Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes

Outcomes

The workforce capacity modelling tool demonstrated that the King's College Hospital population of adults with type 1 diabetes using insulin pumps or hybrid closed loop therapy is expected to more than double over 5 years – an increase of more than 200 people.

The model also projected technology starts by reason for initiation, helping the team identify which activities are reimbursable under NICE technology appraisal guidance on hybrid closed loop systems for managing blood glucose levels in type 1 diabetes (TA943) and when to anticipate device warranty renewals.

Using risk stratification assumptions informed by the National Diabetes Audit, hybrid closed loop system pilot data, and an NHS reference group, the model outlined patient pathways by complexity.

It demonstrated how moving patients from complex pathways to optimisation and PIFU (patient-initiated follow-up) pathways could free clinical capacity for onboarding new patients, address equity gaps in technology access, and enable more proactive monitoring and outreach.

For King's College Hospital, the modelling tool predicted that, without risk stratification, demand for diabetes educators at King's College Hospital will grow by 24% from 2024–25 to 2025–26. But applying effective risk stratification could reduce this demand by more than half, highlighting its potential to improve efficiency and sustainability.

Finally, the tool produced a detailed workforce and activity plan, outlining the number and type of appointments and the staffing levels needed across the 5‑year period. This analysis indicated that King's College Hospital should plan for an uplift of just over 2 full-time equivalents each for educator and administrative roles to manage the additional activity associated with onboarding newly eligible patients under TA943.

Learning

The King's College Hospital experience showed that workforce and operational planning for TA943 should begin early and be grounded in realistic, data-driven forecasts. Modelling revealed that implementing hybrid closed loop systems creates a substantial short-term increase in educator and administrative workload, even within established services. But capacity pressures can be reduced through effective risk stratification and pathway redesign. The model indicated that successful stratification could cut the projected 24% rise in demand for diabetes educators by more than half, supporting a more sustainable and efficient delivery model.

Key learnings for the wider TA943 roll-out include that: