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New report highlights need for evidence-approved medicines to prevent devastating co-morbidities for people with diabetes

A new report from Public Policy Projects (PPP) is calling for changes in the use of approved medicines to improve diabetes care in the UK.
  • Clinical inertia is slowing the use of medicines proven to improve outcomes for people with diabetes. Policy makers must use every available lever to encourage the use of medication that prevents complications such as heart failure and chronic kidney disease. Clinicians suggest a ‘Cardio-renal-metabolic’ outcomes bundle could be added to GP incentives to help increase uptake.
  • Healthcare systems must employ population health management tools and technology to identify people at risk of diabetes, as well as those with unmanaged diabetes, to intervene early with lifestyle plans and using preventative medicines.
  • There are vast inequalities in diabetes outcomes and this is compounded by stigma which impacts self-management of diabetes. There is a need to reconsider traditional healthcare models to reach underserved communities. Within diabetes using those embedded in communities such as community pharmacists and ‘Experts by Experience’ could break through some socio-economic barriers’ that prevent access to healthcare.

A new report from Public Policy Projects (PPP) is calling for changes in the use of approved medicines to improve diabetes care in the UK. The report cites the rising numbers of people with diabetes in the UK and states that diabetes is the second highest expense to the NHS after cancer. The disease is associated with complications and is a long-term, life-changing condition. PPP’s report finds that doctors are currently undertreating people that might benefit from preventative medicines that can delay the onset of complications.

In recent years, there have been advances in diabetes care and this has been reflected in NICE guidelines but, given the burdens on primary care, GPs are not always aware of new guidelines or confident to prescribe new medications. The report suggests that in order to increase uptake of approved medicines, they need to be included in GP incentives and the use of outcomes-based incentives across a bundle of associated health conditions should be considered.

As well as using effective medicines, the report looks at population health management of diabetes patients and suggests that further efforts can be made to identify, and intervene with, those at risk of diabetes or poor diabetes management (which results in poorer outcomes and increased risk of co-morbidities). The introduction of integrated care systems (ICSs) favours population health management and some flex towards local health needs, and ICSs must harness this to effectively target preventative measures. Interventions such as lifestyle programmes, social prescribing and medications should be considered.

The report highlights the significant stigma that is experienced by people with diabetes, especially those living with type 2 diabetes. Within type 1 diabetes, the patient voice has had a significant impact on promoting funding availability for treatments. The stigma surrounding type 2 diabetes has meant that the patient voice has not had the same strength and mobilising this ‘patient power’ would have a significant impact on treatment funding for this patient population.

This stigma impacts people’s self-care and management of the disease. This results in disadvantages in terms of care options, as those experiencing stigma feel less empowered to challenge clinical inertia. The report suggests that for type 1 the patient voice is strong and has exhibited powerful advocacy for people with type 1 diabetes. This is not true for those with type 2 diabetes and the report suggests that the associated stigma is at least in part responsible.

Type 2 diabetes prevalence disproportionately impacts people from deprived areas more than those in affluent areas and those of socio-economic status face significant barriers and inequalities in accessing care. The report argues that care models need to be rethought in order to engage communities that have lower rates of health engagement and are often at higher risks of diabetes. The report showcases pilot projects using Experts by Experience as well as referencing a health approach in Brazil which has shown some success in addressing these issues.

Commenting in the report, one clinical leader* said: “Effective medicines are something we have got a professional responsibility to make sure patients have.” 

Clinicians need to ensure that patient populations have equitable access to medicines in a timely manner. Another clinician* said: “We need to shift thinking in medicines for prevention; these drugs are not seen as preventative and that needs to change”. The expert-led group concluded that it is crucial not to wait for people to develop complications around diabetes, but to identify them early in life to prevent these complications from developing. Striving for this would undoubtedly add quality years to many people’s lives in the UK.

Recommendations from the report

For integrated care boards:

  • Think beyond standard care delivery models when commissioning services – look at how Experts by Experience and those embedded in the community can be used to support adherence to diabetes treatment plans.
  • Use population health management algorithms to identify people at risk of diabetes earlier and intervene where possible.

For primary care leadership:

  • Look both within and outside ICSs for examples of best practice in care delivery and learn from these. Implement processes that support change, to make best practice a reality.
  • Ensure that primary care professionals are aware of the latest NICE guidelines and the evidence for medicines. Where knowledge is lacking, provide training to ensure that healthcare professionals feel empowered to intensify treatments when appropriate and deprescribe when appropriate. Challenge staff where prescription of new, effective medicines is not taking place.
  • Mobilise all primary care staff to help reduce the stigma surrounding type 2 diabetes by promoting the patient voice and having positive conversations around management and treatment of diabetes.

For NHS England and central government

  • Revise the QOF to include an outcomes bundle that takes multiple co-morbidities into account when devising incentives for general practice.
  • Use a ‘polluter pays’ funding model to generate revenue to develop processes to support the growth of population health management across ICSs in the UK. Using population health management would enable earlier identification of individuals at risk of disease and allow earlier interventions which would be cost-saving in the long-term.
  • Consider how to increase the role of community pharmacists for prescribing and deprescribing diabetes treatments. This should be considered (via a consultation process) in the next iteration of the ‘Pharmacy First’ plan.

To view the report in full, please click here.


PPP’s Diabetes Care Programme 2024, System-wide Strategies for Better Diabetes Care, is designed to identify opportunities for improvements and transformation in diabetes care. The programme convenes key stakeholders from primary and secondary care, pharmacy and integrated care boards (ICBs) and other key stakeholders for key discussions across a series of roundtables and events. In April 2024, PPP hosted the first of four roundtables, which was chaired by Professor Partha Kar, Type 1 Diabetes & Technology Lead and GIRFT Clinical Lead for Diabetes at NHS England.

This report was created following an invitation-only roundtable which was attended by more than 20 sector leaders and key stakeholders, including: integrated care system (ICS) leadership, primary care diabetes leads, secondary care consultants, researchers, pharmacists, charities, patient representatives, and key industry representatives, forming part of PPP’s Diabetes Care Programme 2024.

PPP’s next phase of Diabetes care programme centres around the publication of the next three policy report and the Diabetes Care Conference 2024. This will comprise half-day, in-person event, hosted in London on 27th June 2024. The Diabetes Care Conference 2024 builds on the foundations of the four virtual roundtables and one webinar, continuing to connect key health and care stakeholders for localised debate and networking.

The conference is free to attend for relevant healthcare professionals. To register your place, please click here.


KEY INFORMATION

This programme has been sponsored by Boehringer Ingelheim. Boehringer Ingelheim has had no influence over the agenda, programme development, content or selection of faculty. Editorial and content decisions were made solely by PPP, with the faculty chosen by PPP.

About Public Policy Projects

PPP bring together senior leaders and practitioners in the public and private health and life sciences sectors to find realistic solutions to the most pressing issues relating to health and care delivery.

We facilitate effective collaboration between public and private sector organisations. We help businesses to grow their profile within the NHS and wider public sector. In turn, we support public sector leaders and organisations with practical recommendations on implementing policy to improve health and wellbeing outcomes for local populations.

We offer insight, analysis and intelligence through research, editorial, events, and written reports. Our chair Stephen Dorrell, a former Secretary of State for Health, remains actively involved in policy delivery in the health and life sciences sectors.

Programme lead:

For more information about PPP’s Diabetes Care Programme 2024, or to request interviews, please contact:

Ameneh Saatchi, Director of Market Access and Policy, at ameneh.saatchi@publicpolicyprojects.com.

 * All PPP roundtables operate under the Chatham House Rule, so individuals cannot be named.

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