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NHS missing out on benefits of diabetes management technology, new report finds

Systemic barriers are slowing down the NHS's roll-out of continuous glucose monitoring and hybrid closed loop technology, according to a new report from Public Policy Projects.
  • Diabetes technologies like continuous glucose monitoring (CGM) and hybrid closed loop (HCL) devices have been shown to improve quality of life for diabetes patients and their families. These devices offer both clinicians and patients real-time and accessible data, giving reassurance that they are on the right track in their treatment journeys.

  • These technologies reduce the risk of costly complications by enabling better and more proactive glucose management and greater patient empowerment, choice and safety.

  • There are significant barriers to the effective implementation of diabetes technology in the NHS, such as financial burdens and uncertainty within primary care about who is eligible. Patients and their families have expressed concerns around the high cost of mobile phone data, issues with unreliable internet, limited access to data and phones’ incompatibility with the latest diabetes devices. Additionally, those living in areas of deprivation are more impacted, lacking access even when the technology is available.

  • Transitioning to new diabetes technology or switching between technological devices can be a challenge for some patient groups. Patients particularly affected include children, young people and individuals with both eating disorders and diabetes.

A new report from Public Policy Projects’ (PPP) Diabetes Care Programme highlights the benefits of widespread adoption of diabetes technology for type 1 and type 2 insulin users across the UK. However, the report finds that systemic barriers are slowing down the roll-out of diabetes technology, affecting patients across the UK, in particular type 2 insulin users. Some of these barriers include financial inequalities among patient groups, socio-economic deprivation, misunderstanding around eligibility and challenges with switching between technologies, particularly for children transitioning to adulthood.

In 2022, the number of people in the UK with diabetes was estimated to have reached 4.9 million – 13 years earlier than Public Health England’s projected date of 2035.1,2 90 per cent of the diabetes population has type 2 diabetes, and eight per cent has type 1 diabetes. Due to its rapidly increasing prevalence, new approaches to improve diabetes care are needed, including the use of technological innovation.

Download the report here

 

In recent years, NICE has issued a series of guidelines and recommendations to incorporate technology into diabetes care, to support both type 1 and type 2 insulin users across the UK. Technologies like continuous glucose monitoring (CGM) and hybrid closed loop (HCL) systems have been shown to improve quality of life for diabetes patients and can help reduce the risk of costly complications developing. HCL systems are also clinically proven to be more effective than standard care of blood glucose level management.

Despite the numerous benefits, the effective implementation of diabetes technologies within diabetes care is hindered by systemic barriers. Significant inequities persist in access to pumps and CGM technologies, with relative deprivation being the main barrier. If diabetes technology is implemented without addressing these systemic barriers, then inequalities risk being increased, and outcomes will vary between those who can access and afford to run the technology and those who cannot, or do not wish to access it.

Roundtable delegates also discussed difficulties for patients when switching to new technological devices. This is particularly the case for children who are transitioning to adulthood and find themselves switching between different devices.

The report also covers inequalities embedded in R&D, highlighting a need to re-examine reimbursement criteria of new drugs and technologies in the NHS. Currently, NICE uses a cost-effectiveness threshold in the range of £20,000 to £30,000 per quality-adjusted life year (QALY) for reimbursing new drugs, where QALY is the expression of health benefits. Delegates agreed that this threshold is insufficient and unrealistic for some conditions such as dialysis, which has higher care costs. By addressing high R&D costs and unrealistic QALY thresholds, fewer patients will face exclusion.

The report consists of the findings that emerged during the third roundtable of PPP’s System-wide Strategies for Better Diabetes Care programme, chaired by Professor Partha Kar and kindly sponsored by Dexcom. The programme is designed to identify opportunities for improvements and transformation in diabetes care. The roundtable was attended by more than 30 sector leaders from primary and secondary care, pharmacy and integrated care system (ICS) and key industry representatives.

Professor Parth Kar, National Specialty Advisor for Diabetes at NHS England, chaired this session and comments: “Access to diabetes technologies should be universal, irrespective of your type of diabetes. It also needs to be available for everybody, irrespective of your socioeconomic status, ethnicity, or other factors. That’s the stated aim of the NHS.”

The report’s recommendations include:

For primary care leadership:

  • Promote the use of diabetes management technology to all individuals with type 1 or type 2 insulin users. Both groups should use CGM technology or be on the pathway toward getting one, and type 1 diabetes patients should incorporate an HCL system into their diabetes care, if they are already using CGM and insulin pump technology.
  • Ensure primary care is educated on the benefits of diabetes technology, trained on its use and offers it appropriately to patient groups.
  • Create dialogue around patient choice between clinicians and patients, ensuring that diabetes patients feel at ease selecting their preferred diabetes technology. Inform patients about cost-effectiveness of different technology options to promote patient empowerment, transparency and a clear understanding of each option.
  • Educate patients about technology matching to ensure they understand the best options available for their individual needs. This will help patients make informed decisions about their diabetes care and select the technology that is most suitable for them.
  • Provide poverty proofing training to diabetes multidisciplinary teams, to improve understanding of patients from deprived backgrounds and their needs.
  • Optimise peer support in diabetes care, through the creation of forums, like Diabetes UK, that run local and online knowledge sharing groups. This can improve the overall well-being of patients and facilitate knowledge exchange about diabetes technologies, building a supportive community where patients can learn from each other’s experiences and insights.

For integrated care boards:

  • Encourage system level dialogue and direct communication between trusts and primary care teams, to ensure conclusive discussions and agreements with commissioners on priorities and non-priorities.
  • Establish process pathways across ICSs for repurposing unwanted digital equipment, like mobile phones and laptops, for all children and young people living with diabetes, while challenging means testing and stigma. This can be achieved by using specifically allocated NHS regional funding to ensure equal access to diabetes technologies.
  • Industry should ensure compatibility of phone devices and operating systems with patients’ diabetes devices to support sustainable provision of refurbished digital devices, while being adaptable to meet the population needs.

For NHS England and central government:

  • Embed patient centricity into diabetes care, by ensuring strong local clinical leadership and a clear vision. This can maximise benefits of collaboration between the diabetes workforce and the industry.
  • Undertake a review into the reimbursement criteria of new diabetes drugs and technology in the NHS. The current NICE threshold of between £20 000 and £30 000 per QALY year is insufficient and unrealistic for some conditions such as dialysis, which has higher care costs. Further to this, companies should target wider cohorts for new technologies, not only niche groups.
  • Challenge stereotypes and all forms of discrimination including racism, sexism and homophobia within medical force to ensure unbiased delivery of diabetes care. Ensure open and transparent leadership structures so that healthcare professionals feel comfortable having open and honest conversations.

 

The adoption of diabetes technologies will be further explored at Panel 3 at the Diabetes Care Conference 2024 on 27 June. Panel 3 will be dedicated to discussing the role played by technology in bridging the inequality gap and the impact of deprivation on health outcomes for people with diabetes.

For more information and to register your place, click here.

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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