World-first NHS artificial pancreas rollout helps children with diabetes achieve best glucose levels since records began

Hybrid closed-loop insulin pump systems have yielded drastic improvements in controlling high blood glucose levels after being rolled out to tens of thousands of people with type 1 diabetes over the last two years.

According to experts, such benefits could eventually also help millions of people in the UK with type 2 diabetes. 

The five-year NHS rollout of hybrid closed-loop technology (HCL), also described by some as an artificial pancreas, for people with type 1 diabetes in England and Wales has reached its two-year checkpoint.

Focused on children and young people in its opening two years, the rollout has delivered a dramatic surge in adoption across England and Wales with 73 per cent of children now using the technology, up sharply from 43 per cent at launch.

England-wide adoption across all age groups now stands at 18 per cent, as the rollout shifts its focus to adults living with type 1 diabetes for its remaining three years.

The device is a hybrid closed loop system which links a continuous glucose monitor (CGM) with automated insulin pump technology.

It helps to keep blood glucose levels stable by continuously monitoring glucose levels and automatically adjusting insulin delivery using an algorithm, removing much of the mental burden of living with diabetes, especially around mealtimes and during the night.

Latest data from the recently launched National Diabetes Audit dashboards indicate that the technology, which was described as ‘sci-fi like’ at the start of the rollout, is already delivering life-changing results.

In children and young people with type 1 diabetes, median HbA1c levels, a key biomarker of blood glucose management, fell from 58 to 55.5 mmol/mol over the course of the rollout.

These are the lowest levels since records began more than 15 years ago, bringing national levels closer to NICE’s target HbA1c level of 48 mmol/mol (6.5 per cent) or lower, which has been set as a target to minimise the risk of long-term vascular complications.

A total of 19.2 per cent of children and young people are now achieving the NICE-recommended target, compared with 15.4 per cent before the rollout.

Crucially, the percentage of children with HbA1c above 69 mmol/mol, which indicates a significant increased risk of complications, fell from 21.1 per cent to 14.9 per cent.

Internationally, real world studies show childhood type 1 diabetes HbA1c levels typically range between 60 to 73 mmol/mol, suggesting that the NHS scheme is achieving remarkable progress when compared against similar health systems worldwide.

Notably, children and young people using the HCL systems have the lowest HbA1c of all treatment groups, demonstrating that uptake of this technology is a key driver of the national improvement in blood glucose outcomes.

In addition, the percentage of children and young people with type 1 diabetes experiencing at least one hospital admission for diabetic ketoacidosis (DKA) not associated with diagnosis fell by half from 0.8 per cent to 0.4 per cent. DKA is a life-threatening complication caused by uncontrolled high blood glucose levels.

Dr Alistair Lumb, Consultant in Diabetes at Oxford University Hospitals NHS Foundation Trust and Chair of the Diabetes Technology Network-UK, said: “A sustained increase in time spent in the target glucose range can transform daily life for people with type 1 diabetes.

“It means stable glucose levels, better sleep, more energy, less mental strain and freedom from constant monitoring.”

Dr Lumb added: “Over time, this can also help lower the risk of long-term complications that can affect the eyes, kidneys, nerves and heart.”

Hilary Nathan, Director of Policy at Breakthrough T1D, said: “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 guidance from people with lived experience, but we cannot congratulate ourselves just yet as too many people still face barriers to accessing the technology that could transform their daily lives.

“Access must not depend on where someone lives or their confidence in navigating the healthcare system.”

She continued: “The priority now is to press on to ensure equitable access across all four nations so that everyone has a genuine choice of the technology that suits them when they need it and no one is left behind.”

These improvements are significant because the NHS spends about £10.7 billion a year treating diabetes, with 60 per cent of that on treating associated complications.

A 2025 health economic study found that that even modest improvements in blood glucose levels can reduce diabetes complications by up to 53 per cent and save healthcare systems millions in reduced complication costs.

Breakthrough T1D UK says more than 400,000 people in the UK are living with type 1 diabetes, yet only 30 per cent currently meet recommended blood glucose targets.

Cases in children have been on the rise since the COVID-19 pandemic, with diagnosis rates increasing by 14 per cent in the first year and 27 per cent in the second year compared with pre-pandemic levels.

The decision by the National Institute for Health and Care Excellence (NICE) to approve the use of HCL systems for the management of blood glucose levels among key parts of the population paves the way for one of the most exciting and consequential developments in diabetes care offered by the NHS.

Once the NICE technology appraisal has been fully implemented, the health service in England and Wales is set to become a world leader in the management of type-1 diabetes as one of a handful of national health systems providing HCL technology as part of standard, publicly reimbursed care.

Andy Nicholson, MiniMed Director for UK & Ireland, said: “Two years ago, the NHS made automated insulin delivery a reality for more people with diabetes across the UK, transforming lives with greater peace of mind and freedom.

“At MiniMed, we are honoured to support the NHS in expanding access to HCL therapy, believing that everyone deserves the best outcomes with the least burden.”

He added: “We remain committed to working alongside the NHS and the diabetes community so more people can benefit from this life-changing technology.”