Original Title: Closed loop systems and the artificial pancreas for type I diabetes mellitus (T1DM)

Authors' objectives: 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. 

Authors' results and conclusions: To minimise inequalities in accessing diabetes technologies, clinicians should pro-actively discuss with all patients with type 1 diabetes, 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 (children and adults) who: • under their current diabetes care plan, continue to have poor blood sugar control, a high risk of severe hypoglycaemia, or impaired awareness of hypoglycaemia, or • experience severe 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. The following people with type 1 diabetes, who achieve the desired blood sugar control, should be supported to remain on their current diabetes care plan subject to their circumstances and quality of life: • people using finger prick testing plus multiple daily insulin injections • people using flash (FreeStyle Libre®) glucose monitoring plus multiple daily insulin injections • people using CGM plus multiple daily injections, and • people using flash (FreeStyle Libre®) glucose monitoring plus an insulin pump. People who are currently using both a CGM sensor and an insulin pump should be offered a closed loop system. Discussions between patients and clinicians must consider the day-to-day requirements of managing a closed loop system. For example, responding to alerts or changing sensors when required. Support on how to use their closed loop system effectively should be provided to everyone offered the technology. The SCI-Diabetes database should be used to collect data from Scottish patients using closed loop systems. These data will be used to inform quality of care improvements and future advice for NHSScotland.

Authors' recommendations: More trials are needed that test closed loop systems in larger groups of people, over a longer time period, and in a wider variety of participants (for example people with poor glucose control). Trials assessing the artificial pancreas are also required. Trials that collect data to support value for money assessment in the UK would be very beneficial.

Authors' methods: We produced SHTG Recommendations based on the published evidence on clinical effectiveness and safety, SHTG de novo economic modelling, patient experiences and patient preferences.

Project Status: Completed

URL for project: https://shtg.scot/our-advice/closed-loop-systems-and-the-artificial-pancreas-for-type-i-diabetes-mellitus-t1dm/

Year Published: 2022

URL for published report: https://shtg.scot/our-advice/closed-loop-systems-and-the-artificial-pancreas-for-type-i-diabetes-mellitus-t1dm/

Requestor: Scottish Diabetes Group

English language abstract: An English language summary is available

Publication Type: Other

Country: Scotland, United Kingdom

Organisation Name: Scottish Health Technologies Group

Contact Address: Scottish Health Technologies Group, Delta House, 50 West Nile Street, Glasgow, G1 2NP Tel: 0141 225 6998

Contact Name: his.shtg@nhs.scot

Contact Email: his.shtg@nhs.scot

Copyright: Scottish Health Technologies Group