Hybrid closed loop systems, sometimes called an ‘artificial pancreas’, enable an insulin pump and a continuous glucose monitor to work together to help manage blood sugar levels.

The continuous glucose monitor automatically senses sugar levels in the fluid between the blood vessels and cells, without the need for finger-prick testing. A computer programme on a phone or inside an insulin pump uses this data to work out how much insulin the body needs to help keep blood sugar levels stable. The pump then automatically gives the right amount of insulin.

While this removes a lot of the input needed from the person using the system, the individual still needs to tell the system about exercise and input details of the carbohydrates they eat.

People using hybrid closed loop systems have reported having less hypoglycaemic episodes, more confidence in keeping active and less worry about their blood sugar levels during the day or at night. Studies show it reduces the burden of managing diabetes on individuals and their carers.

The National Institute for Care and Excellence (NICE) also gathered evidence to show that hybrid closed loop systems are more effective than standard care at maintaining blood glucose levels within a healthy range.

NICE has recommended that the NHS in England makes hybrid closed loop systems available to the following groups of people:

• adults living with type 1 diabetes who have an HbA1c of 58 mmol/mol (7.5%) or more, or have disabling hypoglycaemia, despite best possible management with at least one of the following:
  • continuous subcutaneous insulin infusion (CSII) (also known as an insulin pump)
  • real-time continuous glucose monitor
  • intermittently scanned continuous glucose monitor
• children and young people living with type 1 diabetes (under 19 years old)
• women, trans men and non-binary people living with type 1 diabetes who are pregnant or planning to become pregnant

For adults the recommendations include certain eligibility criteria. ‘Disabling hypoglycaemia’ is when instances of low blood sugar (hypos) occur frequently or without warning, making the person constantly anxious about having a hypo. The term ‘despite best possible management’ means that a person’s clinic has worked with them to get the best possible results using an insulin pump and/or continuous glucose monitor on its own, before prescribing a hybrid closed loop system.

The national roll-out of hybrid closed loop systems began in April 2024.

To ensure patients are safe, NHS trusts should only provide hybrid closed loop if they have access to specialist trained clinical staff experienced in providing insulin pumps and continuous glucose monitors for type 1 diabetes. NHS England is aware that the level of specialist clinical support varies between trusts and that it will take time to build staff capacity and improve clinical skills within adult diabetes services across the country. Our strategy sets out a phased implementation over 5-years to allow time for this to happen.

It may take up to 5 years for everybody who is eligible to be offered hybrid closed loop. This is because NHS trusts providing care for adults with diabetes need time to build staff capacity and improve the availability of specialist clinical teams, before they are ready to support the roll out of this technology.

Paediatric services caring for children and young people are better placed in terms of access to specialist staff, so will be able to offer hybrid closed loop to a greater number of eligible people over the initial years of the phased roll out.

When individuals living with type 1 diabetes attend appointments for their diabetes care, local diabetes teams will discuss the options available and will make a decision on whether to offer hybrid closed loop based on the team’s capacity and the individual’s clinical need.

People living with type 1 diabetes should continue to attend any appointments for their diabetes care as normal and discuss their options with a healthcare professional at that point in time.

Accessing hybrid closed loop or any other diabetes technology is an individual person’s decision. Healthcare professionals will discuss with people on an individual basis if they are eligible and whether it is suitable for them. Health care professionals will support them in making the best possible decision.

Yes. People with type 1 diabetes should discuss with their health care professional the range of options available to them. Their healthcare professional will support them in making an appropriate decision for their care.

• Women who are pregnant with type 1 diabetes are at increased risk of having a poor pregnancy outcome. Supporting women who are pregnant to spend as much time as possible in the pregnancy blood sugar target range reduces these risks a lot and increases the chances of them having a healthy baby. The earlier in pregnancy that the blood sugar levels get into the target range the better this is.
• The best way to support pregnant women to spend the most amount of time in the pregnancy blood sugar target range is to start them on a pregnancy specific hybrid closed loop system either before pregnancy or as soon as they are pregnant.
• There are several different hybrid closed loop systems available, however not all are licenced and suitable for pregnancy. If you are using a system that is not suitable for pregnancy, we recommend that you discuss options to switch to a compatible system with your local clinical team.

People living with type 1 diabetes can talk to their diabetes care team if they have clinical questions. There is also useful information on the Diabetes UK website about hybrid closed loop systems and a helpful video on the Breakthrough T1D UK website.

This NHS decision support tool helps people understand the diabetes technologies available in the NHS and which they are eligible for. It can be used to support discussions between someone living with type 1 diabetes and their healthcare professional.

Further information on managing type 1 diabetes is also available on the nhs.uk website.