Faster rollout of life-changing insulin technology needed for adults with diabetes

The guidance recommended automated insulin delivery (AID), or hybrid closed-loop, technology for children and young people with type 1 diabetes and for many adults. The importance of the guidance was recognised in NHS England’s response: a five-year implementation plan that included ring-fenced funding to support wide adoption². This was a distinctive move for a distinctive technology.

The question is no longer whether AID works. It is how quickly health systems can make proven technology available to those who stand to benefit most. The national leadership that gave us the NICE guidance and the five-year plan is needed just as much today. Health secretary Yvette Cooper should make it her priority to commission a high-level assessment of what is now needed to make good on the guidance. This is particularly important for the larger adult population, where equitable implementation is more challenging. This would both focus minds on what remains to be done and reaffirm national commitment to transforming the lives of people with type 1 diabetes.

NHSE’s own baseline assumption is that only around 30 per cent of eligible adults will be started on AID technology by the end of the five-year plan period³. This shows the gap that remains and the urgency of the further strategic investment still required. The NHS locally also needs to plan for this, supported by clear national leadership.

Insulet’s work with a number of integrated care boards has revealed what might be called the evidence paradox. AID technology is cost-effective in NICE’s terms, yet system leaders want additional evidence before accelerating implementation. This relates to the beneficial impact of AID on the NHS itself, such as cost and capacity savings.

People whose type 1 diabetes is better managed than with daily injections will make far less of a call on NHS resources over time. The systems also generate data that improve individual care and, in aggregate, help strengthen services and prioritise resources. There can be few better examples of the data-led transformation the NHS wants to achieve.

When AID technology is adopted at scale, the impact is compelling. People living with type 1 diabetes spend more time in a healthy glucose range⁴. Hospital admissions related to acute complications fall⁵. The risk of costly long-term complications decreases^6,7. Quality of life meaningfully improves and societal productivity increases⁸.

AID is testing how the NHS can move beyond introducing new technologies and instead use them to redesign care. This will mean new workforce models, smarter and more proactive use of data, greater attention to health inequalities, and a shift towards personalised, digitally enabled support. As technology takes on much of the routine burden of diabetes management, specialist teams can focus their expertise where it adds greatest value: complex decision-making, education, behavioural support, and helping people achieve their individual goals. This shifts the focus towards prevention, heading off the ill health associated with poorly controlled diabetes.

The success of implementation so far is to the credit of the NHS. Three-quarters of children and young people are now using AID technology⁹. The path ahead looks steeper. Government should invest in AID and recognise the pressures on ICBs. Just as valuable is its leadership. By recommitting to the full implementation of NICE TA943, the secretary of state would send an important signal to the NHS that this area needs its continuing commitment and support.

The ultimate success of NICE’s guidance should not be measured just as an adoption percentage. It lies in whether the guidance works for both people with diabetes and for the NHS: whether it can help create a more preventative, data-led, and people-centred model of diabetes care. With the right policy decisions and commitment, it can do all of these things.

References

^1. National Institute for Health and Care Excellence (2023). Hybrid closed loop systems for managing blood glucose levels in type 1 diabetes (Technology Appraisal Guidance TA943). Published 19 December 2023.

^2. NHS England (2024) Hybrid closed loop technologies: 5-year implementation strategy. London: NHS England. Available at: https://www.england.nhs.uk/publication/hybrid-closed-loop-technologies-5-year-implementation-strategy/ (Accessed August 2026).

^3. Hybrid Closed Loop Technologies Reimbursement Fund, Guidance for ICBs, NHS England, Version 4, March 2026

^4. Renard E, Weinstock RS, Aleppo G, Bode BW, Brown SA, Castorino K, et al. Efficacy and safety of a tubeless AID system compared with pump Therapy with CGM in the treatment of Type 1 diabetes in adults with suboptimal glycemia: a randomised, Parallel-Group clinical trial. Diabetes Care. October 18, 2024; 47(12):2248–57.

^5. Royal College of Paediatrics and Child Health (RCPCH). National Paediatric Diabetes Audit (NPDA) - Reporting dashboards. Quarterly Data 2025/26 Q3. Accessed August 2026. National Paediatric Diabetes Audit (NPDA) - Reporting dashboards.

^6. Roy W. Beck, Richard M. Bergenstal, Tonya D. et al. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. Diabetes Care 1 March 2019; 42 (3): 400–405.

^7. De Meulemeester, J., Charleer, S., Visser, M.M. et al. The association of chronic complications with time in tight range and time in range in people with type 1 diabetes: a retrospective cross-sectional real-world study. Diabetologia 67, 1527–1535 (2024).

^8. Elliott J, Hopley C, Riley D, Dodd O, Maranes LV, Tomas M, et al. Assessment of the added value of a tubeless pump: A time trade‐off (TTO) study for utility elicitation of insulin delivery systems in type 1 diabetes mellitus (T1D). Diabetic Medicine. October 30, 2025; 42(12):e70156.

^9. Hybrid Closed Loop (HCL) use in those with type 1 diabetes as at end of Quarter 4 2025/26: Power BI dashboard. Available at: NHS England HCL Dashboard (Accessed August 2026).