the artificial pancreas, have the potential to transform the lives of people living with type 1 diabetes. Demand for these technologies is increasing, with many people with type 1 diabetes anticipated to benefit from an artificial pancreas or closed loop system in the future. 

Referred by

Scottish Diabetes Group