Wearable Tech Offer to Thousands at Risk of Type 2 Diabetes

Peter Russell

August 12, 2019

Thousands of people in England at risk of developing type 2 diabetes would be eligible to receive wearable tech to help them monitor their physical activity, the NHS announced.

It said that in pilot schemes where wearable tech also offered 24/7 online advice, and the ability to set and monitor goals electronically, there was a significant increase in the number of people joining the Diabetes Prevention Programme (DPP).

Trials of the digital DPP, involving more than 5000 people, found that:

  • 68% of those using digital support were aged under 65

  • The average age of digital participants was 58, lower than the age of those using face-to-face interventions (64 years)

  • 16% of digital registrations were aged between 18-44 years compared with 7% of the same age group who registered for face-to-face support         

Up to a fifth of places on the programme, around 40,000 a year, would be delivered digitally, NHS England said. Expansion of the digital scheme will start this month.

Jonathan Valabhji, NHS national clinical director for diabetes and obesity, said in a statement: "I’m delighted to see such a positive response among younger working age people, which shows how a digital approach can expand the reach of patients’ services as part of the NHS Long Term Plan."

Increase in Dementia and Alzheimer's Deaths

Deaths due to dementia and Alzheimer's disease in England and Wales continued to increase and remained the leading cause of death, accounting for 12.8% of all deaths registered in 2018, latest figures showed.

The Office for National Statistics (ONS) said the increase over recent years could largely be explained by an ageing population. Also, a better understanding of dementia and improved diagnosis may have caused increased reporting of dementia on death certificates.

The Alzheimer's Society called on the Government to prioritise dementia with a dedicated NHS dementia fund. "For 4 years now, we’ve seen deaths caused by dementia increase," commented Sally Copley from the Society. "We need to take action now to tackle the biggest health crisis of our time."

In 2018, there were 541,589 deaths registered, an increase of 1.6% compared with 2017. That made it the highest annual number of deaths since 1999, the ONS reported.

The figures also showed a continued trend for the gap between male and female deaths to narrow. Male life expectancy was improving at a slightly faster rate than female life expectancy, it said.

"Although 2018 saw the highest number of deaths since 1999, when taking the age and size of the population into account, death rates have remained more or less stable since 2011," explained Ben Humberstone, head of health analysis and life events at the ONS in a statement. "Mortality rates fell slightly for males but rose slightly for females in 2018. This is likely to close the gap in life expectancy between the two.

"We’re continuing to see the levelling off of mortality improvements and will understand more as we analyse this data further."

Lung Cancer Drug Approved for CDF

Immunotherapy drug pembrolizumab (Keytruda, Merck Sharp & Dohme) in combination with chemotherapy drugs carboplatin and paclitaxel should be available on the Cancer Drugs Fund (CDF) as a treatment option for untreated metastatic squamous non-small cell lung cancer (NSCLC) in adults, the National Institute for Health and Care Excellence (NICE) announced.

It said trial data suggested that people treated with pembrolizumab combination therapy lived longer than those who had standard chemotherapy. However, trial data was immature, and cost-effectiveness estimates were uncertain.

Around 7500 people in England are diagnosed each year with this type of lung cancer, of whom approximately 1700 could be eligible for pembrolizumab combination therapy, NICE said.

Use in the CDF would give time to address some of the clinical uncertainties, appraisers said.

The recommendation in draft guidance was dependent on:

  • Pembrolizumab being stopped at 2 years of uninterrupted treatment, or earlier if disease progressed

  • The manufacturer providing pembrolizumab according to a managed access agreement

NICE said that an important consideration was that patients with squamous NSCLC often had a poor quality of life, and that potential extension to life was of great importance to them.

Final guidance was expected on 11th September 2019.

Skin Cancer Drug for CDF

NICE also recommended cemiplimab (Libtayo, Sanofi) for use within the CDF as an option for treating locally advanced or metastatic cutaneous squamous cell carcinoma in adults when curative surgery or curative radiotherapy was not appropriate.

In final guidance it said that despite uncertainties over how treatment might prolong life expectancy, there was a high unmet need for treatments for a physically and emotionally challenging condition.

The manufacturer had agreed to supply the NHS with the drug at a confidential discount to the list price.

Breast Cancer Drug

Neratinib (Nerlynx, Pierre Fabre) was recommended as an option for the extended adjuvant treatment of hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-positive early stage breast cancer in adults who completed adjuvant trastuzumab-based therapy less than 1 year ago.

In final draft guidance, it said that clinical trial evidence suggested that women who have treatment with neratinib have less risk of disease recurrence than women who had treatment with a placebo. However, incomplete trial evidence meant that it was not possible to determine longevity from treatment.

Treatment cost was £4500 per box of 180 tablets for 30 days treatment.

Final guidance is expected on 2nd October 2019.

'No' to Ovarian Cancer Drug

In draft guidance, NICE rejected rucaparib (Rubraca, Clovis Oncology), for maintenance treatment in adults of relapsed, platinum-sensitive high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer that had responded to platinum-based chemotherapy.

It said that evidence showed that rucaparib extended the time until cancer progressed compared with routine care. However, it was not possible to estimate how long people lived after treatment because of a lack of trial data.

It was also not recommended for inclusion in the CDF, NICE said.

The list price for rucaparib was £3562 per 60-tablet pack of 300 mg, 250 mg or 200 mg tablets. The manufacturer estimated that the average cost of a course of treatment would be £110,897.

Consultees now have the opportunity to comment on the draft recommendations until the 27th August 2019

Flu Vaccination

NICE issued a draft quality standard aimed at increasing awareness of the flu vaccination for people in eligible groups. It identified opportunities in primary and secondary care to encourage people in those groups to have the vaccination.

The guidance said that:

  • Everyone who can have the free flu jab should be informed about it and should be invited to have it

  • People should be encouraged to have it whenever they see a health or social care professional

  • People should be aware that the flu jab is safe and understand how important it is to protect themselves, and others around them

  • Having the flu vaccination should be made more convenient, such as offering it more widely, including at local pharmacies, and at evenings and weekends

It also underlined the importance of providing flu vaccination to all front-line health and social care staff who have direct contact with patients or clients.

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