Lack of Access to Type 1 Diabetes Technology 'Unacceptable'

Liam Davenport

March 11, 2019

LIVERPOOL — Less than one third of type 1 diabetes patients in England and Wales are achieving their glycaemic control targets partly due to a lack of access to proven technologies that have been fully funded by the NHS, say experts.

Giving a joint presentation at the Diabetes UK Professional Conference, Dr Partha Kar, associate national clinical director for diabetes for NHS England and a consultant at Portsmouth Hospitals NHS Trust, said that only 29.9% of type 1 diabetes patients met their HbA1c target in 2017/18.

The data, which comes from the National Diabetes Audit, showed that, in contrast, the proportion of type 2 diabetes patients meeting their HbA1c target was more than twice that, at 65.8%.

'Stark Differentiation'

Dr Kar said: "There is a stark differentiation in the types of diabetes care. Have we lost our focus over type 1 diabetes?"

He went to say that he has found that there are areas where the local specialist says: "I don't do pumps."

He continued: "The problem is when we go into areas where the data isn't good and the answer is a shrug of the shoulders.

"It doesn't matter how much money you bring, it doesn't matter what your clinical commissioners can or cannot do. It matters what that person wants to do, and that it is something big that we are tackling."

Dr Kar underlined: "If as a specialist team, you're saying I can't be bothered, then my position would be that you shouldn't do type 1 diabetes care. Give it to somebody who is bothered.

"And we're not that far away from when patients will turn around and say: 'Do you know what? I'll go to a place which is bothered.'"

Flash Glucose Monitoring & CGM

Taking over from Dr Kar, Dr Emma Wilmot, a consultant diabetologist at University Hospitals of Derby and Burton and chair, ABCD Diabetes Technology Network (DTN) UK, said that 2018 nevertheless saw a number of achievements in type 1 diabetes care.

She said that the type 1 diabetes Technology Pathway developed by NHS England and Diabetes UK, alongside a multidisciplinary group of experts, was launched.

In addition, flash glucose monitoring with Freestyle Libre and continuous glucose monitoring (CGM) during pregnancy was fully funded, and a working group for CGM in pregnancy was established.

Educational events were held that saw the participation of over 220 healthcare professionals, and DTN UK published three Best Practice Guidelines.

Moreover, the organisation launched an education programme for flash glucose monitoring.

Dr Wilmot said, however, that she is concerned about staffing for type 1 diabetes services, and that "trying to argue the case for more staffing is really challenging".

Staffing Levels

To examine the current situation for staffing levels, a National Diabetes Type 1 Service Audit was conducted in 2018, with the results due in 2019.

Despite these developments, Dr Wilmot told the audience that, in terms of the Technology Pathway, "we have all got our work cut out in terms of making sure we deliver this".

She emphasised that a large part of this is achieving equitable access to structured education for healthcare professionals, "and we know how difficult it is to ensure, firstly, there are enough places in your locality and, secondly, that the people who need access can get it".

Dr Wilmot said that, for NHS patients with type 1 diabetes, there is currently a greater than 10-fold variation in access to continuous subcutaneous insulin infusion (CSII), or insulin pumps.

Furthermore, only 1 in 5 Clinical Commissioning Groups are treating type 1 diabetes in line with National Institute for Health and Care Excellence guidelines.

The consequence is that the uptake of Freestyle Libre in England is so far just 3% of the total number of potential patients, compared with 13% in Scotland, 17% in Wales and 44% in Northern Ireland.

Dr Wilmot underlined: "We all have an individual responsibility to ensure that we have the services that meet the needs of the type 1 diabetes population."

She told the audience that "if you're struggling on this and you're getting push back, bring it to the DTN committee and we'll help you with that".

Best Practice

For 2019, Wilmot said that DTN UK will publish three best practice guides, one of which will be focused on pregnancy and CSII/CGM.

She explained: "When a patient turns up on a Friday night and something's gone wrong, they'll know how to troubleshoot them and keep people safe."

Other guides published in 2019 will consist of one on CGM, and the other a technology guide for diabetes in primary care.

After outlining other educational and technology initiatives for the coming year, Wilmot turned her attention to DIY artificial pancreas systems (APS).

She said that they are a controversial area in diabetes care, at least in part because they are unregulated and the risks are unknown.

She added that it "makes us feel uncomfortable as healthcare professionals in terms of where we stand.

"We're delighted to announce that ABCD will be supporting a national audit of DIY APS users, so when you see someone in clinic, you can collect data on admissions, and get some objective data as to whether this is safe, not safe or there are risks."

Finally, Dr Wilmot highlighted the priorities for DTN UK in 2019, which include improved access to technology, with a focus on delivering CGM to pregnant women and addressing the "unacceptable variation in access to diabetes technologies."

No conflicts of interest or funding declared.

Diabetes UK Professional Conference: Diabetes technology update. Presented March 8.

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