CamAPS FX 1 Dr Sophie Harris Deputy Clinical Director Diabetes September 2021 Role of the HIN Health Innovation Network role to spread and adopt best practice across S London Particularly focusing on improving equity of access to evidence based innovationsinterventions ID: 1037863
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1. Closed loop technology for Type 1 diabetes; CamAPS FX1Dr Sophie Harris – Deputy Clinical Director (Diabetes)September 2021
2. Role of the HINHealth Innovation Network role to spread and adopt best practice across S. LondonParticularly focusing on improving equity of access to evidence based innovations/interventionsWork closely with other AHSNs (e.g. East of England – CamAPS FX)HIN has track record of working with different industry partners, NHS Trusts and commissioners e.g. Pump collaborative
3. Background3KCH & GSTT look after over 4,500 adults and children with Type 1 diabetes; both local and tertiary referralsPathways exist in South London to ensure that people with Type 1 diabetes and severe hypoglycaemia (low blood glucose requiring assistance/admission) are eligible for insulin pump or continuous glucose monitor sensor (CGMS)Technology advancement allows use of CGMS linked to pump to create a ‘closed loop’ or ‘artificial pancreas’ system that automatically adjusts insulin delivery according to blood glucose reading.This technology has been proven to improve glycaemic control (highs and lows), reduce hypoglycaemia and improve time in range. All of these are likely to contribute to reduced acute admissions and reduced risk of long-term complicationsKCH & GSTT adult diabetes teams already offer this technology to a small proportion of their patients:352 (8% of total clinic population)
4. 4Presentation titleDiabetes technology consensus pathwaySource: https://www.diabetes.org.uk/resources-s3/2019-03/Type%201%20Tech%20pathway%20position%20statement%20FINAL%20MARCH%202019.pdf
5. Product – CamAPS FX5There are currently 2 closed loop products available in the UK & used at KCH & GSTTMedtronic systems (640G, 670G & now 780G)Tandem IQ - T-slim & Dexcom CGMSCamAPS FX is an addition to market; unlike the other systems it is an app that provides the link between CGMS and pump (currently Dexcom and Dana pump but likely to expand)CamAPS FX and the algorithm was developed by Professor Hovorka at the University of Cambridge & has been extensively tested.CamAPS FX is CE marked for people with Type 1 diabetes aged 1 year and older. The app was launched in the UK March 2020, see www.camdiab.com.
6. Three closed loop systems compared6Close loop systemClinical benefitsLicensed in children (age)Licensed in pregnancyAdditional benefitsMedtronic 670gImproved HbA1cReduced hypoglycaemia7 yearsNoFree updatesCarelink platformTandem Control IQImproved HbA1cReduced hypoglycaemia6 yearsNoSmartphone controlFree updatesDiasend streamingCamAPS FXImproved HbA1cReduced hypoglycaemia1 yearYesSmartphone controlPlanned intra-operability with other CGMS/CSIIDiasend streaming (remote consultation)Automatic updates (AI)
7. King’s Health Partners closed-loop eligible population 2021/227TrustCurrent number of patients on closed loopCurrent number on BOTH CSII and CGMSPredicted number eligible for closed loop in 20/21Predicted up-grade on CSII & CGMS in 20/21Total for 20/21GSTT adults331685842100KCH adults301845080120Paeds SEL (aged 1-6yr)0?9 (2-3/yr each site)09 (eligible for CamAPS FX only)
8. NHS England Closed Loop pilot8Eligibility criteria:High HbA1c (8.5% (69mmol/mol))Using Libre flash glucose monitorUsing insulin pumpGSTT and KCH identified as sites for pilot of closed loop technologyEvaluation of psychosocial, diabetes, health economic outcomes12 month pilotEnd of pilot return to pre-pilot technology
9. Summary of benefits9Greater choice for our T1 diabetes populationCompatible with different technology across commercial products -> potential to open the market for future further cost reduction & choiceSupport from local clinicians with clear eligibility pathwayBroader licencing: Younger aged children PregnancyNo additional cost to CCGPresentation title
10. The ask:10Currently, Diabetes technology sits under the insulin pump framework (Tower1). Specialist care provides diabetes technology in clinic and the cost is reimbursed via CCG with consumables (e.g. tubing and insulin) provided via GPWork with HIN to navigate the system to deliver an innovative subscription service available to meet local needSetting a precedence for the future subscription commissioningFacilitate equity of accessSupport clinical training / support across S. London