NHS rolls out new generation ‘artificial pancreas’ to help pregnant diabetic women

Thousands of mums-to be in England living with type 1 diabetes are to receive a pregnancy-specific, ‘artificial pancreas' from the NHS to protect mothers and babies' health.  

Under a first of its kind initiative for the NHS in England, local healthcare systems are offering an enhanced type of Hybrid Closed Loop system– also known as an ‘artificial pancreas' to women who have type 1 diabetes who are pregnant or planning a pregnancy, so they can effectively manage their blood glucose levels.

Around 2,000 women in England living with type 1 diabetes become pregnant each year- according to NHS data –and pregnancy hormones can make it harder for them to regulate their blood glucose levels. If diabetes isn't controlled during pregnancy it can lead to stillbirth, miscarriage, birth injuries and increased need for neonatal care.

The revolutionary technology consists of an insulin pump, a glucose sensor, and an advanced algorithm that runs 24/7 on a mobile phone app, which calculates and delivers the precise insulin dosages a woman requires before and during pregnancy.

It also uniquely allows the pregnant women to set a glucose target- unlike other ‘artificial pancreases' – to the lower level required to achieve better outcomes in pregnancy.

More than 600 pregnant women with type 1 diabetes have already been given the life-changing technology by NHS diabetes specialist midwives and diabetologists, under the initiative's first phase.

Kate Brintworth, Chief Midwifery Officer for England, said: “This life-changing technology is great news for women 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.

“The NHS is offering this cutting-edge ‘artificial pancreas' because we want to transform the experiences of women with type 1 diabetes– helping to make this special time in their life safer, less stressful, and more enjoyable.”

Alongside eliminating the need for women living with type 1 diabetes to regularly take finger prick tests and injections of the insulin to treat their condition, the specialist artificial pancreas's digital technology also enables NHS diabetes teams to monitor a user's glucose levels remotely which means mums-to-be can get checks-up by phone from home instead of having to frequently attend hospital appointments. 

Difficulties in controlling blood sugar levels can lead to pregnant women living with type 1 diabetes to have larger babies. On average babies of mothers with type 1 diabetes can be around 50% larger for their gestational age.

Large for gestational age babies are predisposed to developing obesity, type 2 diabetes and cardiovascular disease in later life.

One mother with type1 diabetes who has benefited from using the new generation, pregnancy-specific artificial pancreas is Nina Willer, 40 years-old from Norwich and mum to two children. Nina is a Diabetes Specialist Midwife at Norfolk & Norwich University hospital. Her condition affects many parts of Nina's life, such as food choices and how she manages stress. Nina has also had to learn the intricacies of insulin dosing, inserting cannulas and using continuous glucose monitors to prevent herself having hypoglycaemic (low glucose) and hyperglycaemia (high glucose) attacks, which can lead to seizures, coma or even death.

During her first pregnancy, Nina used an insulin pump and did finger prick glucose tests every hour during the day and every 30 mins overnight. Nina was terrified her glucose levels would drop to a dangerous low level, but also understood that if they went above target for a prolonged time it could cause complications for the baby and the pregnancy. Nina managed to get through that pregnancy and delivered her baby at 36 weeks. Shortly after her birth, Nina's daughter went to Neonatal Intensive Care, for a week, where she received treatment for jaundice, weight issues and other health complications.

For her second pregnancy, Nina used the new developed, specialist Hybrid Closed Loop system- also know an artificial pancreas -for pregnant women. Within hours of being put on the system, Nina noticed huge changes. The system learnt about her glucose patterns very quickly and Nina notice that when her glucose levels started to rise, the system gave her more insulin, and when her levels started to drop, it withheld insulin, meaning she did not then go on to have a hypoglycaemic incident. When Nina felt nauseous and didn't want to eat breakfast, the system understood and kept her glucose levels steady. For the first time in her life, Nina woke up every single morning with a completely normal glucose level, and achieved a full night's sleep. Nina's second daughter was born healthy at 36 weeks pregnant, and they were home and settled 24 hours later.

Nina, said: “This new generation ‘artificial pancreas' is a gamechanger for women with type 1 diabetes who are pregnant or planning a pregnancy, so it is fantastic that its available on NHS to protect the health of mums-to-be and babies.

“As someone who has used this tech when I was pregnant with my own daughter, and as an NHS diabetes specialist midwife to help my patients, I've both experienced and seen how this technology can quickly and simply help women with type 1 diabetes achieving much better glucose levels; and ease the physical and mental burden of this condition.

“I am so proud of what the NHS is doing with the help of this technology, and am acutely aware of the onward effect that this will have, not only for patients but their family, their livelihood and of course their long-term health, once a pregnancy is complete.”

The rollout of pregnancy-specific artificial pancreas technology is a key component of version three of NHS England's innovative Saving Babies' Lives Care Bundle', which includes a range of initiatives for the NHS to reduce stillbirths, preterm births and brain injuries in England. 

Partha Kar, Type 1 Diabetes Technology Lead, NHS England, said: “The rollout of this technology is another example of the NHS taking action to ensure that patients can benefit from the latest technological innovations to improve their medical care.

The universal uptake of Continuous Glucose Monitors by women living with type 1 diabetes was driven by NHS action on this issue in 2019- a global first- and has led to improvements in outcomes for them. It has also paved the way for yet another ‘first' for the NHS by enabling us rollout out this specialist Hybrid Closed Loop system.

“This ingenious- yet simple -technology is helping pregnant woman living with type 1 diabetes- and those planning a pregnancy – live better lives, improving maternal outcomes for them, reducing serious health complications, and making care simpler.”

Type 1 diabetes is thought to develop due to a combination of genetics and other factors which are not yet fully understood, but there is nothing to indicate that lifestyle plays a part.

Amina Hatia, Midwifery Manager for Tommy's, the pregnancy and baby charity, said: “At Tommy's, we know that pregnancy can be a particularly challenging time for women and birthing people living with Type 1 diabetes, and that the right support and technology can make all the difference.

The introduction of artificial pancreas technology for those who are pregnant or planning a pregnancy is a welcome step towards more personalised, compassionate care that empowers women and birthing people to make informed choices about their health. Having access to the best available evidence-based tools can reduce risks, improve outcomes and help reduce inequalities that sadly still exist.

“Every parent deserves the chance to have a safe, healthy pregnancy – and innovations like this bring us closer to making that a reality for everyone.”

Health chiefs have provided £3.7m to local healthcare systems to support the technology's rollout to women who need it, which is part of a wider £60m fund to make the technology available to other groups of patients impacted by type 1 diabetes, this year.

Anthony Walker, Senior Policy Officer at Diabetes UK, said: “Hybrid closed loop technology has the potential to transform the lives of many people with type 1 diabetes. The technology is especially beneficial for people with type 1 diabetes who are pregnant, where it has been shown to improve management of glucose levels and outcomes for both the mother and the baby.

“Offering the hybrid closed loop systems that are proven to be most effective during pregnancy - and the additional devices like mobile phones needed to use them - is essential in ensuring that everyone has access to the right technology for them."

Since 2017/18, NHS England has made around £150 million of transformation funding available to support projects from local health systems to reduce variation in access to services and improve outcomes for people living with Type 1 and Type 2 diabetes.

Health Minister Gillian Merron said: “Motherhood should be one of the most exciting times in a woman's life but for thousands with type 1 diabetes, pregnancy can pose a risk to their and their baby's health.

“Our Plan for Change will ensure that cutting-edge technology gives patients the treatment and peace of mind they need.

“This is a good example of fulfilling promises in our 10 Year Health Plan both to deliver more urgent care in the community right in people's home and to shift the emphasis from sickness to prevention.”

Information about NHS support for diabetes and pregnancy is available on NHS.co.uk.