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

Overview

King's College Hospital used the workforce capacity modelling tool developed by the Health Innovation Network (HIN) South London to plan the implementation of the NICE technology appraisal guidance on hybrid closed loop systems for managing blood glucose levels in type 1 diabetes (TA943) in its adult type 1 diabetes service. The team aimed to forecast the staff time and capacity needed to deliver the hybrid closed loop systems recommended in the technology appraisal, achieve a 70% uptake among eligible patients, and manage this alongside existing service commitments. From its previous experience implementing the NICE technology appraisal guidance on continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (TA151),King's College Hospital recognised the gap between eligibility and actual uptake of diabetes technologies.

TA151 increased eligibility for pump therapy by 2.3 times, yet uptake lagged behind. Within the adult type 1 diabetes population, 43% of patients were already using pumps, while 21% were eligible but not yet on therapy. With the introduction of TA943, a further 15% of patients became eligible, meaning that approximately 36% of the clinic population now needs to be transitioned to the advanced technology.

King's College Hospital also identified persistent disparities in technology access, with lower uptake among patients from deprived areas and ethnic minority backgrounds. The phased implementation of hybrid closed loop systems presents both an opportunity and a risk for addressing or widening these inequalities.

While NHS England has committed to funding 75% of device costs for eligible patients under TA943 over a 5‑year period, services still face substantial challenges. These include managing the additional clinical and administrative workload for device initiation, training, and ongoing support, as well as maintaining accurate digital reporting to secure reimbursement. Services must also plan for the post-warranty renewal costs once devices reach the end of their 4‑year lifespan.

Given these challenges, King's College Hospital adopted a data-driven approach to implementing TA943. The team sought to understand the additional workforce capacity and specialist skills needed to deliver hybrid closed loop technologies to a diverse patient population. It also aimed to track how transitioning patients onto hybrid closed loop systems could reduce reliance on complex care pathways, freeing up clinical capacity in later years and supporting reinvestment in device re-procurement once warranties expire.

King's College Hospital used the HIN South London's hybrid closed loop workforce capacity modelling tool to stage plan implementation, forecast workforce activity, and estimate the number of patients expected to move to lower-complexity pathways as a result of hybrid closed loop system adoption. The tool also enabled King's College Hospital to model annual device procurement needs and plan effectively to achieve the target of 70% uptake among eligible patients.