Diabetes Treatments

Tuesday 29th October 2024 Westminster Hall

11:00

[Carolyn Harris (in the Chair)]

I will call Sarah Bool to move the motion, and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention.

[Sarah Bool (South Northamptonshire) (Con)]

I beg to move,

That this House has considered diabetes treatments.

It is a pleasure to serve under your chairmanship, Mrs Harris. On 21 May 2021, my world changed forever when I was diagnosed with type 1 diabetes at the age of 33. While my diagnosis was a shock, given its late onset, the feelings of fear, disbelief and sadness are shared by all those diagnosed—young or old, with type 1 or type 2.

Diabetes is a complicated condition that has been done the great disservice of being stigmatised through misunderstanding. It is not necessarily that we have eaten too many sweets or not looked after ourselves. Type 1 is an autoimmune condition—we did nothing to cause it—and people can develop it later in life; Mr Speaker and I can attest to that. Type 2 is not just for the over-40s and the unfit; someone can be slim and active, like Sir Steve Redgrave, and still be diagnosed. That is why I have secured today’s debate. Breaking down the stigma and investing in early treatment of diabetes is so important to allow patients to live fulfilled lives, and to do so in the most long-term, cost-efficient manner for the Government.

Our understanding of how to treat diabetes has come on leaps and bounds since the discovery of insulin back in 1921, but there is still so much more that we can do. Some 5.6 million people in the UK are diagnosed with diabetes. That includes 4,329 people in my constituency of South Northamptonshire—more than 6% of the population. However, last year, just 54% of my constituents with diabetes received all eight of their essential checks, which are important for identifying and preventing complications.

The total cost of diabetes to the NHS is estimated at £10.7 billion, and 60% of that is spent on the costs of diabetes complications. Every week, complications from diabetes lead to 2,990 cases of heart failure, more than 184 amputations, 930 strokes and 660 heart attacks. Those should be preventable with the right education, the right support, and the right attitude from individuals and the Government.

There is so much that I could talk about on diabetes, but this is a short debate, so my initial ask of the Government, on type 1, is that we end the postcode lottery, with equitable treatment for those living with diabetes wherever they live in the UK.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. I declare an interest: I am a type 2 diabetic. In our discussion before the debate, I informed the hon. Lady that, when I was first diagnosed some 18 years ago, believe it or not, I was at least 17 stone and probably getting bigger by the minute. I went on a diet because that was what the doctor recommended; I am down to a nice trim 13¼ stone.

I am thankful for the NHS and the treatment offered, but there is a clear disparity between the treatment offered in different areas of the United Kingdom. Does the hon. Lady agree that diabetes does not have to be a death sentence, but does not have to adversely affect quality of life either? We must ensure that, no matter where someone is in this great United Kingdom of Great Britain and Northern Ireland, they should get a level of diabetic care that enables them to live life to the fullest. Does the hon. Lady agree?

[Sarah Bool]

Absolutely. I totally agree, and the hon. Gentleman makes a very powerful point. It does not have to be a death sentence; it can even lead someone to No. 10 Downing Street, if they are Baroness May, so it should not prevent anyone from achieving anything.

Going back to my asks for type 1, we must also commit to greater access to technology for diabetes, such as hybrid closed loop technology, and increase awareness of the condition and treatments in schools and among the public. We also want to see the expansion of early testing for type 1 diabetes to identify children who are living with the condition and to make sure that they and their families get the right support.

I apologise in advance to hon. and right hon. Members if I suddenly start to beep during this debate, or in the Chamber in the future. They can be assured that it is not because I am some form of 21st century R2D2; it is because I wear an insulin pump and sensors. When my blood sugar is running low, it will alert me so that I can consume a lifesaving sugary treat. This hybrid closed loop system has dramatically improved the quality of my life with type 1. It does not just benefit adults with diabetes like me; there are parents of young children with a HCL who feel they can finally sleep at night without fear of missing a nighttime low blood sugar for their little ones.

Type 1 is also a condition that creates a serious mental burden on those who live with it and their loved ones. As a condition where someone’s pancreas stops working and no longer produces insulin, it requires constant thought and calculations alongside normal activities. Each day, a person with type 1 is assessing how many carbohydrates there are in their food and how much insulin they should dose, taking into account whether they have exercised, will be exercising, or generally rushing around; how hot or cold it is; how tired they are; how stressed they are, with public speaking adding to the mix for me; for women in particular, what their hormones are doing; and, when they have low blood sugar, how quickly they can access a sugar supply.

My insulin pump and sensor have ensured that many of those burdens have been eased. I just wish that more of my fellow diabetics had the same opportunity. I know of one lady from the south-west of England whose local integrated care board did not prescribe HCLs, so she had to move to London, away from her support network, just to access that vital technology. That cannot be right. As part of building an NHS fit for the future, Ministers should ensure that wherever someone is in the UK, they can access vital treatments for diabetes, such as the HCL.

There are other treatments that the Government should commit to fully exploring, such as early detection and new drugs. As with my diagnosis, more than 80% of type 1 diagnoses occur in people with no known family connection to type 1 diabetes. Many people are not aware of the four “T” symptoms that they should look out for: thirst, toilet, tiredness and thin. Early detection is vital in preventing complications such as diabetic ketoacidosis, which one in four children with type 1 are diagnosed with, and which can be lethal. Early detection can also identify people who would benefit from early intervention clinical trials and treatments.

The ELSA study is a programme funded by Breakthrough T1D that offers children between the ages of three and 13 a simple finger stick blood test to determine their risk of developing type 1 diabetes. The study is currently open to families across England, Scotland, Wales and Northern Ireland, with over 20,000 children having been screened so far. I ask that the Government work to have the programme expanded and implemented on the NHS nationwide, as it could drastically reduce the instances of future complications from type 1.

[Jim Shannon]

I thank the hon. Lady for giving way again. One of the things that we have noticed back home in Northern Ireland is that even if someone gets a type 1 diabetes diagnosis early on, it does not mean that their life is over—they can still go on. We have a high prevalence of young children in Northern Ireland who have type 1 diabetes, and for them it is rather scary but also a fact of life. I have seen some of those young boys and girls growing up and the diabetes has not affected their life at all. It is important to know that those being diagnosed early with diabetes can have a normal life and family.

[Sarah Bool]

I absolutely concur with the hon. Gentleman; people can live a fulfilling and fulfilled life, but they do need a little more help along the way. If we get that at the right time, it can literally transform a life so that they can live like everyone else.

One of the promising new treatments coming forward is teplizumab, which will delay the onset of type 1 in children by an average of three years. Approved by the Food and Drug Administration in the US in 2022, it is about to start a technological appraisal by the National Institute for Health and Care Excellence. In conjunction with the national early detection programme, teplizumab could drastically reduce the complications associated with type 1.

With the rise of social media, we have seen an ever-growing societal preoccupation with body image. Earlier this year Baroness May and Sir George Howarth released a parliamentary report into type 1 and disordered eating, also known as T1DE. T1DE is an eating disorder where someone might restrict their insulin to lose weight or experience an eating disorder such as bulimia or anorexia alongside type 1. Evidence suggests that up to 40% of women and girls and up to 15% of men and boys with diabetes experience some form of disordered eating, so we really must continue the work of Baroness May and Sir George in raising the profile of diabetes and its complications.

On type 1, I ask the Minister to ensure that the Government work with the NHS to increase awareness of the hybrid closed-loop technology, particularly among lower socioeconomic groups, and to fund its roll-out nationally; to provide comprehensive training for healthcare practitioners on HCL technology; and to establish a national diabetes registry to support technology adoption and track health outcomes.

Turning to type 2 diabetes, right hon. and hon. Members will have heard a lot about and might even have been tempted by Ozempic and Wegovy, known as the GLP-1 medications—seemingly magic solutions that have helped many in the public eye to shed unwanted pounds. However, that class of medication is an important treatment for those with type 2 diabetes as it is prescribed to lower blood glucose levels. My concern, and that of some of my constituents who have written to me, is that there is a real risk of a shortage of those medicines for type 2 diabetics while they are being prescribed for weight loss. It is therefore essential that the supply of those drugs is protected for diabetics. Will the Minister take action to ensure that everyone with or at risk of type 2 diabetes can access the medications that they can benefit from?

Alongside medications, we should ensure that newly diagnosed type 2 diabetics are given the right support. In some cases it is possible to put type 2 into remission, so it is essential that access to evidence-based services such as the NHS path to remission programme is increased for people in the first three years of their diagnosis. Likewise, people under the age of 40 with type 2 are at increased risk of developing diabetes complications, but are less likely to receive their essential care. The NHS type 2 diabetes in the young programme—T2Day—provides extra support for that group, including confirmation of diagnosis, additional checks, contraception and pre-conception planning, and assessment of cardiovascular risk. The Government must commit to sustainable long-term funding for the programme to ensure that the rise in type 2 diabetes in working age adults does not lead to a drastic increase in serious complications.

There are also inequalities across the diagnosis of diabetes. Those living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes but less likely to receive their diabetes care, and they go on to experience worse health outcomes. As the Government develop their plan for the NHS, they should use health inequality impact assessments for all diabetes-related policies to understand how reforms affect different groups.

As right hon. and hon. Members might have worked out by now, I could speak about diabetes all the way to the moment of interruption this evening, but I will draw my speech to a close. Acting as our own pancreas is hard and our illness requires 24-hour attention. Diabetes treatment is relentless, but so are we.

11:13

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I welcome the hon. Member for South Northamptonshire (Sarah Bool) to this place, as I have not had a chance to do that. I thank her for securing the debate and sharing her own personal experience. She spoke powerfully about her fear, disbelief and sadness at her own diagnosis.

More than 4.9 million people in the UK have diabetes and 2 million people are now at risk of type 2 diabetes. The impact on the health and wellbeing of the nation and on the lives of people with diabetes and their families cannot be overstated. The hon. Lady has put a superb case this morning. A central mission of this Government is to build a health service and care system fit for the future. As part of that, tackling preventable ill health such as type 2 diabetes is crucial. At the same time, we want to ensure that people with types 1 and 2 diabetes receive the best possible care so that they can live healthier lives wherever they live in the United Kingdom.

As the hon. Member for South Northamptonshire mentioned, a central factor to people with diabetes living well is ensuring that they have access to annual diabetes reviews that cover the eight processes recommended by NICE. Annual diabetic reviews are associated with reduced emergency admissions, amputations, retinopathy and mortality. However, in 2019 only 42% of people with type 1 diabetes received all eight health checks, and that figure dropped significantly during the covid-19 pandemic. The NHS has worked hard to recover these services, and the proportion of people with type 1 and type 2 diabetes receiving all eight care processes reached 43.3% and 62.3% respectively in 2023-24. Although that is an improvement, in order to drive faster uptake the NHS will invest £14.5 million over the next two years to support up to 140,000 people aged between 18 and 39 to receive additional tailored health checks from healthcare staff. That will include support to help break down any stigma associated with the disease and support people with diabetes management through blood sugar-level control, weight management and cardiovascular risk minimisation.

I want to draw attention to what the hon. Lady said about stigma, because it is important. My best friend from university was diagnosed in her early 20s, which was some time ago—she will not thank me for mentioning that. I have family and constituents who have type 1, and I have learnt a lot from them about how important it is to look after oneself and get the care that one needs. I also commend Baroness May and Sir George Howarth. They were a formidable duo in Parliament, raising awareness of what is possible. They were both great servants of their respective parties, and I know they will continue that work.

Technology also plays a critical role in helping people with diabetes to live healthier lives, and I am pleased to hear of the personal impact a hybrid closed loop system has had on the hon. Member’s life. As many will be aware, NICE has made recommendations on offering real-time continuous glucose monitoring and hybrid closed loop technology to adults and children with type 1 and type 2 diabetes. The NHS is making progress, with over 65% of people with type 1 diabetes using glucose monitoring to help manage their condition, and I expect to see similar rapid progress for people with type 2 diabetes.

Following NICE’s final guidance in December 2023 on HCL systems, NHS England has developed a five-year national strategy with guidance for NHS providers on a phased uptake for delivering this life-changing technology to eligible diabetes patients. I am sure the hon. Member and others will be watching that roll-out closely. It started this April with an initial focus on children, young people, pregnant women or those planning to become pregnant, and adults already using pumps who want to transition to a HCL system. The longer implementation period is because of a need to build essential workforce competencies in specialist adult services. To ensure that patients are safe, NHS trusts should only provide HCLs if they have access to specialist, trained clinical staff experienced in providing insulin pumps and continuous glucose monitors for type 1 diabetes. I know that waiting to access this technology is causing many people distress, and I assure the hon. Member that NHS progress in delivering these technologies is a matter of importance to this Government.

I also thank the hon. Member for raising the important issue of type 1 and disordered eating. NHS England has provided funding for eight integrated care boards to support the development and establishment of type 1 disordered eating services in every NHS region. NHS England is drawing on learning from the existing services, other emerging evidence and the findings of a recent parliamentary inquiry to ensure that all areas of the country are supported to improve care for those identified as having type 1 disordered eating.

On type 2 diabetes, the hon. Member expressed concerns about access to GLP-1 medications, such as Ozempic. Following intensive work with industry, the broad supply position for GLP-1 medications in the United Kingdom has improved. However, global supply issues remain for specific medicines, including Ozempic. We continue to work closely with manufacturers and others in the supply chain to help ensure the continued supply of GLP-1 receptor agnostics for UK patients, and to resolve the remaining supply issues as quickly as possible, for example by asking suppliers to expedite deliveries.

I now turn to prevention and to the support available for people to put their type 2 diabetes into remission, which, as the hon. Lady outlined, is possible. In fact, I canvassed somebody last weekend who was very proud of their ability to do that. It is great work. Lord Darzi’s report on the NHS, which was published last month, noted the worrying increase in the prevalence of people with type 2 diabetes and the necessity of prevention.

The prevention of diseases, including diabetes, is a priority for this Government. The Healthier You NHS diabetes prevention programme supports people at risk of developing type 2 diabetes to make lifestyle changes, either through face-to -ace group programmes or digital services. The programme reduces the risk of type 2 diabetes by 40%. The programme has also been working to raise awareness among the diabetes healthcare professional community about the growing numbers of children and young adults with type 2 diabetes, and we have heard about that today.

Healthcare professionals need to understand the more aggressive nature of early onset type 2 diabetes, compared with older onset type 2 diabetes, to support earlier diagnosis. Further, given the inequalities in who develops type 2 diabetes and the poorer outcomes for those of south Asian and black ethnicity, which were also mentioned by the hon. Member, the NHS has established a focused engagement campaign, using social media and more traditional approaches to raise awareness and boost the uptake from those groups.

Living with type 2 diabetes is not inevitable if early action is taken to live a healthier life. As the hon. Member said, the NHS type 2 diabetes path to remission programme is a joint initiative between NHS England and Diabetes UK. It provides a low calorie diet and support to people who have been recently diagnosed with type 2 diabetes who are living with obesity or are overweight. This year, the programme has been expanded to make it available across all England, enabling more people to benefit and to recover from type 2 diabetes.

The hon. Member asked specifically about the ELSA study, which I understand is recruiting 20,000 children in the UK, to better understand the potential benefits of screening for type 1 diabetes. I understand that the University of Bristol, in my home city, is also undertaking a similar study, looking at the risk of type 1 diabetes in adults. The Government look forward to seeing the outcome of both of those studies, to help inform future policy making.

By moving from sickness to prevention, the Government want to shorten the amount of time people spend in ill health and prevent illnesses before they happen. That is one of the goals of reforming the NHS, which is part of the Government’s 10-year plan. I know that the hon. Lady will contribute to the debate in the rest of this Parliament.

Question put and agreed to.

11:22

Sitting suspended.