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NICE’s latest consultation on hybrid closed loop

As part of its assessment of hybrid closed loop (HCL), the National Institute for Health and Care Excellence (NICE) has today published an additional consultation on its roll out.
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Kate Lawton 21 August 2023

Illustration of the hybrid closed loop technology system, funded as part of treatment research for type 1 diabetes by JDRF.

The consultation document proposes a carefully controlled implementation period of five years. Technology Appraisals are normally required to be implemented after three months without any phased prioritisation. This can lead to inequity in access by those who have the greatest need. We anticipate this phased rollout period will help those with greatest need access HCL systems soonest – just as the phased Covid vaccination programme prioritised those who needed the most protection.

The final NICE appraisal document, detailing the exact criteria of who will be eligible for hybrid closed loop is due later this year. We will monitor this closely and provide comment separately if necessary.

Why is there a variation in the funding requirement?

The decision to extend the rollout period was driven by several factors:

Clinical Capacity: The extended rollout recognises the need for sufficient clinical capacity to ensure effective training and support for both healthcare staff and patients.

Specialist Support: The complex nature of insulin pumps, glucose monitors, and HCL systems requires specialised training and support for healthcare professionals. This extended period allows for the necessary investment in the workforce to provide comprehensive guidance and assistance to patients.

Variations in Access: Variations in the provision of continuous glucose monitors and insulin pumps across different healthcare centres have been acknowledged. This phased rollout will help ensure that you have access to the same standard of technology, no matter where you live.

Healthcare Inequalities: Access to technology can impact the uptake of HCL systems. The extended rollout aims to mitigate potential healthcare inequalities and ensure that the introduction of HCL does not increase existing inequalities.

Patient Benefit: The phased rollout is not expected to adversely affect patient outcomes. The National Diabetes Audit has highlighted improvements in glycaemic control for people with type 1 diabetes, and the effective implementation of HCL systems is poised to further enhance this progress.

Targeted Implementation: The proposed extended rollout will focus  where the demand is highest, starting with children, younger adults, pregnancy, existing pump users transitioning to HCL, gradually expanding to new pump users.

Procurement Process: The current variation in procurement of diabetes technology, including insulin pumps, will be addressed through the development of a new commercial framework via a formal procurement process by NHS England. This effort aims to ensure consistent access to cost-effective prices across different healthcare providers.


Advancements in type 1 technology have enabled people with the condition to live longer, healthier lives without fear, by reducing the risks of complications including heart failure, loss of limbs, kidney failure and sight loss. The roll out of HCL presents the chance for yet another significant leap in treatment progress for type 1 diabetes, with the potential to remove some of the burden and transform the lives of hundreds of thousands of people.

Our response

Speaking about the development, Rachael Chrisp, Head of Policy and Public Affairs at JDRF, commented: “This proposed extended rollout marks a step closer in our journey towards improving the lives of people with type 1 diabetes. By advocating for improved criteria and a comprehensive phased implementation, we are ensuring that HCL technology becomes accessible to those who need it the most.”

The consultation for the extended roll out period is now underway, and stakeholders from across the healthcare spectrum are invited to provide their input before the final guidance is published. With JDRF’s continued dedication and collaboration with NICE, the future holds promising prospects for everyone living with type 1 diabetes in England and Wales.

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