Guidelines : Hybrid Closed Loop Systems

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) recommends the phased implementation of NICE TA943 Hybrid Closed Loop Systems for managing blood glucose levels in type I diabetes.

The financial framework supporting the phased implementation of NICE TA943 is yet to be published. Until the financial framework is released, hospital diabetes specialist clinicians can discuss the suitability of HCL with eligible patients at their next scheduled clinic appointment taking into account those with the highest clinical need and the resources available in year. In line with the national guidance this will be a phased implementation over a 5 year period. Further work to clarify the phased implementation will be undertaken by the system wide HCL steering group when the financial framework is published.

The cost effective HCLs have been agreed as follows:

RED traffic light status (Initiation and continued supplies will be through the specialist diabetes service.)

Insulin Pumps:

• DANA I insulin pump
• Mylife Ypsopump insulin pump
• Medtronic 780g insulin pump
• Tandem t:slim insulin pump
• Omnipod 5 insulin pump

Continuous Glucose Monitoring

• Dexcom 6
• Dexcom 7
• FreeStyle Libre 3
• Guardian 4

Algorithm

• mylife CamAPS
• CamAPS

BLUE (with information sheet) traffic light status. Initiation will be by the diabetes specialist service, who will provide the first 28 days of treatment (and capillary test strips if required), prior to transfer of care to primary care.

• FreeStyle Libre 2 plus

NON-FORMULARY      

• The APC did not support the use of the Medtrum A8 Touchcare Nano HCL system based on accuracy concerns with the continuous glucose monitoring. Previously discussed at APC in April 23
•  https://surreyccg.res-systems.net/PAD/Search/DrugConditionProfile/6672

Insulin Pump warranties

The Surrey Heartlands Integrated Care System Area Prescribing Committee have re-affirmed the position on insulin pump warranties.

The 'tethered' (with tubing) insulin pumps have a 4 year warranty. A patient can be switched 'in warranty', to another insulin pump where:

• The Diabetes specialist team consider that the use if the current tethered insulin pump poses a safety concerns OR
• The Diabetes specialist team consider that the patient is unable to maintain expected blood sugar levels with their current 'tethered' insulin pump.