NHS rollout of artificial pancreas narrows inequality in diabetes care | Diabetes

The rollout of a “life-changing” artificial pancreas on the NHS for people with type 1 diabetes has helped reduce ethnic and socio-economic inequalities in access to treatment, figures show.

Formally known as a hybrid closed-loop system, an artificial pancreas consists of three interconnected parts: a body-worn sensor called a continuous glucose monitor; an algorithm either built into the pump or on a separate device such as a phone that calculates the precise dose of insulin needed; and an insulin pump which delivers the dose into the bloodstream.

For patients, the device removes much of the mental burden of managing blood sugar levels, particularly at mealtimes and during the night. According to previous clinical trials, the device is more effective at managing diabetes than current diabetes technology, such as using continuous glucose monitors alone.

Previous deployments of diabetes technology have had stark disparities in adoption across ethnicity and deprivation. Studies have shown that people from minority ethnic backgrounds in England are less likely to have access to continuous glucose monitors, while people from disadvantaged backgrounds have been unable to make full use of the technology.

However, the first two years of artificial pancreas deployment reversed this trend, with a difference in uptake of just 3% between those from the most and least deprived backgrounds, as well as those from ethnic minorities, compared to their white counterparts.

Naiha Shafiq, 27, from London, received an artificial pancreas three years ago. She said the device had “changed her life” as she was previously hospitalized several times with diabetic ketoacidosis, a life-threatening complication, due to her difficulties administering her insulin injections.

“There was a time when I was in the hospital every three to five days,” Shafiq said. “When I got pregnant, I knew something had to change for me, for the sake of my son. That’s when the team introduced me to the pump. I was very hesitant at first, but once I started, I loved it.”

For Shafiq, administering his insulin was previously made more difficult due to his religious beliefs. “As a Muslim woman who wears hijab, it was extremely difficult for me to receive injections because I was always looking for a private place to inject most of the time, and if there was no private place to inject, I would miss the injections because I wasn’t comfortable. The pump now makes life so much easier.”

In 2023, the NHS said more than 150,000 adults and children with type 1 diabetes would be offered the device. The first two years since launch have focused on children, and around 32,000 of them have been fitted with the device on the NHS, representing 72.3% of those eligible. The program will continue over the next several years until all eligible children and adults with type 1 diabetes have received the device.

Helen Kirrane, head of policy and campaigns at Diabetes UK, said the device had made a “significant and life-changing difference to many thousands of people living with type 1 diabetes”.

“We are incredibly proud of the role that Diabetes UK’s research and advocacy has played in getting us to this point, where a world-leading rollout is taking place on the NHS with equity at the heart,” Kirrane said. “But it is clear that there is still work to be done and, with some people still not benefitting from this transformative technology, the challenge now is to ensure that everyone eligible can access it across the UK, regardless of their background or where they live.”

Hilary Nathan, policy director at research and advocacy organization Breakthrough T1D, said: “The UK is rightly recognized as a world leader in the deployment of hybrid closed-loop systems for people living with type 1 diabetes, reflecting years of research, advocacy and leadership from people with lived experience.

“The priority now is to ensure fair access across all four UK countries, so that everyone can truly choose the technology that suits them when they need it and the benefits of innovation are felt fairly in every community, with no one left behind. »

Mr Clare Hambling, National Clinical Director for Diabetes and Obesity, said: “It is fantastic to see that the world-first deployment of this revolutionary technology is already transforming the lives of tens of thousands of children and young people living with type 1 diabetes in the NHS.

“These revolutionary devices have represented a real step change in care for many families and these advances are testament to the dedication of our pediatric diabetes teams across the country to ensure as many young people who need them can access them as quickly as possible, no matter where they live.”