New national guidance has been issued recommending the use of hybrid closed-loop (HCL) systems for pregnant women living with Type 1 diabetes. The updated advice, published by NHS England and the National Institute for Health and Care Excellence (NICE), aims to significantly improve blood glucose control during pregnancy, thereby reducing the risk of complications for both mother and child.
HCL systems, often referred to as 'artificial pancreas' technology, continuously monitor glucose levels and automatically adjust insulin delivery through an insulin pump. This innovative technology has been shown to help maintain glucose levels within a target range, which is crucial during pregnancy to prevent adverse outcomes. Poorly controlled diabetes in pregnancy can lead to a range of serious issues, including pre-eclampsia, preterm birth, and increased risk of C-sections for mothers, as well as neonatal hypoglycaemia, macrosomia (larger than average babies), and respiratory distress syndrome for infants.
This latest guidance builds upon earlier recommendations from NICE, which in December 2023, advised that HCL systems should be offered to most people with Type 1 diabetes in England. The expansion to include pregnant women underscores the growing evidence base supporting the effectiveness of these devices in managing the complex physiological changes of pregnancy alongside Type 1 diabetes. The move is expected to be welcomed by healthcare professionals and patients alike, providing a standardised approach to care.
The implementation of HCL technology is part of a broader NHS strategy to integrate advanced diabetes management tools into routine care. While the initial rollout for non-pregnant individuals is already underway, this specific guidance addresses a particularly vulnerable patient group where tight glucose control is paramount. Ensuring access and appropriate training for both patients and clinicians will be key to the successful adoption of these systems across the NHS.
For pregnant women with Type 1 diabetes, maintaining stable blood glucose levels can be challenging due to hormonal fluctuations and changing insulin requirements. The automated nature of HCL systems can alleviate some of this burden, potentially leading to better health outcomes and a more positive pregnancy experience. It is estimated that approximately 3-5% of pregnancies in the UK are affected by pre-existing diabetes, with Type 1 diabetes accounting for a significant proportion.