Artificial Pancreas Rollout Narrows Inequality in Diabetes Treatment
The introduction of a "life-changing" artificial pancreas for individuals with type 1 diabetes on the NHS has contributed to reducing ethnic and socioeconomic disparities in access to treatment, according to recent data.
Known officially as a hybrid closed-loop system, the artificial pancreas integrates three components: a continuous glucose monitor sensor worn on the body; an algorithm embedded in the insulin pump or a separate device such as a smartphone that calculates precise insulin doses; and an insulin pump that administers the insulin into the bloodstream.
This device alleviates much of the mental burden associated with managing blood glucose levels, particularly around meals and overnight. Clinical trials have demonstrated that the artificial pancreas is more effective at diabetes management than previous technologies, including continuous glucose monitors alone.
Historically, uptake of diabetes technologies has exhibited significant disparities based on ethnicity and deprivation. Studies indicate that people from minority ethnic backgrounds in England have been less likely to access continuous glucose monitors, and those from deprived backgrounds have also experienced lower access rates.
However, data from the first two years of the artificial pancreas rollout reveal a reversal of this trend, with only a 3% difference in uptake between the most and least deprived groups, as well as between minority ethnic groups and white counterparts.
Patient Experience: Naiha Shafiq
Naiha Shafiq, 27, from London, has been using an artificial pancreas for three years. She described the device as "life-changing," noting that prior to its use she was frequently hospitalized with diabetic ketoacidosis, a severe complication resulting from difficulties managing insulin injections.
"There was a time I would be in hospital every three to five days," Shafiq said. "When I fell pregnant, I knew something had to change for me for the sake of my son. That’s when the team introduced me to the pump. I was very hesitant at first but once I got started, I loved it."
Shafiq also highlighted challenges related to her religious beliefs that made insulin injections difficult. As a Muslim woman who wears a hijab, she often struggled to find private places to inject insulin, sometimes missing doses due to discomfort. The pump has simplified her management of diabetes considerably.
"As a Muslim woman who wears hijab it was extremely difficult for me to be on injections as I would always look for somewhere private to inject most times, and if there was nowhere private to inject I would miss injections because I wasn’t comfortable. The pump makes life now so much easier."
Rollout Progress and Future Plans
In 2023, the NHS reported that over 150,000 adults and children with type 1 diabetes are currently receiving care. The initial two years of the artificial pancreas programme have prioritized children, with approximately 32,000 children fitted with the device on the NHS, representing 72.3% of those eligible. The programme will continue over the coming years until all eligible children and adults with type 1 diabetes have access to the device.
Expert Perspectives
Helen Kirrane, head of policy and campaigns at Diabetes UK, emphasized the significant impact of the device.
"We’re incredibly proud of the role Diabetes UK research and advocacy has played in getting us to this point, where a world-leading rollout is taking place on the NHS with equity at its very core," Kirrane said. "But it is clear there is more work to be done and, with some people still missing out on this transformative technology, the challenge now is ensuring that everyone who is eligible can access it across the UK, regardless of their background or where they live."
Hilary Nathan, director of policy at Breakthrough T1D, highlighted the UK's leadership in this area.
"The UK is rightly being recognised as a global leader in the rollout of hybrid closed-loop systems for people living with type 1 diabetes, reflecting years of research, advocacy and leadership from people with lived experience.
"The priority now is to ensure equitable access across all four nations of the UK, so that everyone has a genuine choice of the technology that suits them when they need it and so the benefits of innovation are felt fairly across every community, with no one left behind."
Dr Clare Hambling, National Clinical Director for diabetes and obesity, praised the progress made.
"It is fantastic to see that the world-first rollout of this ground-breaking technology is already transforming the lives of tens of thousands of children and young people living with type 1 diabetes on the NHS.
"These revolutionary devices have a represented a real step-change in care for so many families and this progress is testament to the dedication of our paediatric diabetes teams across the country to ensure as many young people who need them have been able to access them as quickly as possible, no matter where they live."
