Women with type 1 diabetes who are pregnant or planning a pregnancy should be offered a pregnancy-specific 'artificial pancreas' device, according to draft guidance published by NICE.
The device, known as a hybrid closed loop (HCL) system, automatically monitors blood sugar and delivers insulin through a small pump worn on the body. It removes the need for frequent finger prick tests and manual insulin injections.
The updated guideline sets out that:
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Everyone who is planning a pregnancy should be offered a pregnancy-specific HCL system from the point of pregnancy planning
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Training and support should be provided by specialist multidisciplinary teams
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Women should be able to continue using their HCL system during labour and birth, if this has been discussed and agreed in advance and it is safe to do so
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Women can choose to continue using pregnancy specific HCL systems for at least six months after birth
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Clinicians should regularly revisit the option with anyone who initially declined
The guidance also defines what a pregnancy-specific HCL system must do. It must be licensed for use in pregnancy. It must allow blood sugar targets within pregnancy ranges. It must deliver at least 5% more time within the safe blood sugar range compared to standard care.
Eric Power, interim director of the centre for guidelines at NICE, said, "Thousands of women with type 1 diabetes give birth in England and Wales every year. Every one of them faces the challenge of maintaining safe blood sugar levels for themselves and their baby, from the moment they start planning a pregnancy.
“These draft recommendations would mean that pregnancy-specific hybrid closed loop technology should be offered to all of them. The evidence shows these systems help people spend significantly more time within safe blood sugar ranges. That is a meaningful improvement in care, and it is what NICE guidance is here to deliver."
Dr Marie Anne Ledingham, consultant obstetrician and consultant clinical adviser to NICE, said, "Throughout my career, I have looked after women with type 1 diabetes through some of the most complex and emotionally charged pregnancies you can imagine. These women work incredibly hard. They are checking their blood sugar constantly, adjusting their insulin, worrying about every reading.
“Pregnancy-specific hybrid closed loop systems give clinical teams a better tool and give patients more confidence. Women come to clinic less exhausted. They sleep better and feel more in control. And we see that reflected in their blood sugar data.
“These draft recommendations set out a clear framework for offering this technology from the moment pregnancy is being planned, alongside the training and support to use it safely and effectively.”
Marc Atkin, National Specialty Advisor for Diabetes at NHS England, said, “The NHS is already offering this specialist technology to thousands of pregnant women living with type 1 diabetes because their chronic condition can make it difficult for them to effectively regulate their blood glucose levels to have a safe pregnancy.
“Effective management of blood glucose levels before and during pregnancy for women living with type 1 diabetes has been shown to reduce the risk of poor maternity outcomes, such as miscarriage, stillbirth birth and birth injuries, and minimise risk to a baby’s development.
“Having effective guidance for NHS staff on how best to utilise this technology will enable them to help these women during this special time by make their lives safer, less stressful, and more enjoyable.”
Visit: https://www.nice.org.uk/guidance/indevelopment/gid-ng10450/documents
