t:slim X2 insulin pump for managing blood glucose levels in type 1 diabetes

Level of innovation

All experts viewed the device as an improvement to standard care when combined with a G6 continuous glucose monitor (CGM). One expert thought it was innovative specifically with the additional use of the Control‑IQ software. Four of the experts mentioned improvements because calibration (using finger prick testing) is not needed for the G6 CGM. Two experts mentioned the increased accuracy of this CGM. The other advantages of this device listed were the reduced size of the pump, larger touch screen and the ability to remotely update software.

Potential patient impact

All experts thought that the increased time within glucose target range was the main benefit of the t:slim X2 insulin pump and CGM system. All experts thought that this system would improve quality of life and 2 experts noted that it would reduce the burden of diabetes self-management. Two experts mentioned that education in device usage and diabetes care is also a key factor in improving diabetes management.

The experts thought that this device would mostly benefit people with recurrent severe hypoglycaemia or those who lack hypoglycaemia awareness. It could also benefit other groups of people including those who are unable to maintain glucose control despite using either a CGM or insulin pump in isolation; those showing signs of developing diabetic complications; young people who may have changing basal insulin requirements; and to support optimal glucose for people awaiting pancreas or islet transplantation.

Potential system impact

Overall, experts thought that better diabetes self-management would lead to a reduced burden on the NHS. This includes reduced outpatient attendance; fewer emergency admissions and ambulance call outs; as well as reducing future diabetes-related complications.

Two of the experts thought this technology would cost less than standard care and 1 expert thought it would be cost neutral in the long term because of potential reductions in diabetic complications. One expert thought it would cost less or the same depending on whether the long-term effect of manging HbA1c levels led to reduced diabetic complications. One expert thought it would cost more than standard care as insulin pumps with or without CGMs are not currently routinely used for all patients.

Two experts felt there would be no current resource impact because the proportion of patients with insulin pumps is currently low. Two experts stated there would need to be an increase in healthcare staff and education to implement widespread use of an insulin pump. This would be in addition to increased administrative support to maintain patient records and data. One expert suggested that the technology is best started in specialised centres to gain experience in supporting patients.

No safety issues were identified by the experts, aside from the general risk of hyperglycaemia from insulin pump use.

General comments

The experts commented that they have had positive experiences with the technology. However, they did mention that the uptake is limited by the criteria for accessing CGMs and insulin pumps on the NHS. As a result, some patients chose to buy their own pumps or CGMs. All experts suggested that this technology should be in addition to standard care. Some experts noted that different treatment options should remain available to allow for patient choice. Although all studies included were done in the US, this is similar to studies for other insulin pumps.