HCL (Hybrid Closed Loop) News announcement

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gillrogers said:
In fact im sure there was something about the reasearch showing there was no economical benefits with us older peeps or words to the effect.
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That seems likely, yes. My guess is there's still some benefit and as they get more experience in rolling it out they'll be able to collect enough evidence (and reduce costs) such that it'll make sense to make it available to all of us. So not so much that there's a net saving (as may well be the case for children and the pregnant) but that the net cost is a reasonable one for the benefits.

Much as happened with CGMs (well, not so much costs with those).
 
nonethewiser said:
Wouldn't begrudge children & young adults being first to benefit from it if honest, wish tech like that was around back when we were all diagnosed.
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Oh of course not. Im sorry if im sounding selfish. Not my intention at all.
 
Partha will be out there taking names and kicking butt, as usual...
 
Bruce Stephens said:
Me too, though I like to think of it as being after the test subjects. There'll surely be things that DSNs and manufacturers learn which I hope will make our experience that much better.
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While the process of getting on a HCL system will be new for the NHS, HCL systems themselves are not new, so the first people put on them through the NHS won't be test subjects for the actual systems. Unless, of course, the NHS makes a deal with a manufacturer to get NHS-specific tech, like what they did with Dexcom One.

HCL are widely used in other countries, especially the US, so there are lots of test subjects around the world going before you if you're worried about it.

I'm in Germany and had my pick of three different run-of-the-mill HCL systems: Medtronic, Tandem t:slim and Ypsopump. I went with Tandem t:slim and Dexcom G6 and it's great.
 
Finn said:
HCL systems themselves are not new
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Oh, of course. And right now there are DSNs helping. But with the much larger rollout (including to lots of people who've never used a pump before) I'm sure there's lots to learn about how to do this at some scale.
 
Finn said:
While the process of getting on a HCL system will be new for the NHS, HCL systems themselves are not new, so the first people put on them through the NHS won't be test subjects for the actual systems. Unless, of course, the NHS makes a deal with a manufacturer to get NHS-specific tech, like what they did with Dexcom One.

HCL are widely used in other countries, especially the US, so there are lots of test subjects around the world going before you if you're worried about it.

I'm in Germany and had my pick of three different run-of-the-mill HCL systems: Medtronic, Tandem t:slim and Ypsopump. I went with Tandem t:slim and Dexcom G6 and it's great.
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NHS has been dishing out HCL for a while just like other countries, I would have the choice of Medtronic, Tandem, Ypsopump or Omnipod 5.

Have to agree children and young adults must have priority, although far to many people are engineering there diabetes just to get on the pump list.
 
gillrogers said:
but have a big and almost paralysing fear of them.
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That is exactly the definition of disabling hypoglycaemia in the Guidance for pumps @gillrogers

“ ‘Disabling hypoglycaemia’ is when hypoglycaemic episodes occur frequently or without warning so that the person is constantly anxious about another episode occurring, which has a negative impact on their quality of life.”


I don’t see that NICE could change this definition that they have been using for decades.

So even if you don’t need 3rd party help for hypos, if they are unpredictable and cause you constant anxiety you should make your case, and let your clinic know how anxious they make you and any workarounds (eg running higher than you’d like) you use.
 
Just checked the HCL guidance, and the definition of disabling hypoglycaemia remains as above. Frequent or erratic and causing anxiety / having a negative impact on quality of life.
 
trophywench said:
Just so you know, I asked about it today at D clinic - officially they haven't yet been informed that anything is changing.
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Wow! I had my appointment at the start of last month and they told me about the upcoming change from NICE.
They did not know how it would impact their clinic but knew about the NICE update.

Shame your team don't keep up to date. Or maybe they have been knocked back too many times by the accountants that they have given up.
 
helli said:
Wow! I had my appointment at the start of last month and they told me about the upcoming change from NICE.
They did not know how it would impact their clinic but knew about the NICE update.

Shame your team don't keep up to date. Or maybe they have been knocked back too many times by the accountants that they have given up.
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A side note...i wonder how this will affect cgm as well, cos gosh knows how long i would have lasted if a pump were using libre 2 data to automatically deliver insulin to me, as it would bug out for like ages at a time and give dodgy data the first day...
 
Libre as it is now, cannot be calibrated using fingerpricks and therefore cannot possibly learn from your body what your body does when X or Y happens, because it just doesn't - whereas the likes of the Dexcom you have, can and therefore does since both whatever pump it is paired with AND your body's interstitial fluid AND the fingerpricks you do are feeding it info. I imagine/suppose but don't know that CGMs generally will actually get better and better as time goes on with the greater involvement of AI .
 
helli said:
Wow! I had my appointment at the start of last month and they told me about the upcoming change from NICE.
They did not know how it would impact their clinic but knew about the NICE update.

Shame your team don't keep up to date. Or maybe they have been knocked back too many times by the accountants that they have given up.
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A very long time ago I found out that even clinicians - and most of the other professions I really liked only do their work related things during their working hours I never said they didn't know about it - only that at about 2.30pm yesterday the Dr I saw couldn't or wouldn't tell me how or when or in what way this will be rolled out to their clients.
 
I remember self funding Libre very early on and had no hope at that time that the sensors would become available on NHS. Now that is far more available. I suspect that HCL will do the same eventually. Starting with youngsters and those wanting to get pregnancy make sense, along with those with disabling Hypos (fear or frequency) or lack of hypo awareness. I think it will come but may take a while.
 
SB2015 said:
I remember self funding Libre very early on and had no hope at that time that the sensors would become available on NHS. Now that is far more available.
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Not just "more available", but over 94% of people with Type 1 actually use a CGM. I don't know what the 6% are doing, but I presume it's some combination of people who're paying for a CGM because they can't get the right one from the NHS (yet) and some people who don't want to use a CGM for some reason (some perhaps because they find they don't work). Which is an amazing increase over ~5 years when the figure was under 10%.

Partha Kar has (recently) predicted that much the same will happen with HCL over the next 5 years. I presume getting us using a pump will be much more challenging so I'm not quite convinced he's right but I'm not so sure it's a crazy prediction. He's got journalists (and politicians) excited about the prospect so I think local areas will have a harder time than they seem to have had ignoring TA151 (the earlier pump TA).

We still don't know much about extra funding for the initial TA or the deals with manufacturers, let alone whether it might be realistic to extend it to everyone with Type 1. On the other hand the initial criteria look like they'll include most people, so extending it to everyone doesn't seem like a big jump. (With CGMs the ratio was the other way around: it went from ~25% to everyone.)
 
This isn't going to become available for all immediately, but I remember when I was diagnosed only 4 or so years ago, having to find out about CGM myself, learn how to use it myself, fund it myself, and getting quite a bit of skepticism from a DSN about it being 'too much information'. Fast forward not very long, and as @Bruce Stephens says CGM is now thanks to Prof Kar and colleagues pretty much standard of care. I suspect, over time, HCL will go the same way, but it will take time for clinics to adapt Starting with those who have rapidly changing insulin needs such as pregnant women or children makes sense to me. Fingers crossed for the future 🙂
 
At the moment you have to be under hospital care if you want a pump, GPs don’t tend to know anything about them. Is that going to change, if these systems are going to be offered to all T1s? You need someone who knows what they are doing to teach you how to use it and support you, at least in the beginning. My mum is under GP care only for her diabetes, and she’s happy with that (she’s a complete dinosaur with regards to technology and would not want any sort of CGM or pump if it was offered to her on a plate}. There must be plenty of people who would love to get one though, who might not already be under hospital care.
 
Sally71 said:
Is that going to change, if these systems are going to be offered to all T1s?
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I think that's one of the many questions we don't have an answer to, yet. Everything I've heard suggests that hospital teams will be doing the initial training and so on, but whether further mundane stuff like providing ongoing supplies might be handled by GPs isn't something I've seen mentioned.

(We're not at the stage when it's "all T1s", but the rollout is for a majority so I'd guess what happens over the next few years would likely stay if and when it is for all. Unless they come up with something that works better.)
Sally71 said:
There must be plenty of people who would love to get one though, who might not already be under hospital care.
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I'm also under the care of my GP surgery, but the hospital team is just a referral away (and I have contact details). I'd guess that's not uncommon.
 
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