Lesley Jordan, chief executive of INPUT, a charity committed to increasing access to diabetes technology, believes that figure could be significantly reduced with increased access to technology which supports self management.
Type 1 diabetes is an autoimmune condition that can neither be prevented nor cured. For people living with the condition, every meal or activity has to be carefully calculated, blood glucose levels constantly checked and insulin injected multiple times a day. An individual’s need for insulin varies daily: there is no fixed dose that works perfectly every day.
More tools are on the market to help patients take control, including insulin pumps, continuous glucose monitoring (CGM) and sensor-augmented pump therapy. To date, only insulin pumps, which enable patients to administer insulin in smaller, more frequent and more precise doses, has been clinically assessed and recommended by the National Institute for Clinical Excellence (NICE). Despite the fact that the assessment was made more than 13 years ago, the number of people benefitting falls short of the target set.
“One problem is the criteria are not understood correctly,” explains Jordan. “We hear a lot of people saying they are not being prescribed a pump because they don’t fulfil both criteria, when the guidelines state you only need to fulfil one.”
Alongside the pumps, Jordan believes that CGM, which helps people to monitor their glucose levels and sensor-augmented pump therapy, which combines an insulin pump and CGM, could improve patients’ quality of life and clinical outcomes.
“In order to get CGM and hybrid closed loops funded, they need to have greater impact on HbA1c [which is the long-term measure of glucose control] in trials,” explains Jordan. “But trials don’t go far enough to assess the clinical benefit beyond HbA1c – such as minimising hypoglycaemia risk and minimising the disruption to daily life caused by managing a demanding condition. You might have someone who is managing to achieve a good HbA1c, but to do so they have to inject six times per day, prick their fingers 12 times per day, or give up sports because of the impact on their blood glucose levels.”
Clinical and diagnostic guidance published by NICE last year and earlier this year have paved the way for the NHS to fund CGM and sensor augmented pumps. However, confusion over who’ll pick up the bill is delaying progress and, potentially, denying many people access to life-changing technology.
