Intended for healthcare professionals


Closed loop systems in type 1 diabetes

BMJ 2018; 361 doi: (Published 18 April 2018) Cite this as: BMJ 2018;361:k1613
  1. Norman Waugh, professor of public health medicine and health technology assessment1,
  2. Amanda Adler, consultant physician and chair2 3,
  3. Ian Craigie, chair4,
  4. Timothy Omer, person with type 1 diabetes5
  1. 1University of Warwick, Warwick CV4 7AL, UK
  2. 2Addenbrooke’s Hospital, Cambridge, UK
  3. 3NICE Technology Appraisal Committee B, London, UK
  4. 4Scottish Study Group for the Care of Diabetes in the Young, Greater Glasgow and Clyde Children’s Diabetes Service, Glasgow, UK
  5. 5#WeAreNotWaiting patient movement, London, UK
  1. Correspondence to: N Waugh norman.waugh{at}

A promising development, now patients and policy makers need much better evidence

People with type 1 diabetes, whose immune systems destroy their insulin producing pancreatic cells, must inject insulin to stay alive. Tight control of plasma glucose prevents or delays complications such as retinopathy and nephropathy; it also avoids hypoglycaemia, the most common adverse effect of insulin treatment, which can cause, at worst, disorientation and death.

To achieve glycaemic control, people need either multiple daily injections (including long acting basal insulin once or twice daily, plus short acting insulin with meals) or an insulin pump (continuous subcutaneous insulin infusion). They must monitor blood glucose concentrations (generally by finger pricking), and adjust their insulin doses based on blood glucose, food and alcohol intake, and physical activity.1 They should learn to adjust insulin doses through structured education programmes such as DAFNE (dose adjustment for normal eating),2 or similar programmes for children and adolescents.

The key to achieving good control is self-management. But that is hard, even for the best motivated and educated individuals. Most people with type 1 …

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