An announcement of the recommendations was made on 7 November 2023 at NICE’s annual conference in Manchester by NICE chief executive Dr Sam Roberts.

Thousands of people with type 1 diabetes could be offered wearable technology to help them manage their condition following the publication of final draft guidance by NICE.

An independent NICE committee has recommended people whose diabetes is not controlled with their current device despite best possible management with an insulin pump, or real-time or intermittently scanned continuous glucose monitoring, are offered a hybrid closed loop system.

Hybrid closed loop systems comprise a continuous glucose monitor sensor attached to the body. This transmits data to a body-worn insulin pump. It calculates how much insulin needs to be automatically delivered into the body to keep blood glucose levels within a healthy range.

People can use these systems to continue normal activities without the need for regular finger prick testing or injecting themselves with insulin to control their blood sugar levels. Keeping blood sugar levels under tight control greatly reduces the risk of complications such as blindness and amputations.

Clinical trial and real-world evidence show that hybrid closed loop systems are more effective than standard care at maintaining blood glucose levels within a healthy range. Evidence suggests that the systems appear to be more effective for people with higher long-term average blood glucose levels.

NICE has agreed with NHS England that all children and young people, women who are pregnant or planning a pregnancy, and those people who already have an insulin pump will be first to be offered a hybrid closed loop system as part of a 5-year roll-out plan.

The technology will also be issued to those adults with an average HbA1c reading of 7.5% or more. NICE guidelines recommend people should aim for an HbA1c level of 6.5% or lower. Adults who suffer disabling hypoglycaemia, defined as an abnormally low level of glucose the blood, despite best possible management will also be offered the technology.

According to the National Diabetes Audit 2021-22 for England and Wales there are 270,935 people in England and 16,090 people in Wales living with type 1 diabetes.

Professor Jonathan Benger, chief medical officer at NICE, said: “With around ten percent 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 game changer 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.

“It has been a team effort to get this appraisal to a successful conclusion. I would like to pay tribute to the hard work of the NICE staff, the independent committee, and our colleagues at NHS England and in industry to ensure people with type 1 diabetes will benefit from this life-changing technology.”
England’s integrated care boards, which are overseen by NHS England on a regional basis, would usually implement NICE recommendations within 90 days of the publication of final guidance.

However with the need for trusts to employ extra staff to complete the roll out – alongside specialist training for both patients and staff – NICE has accepted a funding variation request from NHS England which will see the technology rolled out over a five-year period.

In type 1 diabetes, a person’s blood glucose level becomes too high (hyperglycaemia) because there is no, or very little, production of insulin by the pancreas. Blood glucose levels can only be regulated by giving insulin to prevent hyperglycaemia. If type 1 diabetes is not well controlled, people are at increased risk of long-term complications including blindness, amputations and kidney problems.

Consultees and commentators can appeal the committee’s decision during the next two weeks. Final guidance is expected to publish in December 2023.

Semaglutide for early onset Type 1 diabetes – but a very small study…

In a small study involving only 10 people, semaglutide, a Type 2 drug, was given to people with Type 1 diabetes soon after the diagnosis. This led to no need for mealtime insulin in all patients and no need for basal insulin in most, along with improved glycaemic control. (The New England Journal of Medicine. September 2023)

Before building up our hopes, we have to recognise that this is a very small study and a much larger study is needed. In addition, we have to question whether there could be adverse effects.

What is semiglutide?
Semaglutide (Ozempic) helps reduce blood sugar levels by increasing the amount of insulin released, preventing glucagon release, and slowing how fast the stomach empties. It is given by a weekly injection under the skin. It is a safe and effective treatment for adults with Type 2 diabetes.

Taking this research in the UK
Professor Timothy Barrett, a Professor of Paediatrics and Child Health at the University of Birmingham, is planning to test whether semaglutide can help children and young people with Type 1 diabetes manage their blood sugar levels alongside insulin. In most children and young people with Type 1 blood sugars are often too high, despite however hard they try to avoid this. This research is to establish whether semaglutide, along with insulin, can help young people can keep blood sugars lower and lower the risks of complications.

The researchers will run their clinical trial at four hospitals in Birmingham, Cambridge, Leicester and Sheffield. 230 people with Type 1 between the ages of 10-24 years old will take part in the clinical trial. The participants will be given semaglutide for six months, plus their usual insulin treatment.

NHS rolls out world-first programme to transform diabetes care for under 40s ‘T2Day: Type 2 Diabetes in the Young’

NHS Press Release, 29th August 2023

UK Stakeholder | Press Releases | NHS England | 29 August 2023

Tens of thousands of people in England living with early onset type 2 diabetes will benefit from more intensive and targeted care, thanks to a world-first initiative being rolled out by the NHS.

Around 140,000 people aged 18 to 39 years old will receive additional tailored health checks from healthcare staff, and support with diabetes management, such as blood sugar level control, weight management and cardiovascular risk minimisation.

Under the ambitious new programme, named ‘T2Day: Type 2 Diabetes in the Young’, patients will benefit from extra one-to-one reviews as well as the option of new medicines and treatments where indicated, to help better manage their diabetes.

Addressing the additional risks associated with the condition during pregnancy, there will also be dedicated support available for women, including access to contraception and folic acid supplements.

Backed by £14.5 million, local health teams will be supported to roll out the new scheme to help minimise the risk of these people developing health complications and severe illness and to support a reduction in health inequalities.

Eligible individuals may also be able to access the NHS Type 2 Diabetes Path to Remission Programme – a year long programme including 12 weeks of low-calorie total diet replacement products and support to re-introduce food, with the aim of supporting participants to improve their blood sugar levels, reduce diabetes-related medication and in some cases put their type 2 diabetes into remission.

The NHS is the first health system in the world to put in place a national, targeted programme for this high-risk group of people.

Early onset type 2 diabetes is more aggressive than later onset type 2 diabetes and is more prevalent in people living within deprived areas and individuals from minority ethnic groups.

Defined as a serious disease by medical experts, early onset type diabetes is associated with premature mortality, worse long-term health outcomes, and higher risk of diabetes-related health complications, such as sight loss, kidney failure, amputation, heart attacks and strokes.

Professor Jonathan Valabhji, National Clinical Director for Diabetes and Obesity said: “Type 2 diabetes in people under 40 is a growing problem globally – England is no exception, meaning there is an ever-increasing challenge for the NHS.

“We know this age group is least likely to complete vital annual health checks but we want to ensure people are able to manage their diabetes well and reduce the risk of serious complications, which is exactly why we have embarked on an ambitious and world-first initiative called T2Day: Type 2 Diabetes in the Young.

“The programme will provide targeted intervention for each person under the age of 40 living with type 2 diabetes, including additional reviews focused on completing proven diabetes care processes, managing blood sugar levels, weight management, preparation for pregnancy, and supporting any unmet psychological or social needs.

“We are delighted to roll out this initiative, which we hope will be a big step forward to improving care in this high-risk group of individuals.”

Analysis of the National Diabetes Audit has shown that the rate at which young adults are diagnosed with early-onset type 2 diabetes has risen faster than the rate of diagnosis in over 40s in England.