People with learning disabilities and mental health conditions are being denied access to innovative diabetes technology that could help them manage their condition more safely, according to a new safety investigation report.
The report found that access to so-called “artificial pancreas” technology is inconsistent across England, with eligibility and uptake often influenced by where patients live. Investigators also uncovered evidence suggesting that some individuals may have faced barriers to access because of their age or disability.
Known as hybrid closed loop (HCL) systems, the technology automatically adjusts insulin delivery by linking an insulin pump with a continuous glucose monitor. When used safely, HCL systems can reduce the risk of serious complications while easing the day-to-day burden of diabetes management.
However, the investigation found that assumptions about patients’ ability to use the technology safely are contributing to unequal access. Several healthcare professionals expressed concerns that HCL systems could be “too difficult” for people with learning disabilities to manage.
Despite these perceptions, investigators identified specialist teams successfully supporting individuals with learning disabilities and mental health conditions to use the technology through tailored training and ongoing support programmes.
The findings come at a crucial time for the NHS rollout of HCL systems. While more than three-quarters of eligible children and young people have access to the technology, uptake among eligible adults remains significantly lower, with only around one in eight currently using an HCL system.
The NHS is now halfway through its five-year rollout programme, but clinicians reported uncertainty about how access and support will be maintained once the initiative concludes. The report calls on NHS England and the Department of Health and Social Care to develop clear, long-term guidance to ensure equitable and sustainable access to the technology, particularly for adults with more complex needs.
The investigation also highlighted workforce challenges, revealing that some healthcare staff do not feel adequately prepared to support patients who already use HCL systems. Community nurses reported a lack of training, with some describing feeling “fear” around the technology and admitting they “wouldn’t touch” an HCL system because they lacked the confidence to manage it.
This latest publication is the final report in a series of four investigations examining how people with diabetes manage their own insulin in community settings. Across all four reports, recurring issues were identified, including inconsistencies in service provision, workforce capability and care coordination.
As a result, investigators are calling for a nationally coordinated approach to community diabetes care that better integrates GPs, community nursing teams, diabetes specialists, mental health services and learning disability support services.
Nick Woodier, Senior Safety Investigator said:
"This technology can make a real difference to people’s lives. But even if someone meets the criteria to receive the technology, whether they get it may depend on where they live, or on assumptions about what they can manage. We recognise that technology may not be safe for some people, but we also met NHS teams who had helped people with learning disabilities and mental health problems to use it safely. That kind of support should be available to everyone who could safely benefit.”
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