- A new device will reduce the need for regular injections for type 1 diabetes sufferers
NHS England chiefs are set to give the go-ahead to a ground-breaking medical technology that has been described as “the closest thing to a cure for type 1 diabetes that science can provide”, The Mail on Sunday can reveal.
Currently, most type 1 diabetics rely on multiple daily self-injections of insulin medication to control the extremely high blood sugar that the disease causes. Without them, they would not survive. But a pioneering gadget called a closed-loop hybrid system relieves sufferers of regular strokes.
It also stops them from having to constantly check their blood sugar levels to calculate how much insulin they need to inject – a difficult responsibility as the dose needed can vary depending on sleep patterns, exercise, illness and diet.
Instead, the gadget continuously monitors blood sugar and uses a complex algorithm to predict how much insulin a patient needs before automatically delivering the correct dose.
The system connects to an app on the patient’s phone and learns what the individual’s body needs over time, keeping blood sugar levels much more stable than the current treatment method.
Most importantly, it reduces the risk of potentially fatal hypoglycemic attacks – known as hypoglycemia – and dangerously high blood sugar, which can cause another potentially fatal condition, diabetic ketoacidosis, which makes the blood acidic and toxic.
One type 1 diabetic who volunteered to trial the pioneering device said: “To say it’s life-changing doesn’t come close.”
Mum-of-two Nina Wheeler, 38, from Norwich, added: “I think it’s the closest I’ve ever come to a cure in my life.”
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And for six-year-old Sophia Upjohn, getting the technology when she was just three means she avoids regular insulin injections and will grow up “less different from everyone else”, according to her mother Tanya.
On Tuesday, the NHS watchdog, the National Institute for Health and Care Excellence (NICE), will meet to confirm whether it will follow Scotland’s lead in bringing the technology to the NHS.
After officials agreed cost reductions with providers, NICE is expected to agree to fund it for up to 75 per cent of people with type 1 diabetes in England – around 200,000 people. Wales are likely to follow suit.
It is expected to be offered to all 36,000 children with the condition, a move which – by keeping their blood sugar stable from the early stages of their disease – could save them a lifetime of complications linked to the condition, including kidney disease, heart problems , amputation and eye damage.
All women with type 1 diabetes planning to become pregnant will receive the device after research found it could reduce stillbirths, birth defects and neonatal intensive care unit admissions.
And all adults with an HbA1c above 7.5 (meaning 75 percent of the hemoglobin in the blood is saturated with sugar)—about 65 percent of adults with type 1 diabetes—will also be offered the device.
Professor Partha Carr, NHS England’s clinical director of diabetes, told the Department of Science: “Apart from a cure, there is nothing else available in science for type 1 diabetes. This is it. This is the final piece of the puzzle for people with this disease. From the patient’s point of view, this significantly changes the quality of life.
“From an NHS perspective, we are leading the world in offering this to patients. And from a policy perspective, I can’t think of anything that really deals with prevention as much as this.
“This transforms the health of the country decades into the future because you eliminate the risk of complications from unstable blood sugar. Children, if given this, may not suffer from them at all.
Type 1 diabetes occurs when the pancreas, a gland in the abdomen, stops producing insulin, the hormone needed to move sugar from the blood into the cells, where it is burned for energy.
This is different from the more common type 2 diabetes, where insulin is produced but the body’s cells do not respond to it normally. In both cases, this leads to the accumulation of sugar absorbed from the food in the blood, causing damage to blood vessels and organs.
Without sugar to use as energy, the body burns fat. A byproduct of this process are chemicals called ketones. At very high levels, they become toxic – causing diabetic ketoacidosis, which can lead to loss of consciousness, stroke or death.
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The problem is more common in type 1 diabetes, due to the complete lack of natural insulin in the body. Insulin keeps blood sugar under control, but the use of the drug requires constant monitoring. Using too little means blood sugar stays higher than it should, again increasing the risks. But calculating the right amount of insulin to take can be challenging, especially for pregnant women and young children, whose levels fluctuate more quickly.
Hilary Nelson, policy director at type 1 diabetes charity JDRF, explains: “Research shows that people with diabetes have to make an average of 180 decisions a day related to their condition.
“If you’re tired, stressed, if you ran for the bus or ate a pizza, it will change how much insulin your body needs. This requires relentless focus and is especially difficult for parents of children with diabetes. Some have to quit their jobs as it takes a lot of time.
The closed-loop system works by connecting two pieces of technology already used by patients—a continuous glucose monitor and an insulin pump—with a computer program controlled by a mobile phone app. The monitors, which include the FreeStyle Libre – used by former Prime Minister Theresa May, who has type 1 diabetes – are about the size of a pound coin and are placed on the skin, usually on the arm. They constantly monitor sugar levels through skin sensors.
Insulin pumps are small devices that replace regular injections by delivering insulin – the amount programmed by the patient – into the body. The latest models attach directly to the skin, but other versions are connected by tubing to a cannula that is inserted into a vein. The device is worn in a belt or garment.
The closed-loop system takes measurements from the monitor and uses an algorithm to calculate whether blood sugar levels are rising or falling and how much insulin is needed. It communicates with the pump to tell it how much to give or whether to pause – without the patient having to do anything.
An alarm will sound on the patient’s phone if sugar levels become dangerously low or high.
The only information the patient has to give is before a meal, when they have to calculate how many carbohydrates – which can raise sugar levels – they will consume.
Nina Wheeler has been using the kit for three years and says she has “never looked back”. Diagnosed with type 1 diabetes when she was 20, her condition made her first pregnancy “terrifying”, she says.
Nina had to retire from her job as a specialist diabetes midwife to look after her own health as the pregnancy made her blood sugar dangerously difficult to control.
She says: “I kept checking it, all night. I had this fear that I would get hypoglycemia at night and not wake up in the morning.
“I knew I had to protect my unborn child. I have seen in my work how dangerous unstable blood sugars can be for a growing baby.
Indeed, older daughter Ava was born with severe jaundice and breathing problems—both known complications in babies of diabetic mothers—and had to be rushed to the intensive care unit.
Thanks to the closed cycle system, Nina’s second pregnancy in 2021 with younger daughter Blythe could not have been more different.
“I knew my blood sugar was stable, so I slept through the night and was able to work the whole time,” she says.
Most importantly, Blythe was born with only mild jaundice and the couple went home the next day.
Nina adds: “Anyone with diabetes has to think about their condition almost 100 percent of the time.
“But with this system, you get a moment to breathe without it being at the forefront of your mind.
“The algorithm sorts everything out, leaving you able to do your job properly and play with your kids.”
Nina keeps the pump in her pocket or tucked in her bra. It connects to the cannula in her arm via a tube.
“Instead of your blood sugar going from really low to really high, it’s much smoother and less extreme,” she says. “I feel healthier and more energetic. I’m with the kids more because I don’t have to constantly monitor my blood sugar – I know an alarm will go off if there’s a problem.”
Sophia Upjohn, from Ruislip, West London, was diagnosed with type 1 diabetes in 2021, aged three, after developing extreme thirst and starting to wet the bed regularly at night. The new system was immediately offered to her by specialists at Hillingdon Hospital – at a cost of £80 a month.
“It was traumatic at first,” recalls her mother Tanya, 38. “We were learning how to manage it and the algorithm was learning what worked for Sophia.
“But she doesn’t get constant injections or finger pricks that would interrupt her school day. She has to be less than twenty feet away from her phone at all times, but her teachers know how to use it and add the carbs she eats at lunch.
“We hope this means she can live her life without being defined by diabetes.” The more controlled it is now, the fewer long-term health effects, such as kidney or heart problems, she will have later.
Sofia holds her pump on a belt that connects to a cannula in her abdomen or lower back. This changes every two days.
“She likes to accessorize the belts,” says Tanya. “In kindergarten, the other kids put on little bags to be like her.”
In contrast, the experience of Lesley Jordan, 57, from Brentwood, Essex, who was diagnosed with type 1 diabetes when she was two, could not be more different.
Treatment was then daily insulin injection using a reusable glass syringe and steel needle.
Today, she has the closed-loop system, which she describes as “the most innovative development in my 55 years with this disease.”
Leslie, who works as JDRF’s Technology Access Manager, does have some diabetes-related complications, such as retinopathy — vision loss — and damaged nerves in her gut, thanks to decades of fluctuating blood sugar. But she says the new kit is “phenomenal”.
“It’s wonderful to see these changes happening — and this isn’t even as good as it’s going to be,” she says. “Technology will improve and one day we may forget we ever had type 1 diabetes.”
But there are challenges that remain.
Currently, only 15 percent of adults and 40 percent of children with type 1 diabetes have insulin pumps—essential for a closed-loop system. And not everyone wants a device attached to them, says Prof Carr.
Diabetes services are also already overstretched. But it is understood that NICE will give five years for implementation.
The ambition is to widen the eligibility criteria so that in future anyone with type 1 diabetes who wants the device can have it.
Professor Carr said: “We are working with NICE to try to review the guidelines again in a few years’ time and close the gap for the others, but I am so proud to have reached this stage.”