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Women with type 1 diabetes should be offered a pregnancy-specific hybrid closed loop (HCL) system on the NHS from the point of planning a pregnancy, draft guidance from the National Institute for Health and Care Excellence (NICE) recommends.
HCL devices — also known as an “artificial pancreas” — automatically monitor glucose levels and deliver insulin through a wearable pump. In 2023, they were recommended for women with type 1 diabetes who are pregnant or planning a pregnancy, and NICE agreed a five-year roll-out plan for the devices with NHS England.
The new NICE guidance, published on 3 June 2026, expands on the 2023 guidance and sets out that for this cohort, devices must be licensed for use in pregnancy, have a glucose target of ≤5 mmol/L, and show evidence of a clinically relevant improvement in maternal glucose outcomes compared with standard care (continuous glucose monitoring and insulin injections, or an insulin pump alone).
Currently, just one system that meets these requirements is available: CamAPS FX (Ypsomed mylife).
Under the new guidance, patients can continue using their pregnancy-specific HCL system during labour and birth, if this has been discussed, agreed in advance and it is safe to do so, and for at least six months after birth.
NICE also said clinicians should offer training and support on HCLs for women with type 1 diabetes who are pregnant or planning a pregnancy, and should regularly revisit the option with anyone who initially declined.
In an announcement alongside the guidance, Marc Atkin, national specialty advisor for diabetes at NHS England, said: “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.”
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.”
Commenting on the guidance, Eleanor Scott, professor of medicine (diabetes and maternal health) at the University of Leeds, told The Pharmaceutical Journal: ‘The evidence from clinical trials and real-world data is increasingly clear: using a pregnancy-specific system is essential for improved outcomes for mothers with type 1 diabetes and their babies.
“Pregnancy places uniquely demanding metabolic challenges on glucose management, and a purpose-designed system is demonstrably better equipped to meet them. It is excellent news that NICE has carefully reviewed this evidence and updated its guidance accordingly — a decision that, alongside NHS England’s implementation through Saving Babies Lives, will maximise benefits for every woman with T1D navigating pregnancy,” she said.
In 2023, Scott co-authored a study that found HCL therapies significantly improved glycaemic control compared with standard insulin therapy.
The consultation on the draft guidance closes on 16 June 2026.
