Type 2 Diabetes: Continuous Glucose Monitors
Lord Rennard Excerpts(4 days, 11 hours ago)
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Lord Rennard
To ask His Majesty’s Government how they intend to monitor access to continuous glucose monitors for people with type 2 diabetes; and how such monitoring will take account of any inequalities based on deprivation and ethnicity.
Baroness Merron (Lab)
I could get used to that reception, but I am not sure that I will get used to three Questions and a repeat UQ. However, I thank your Lordships’ House.
More than 200,000 eligible people living with diabetes currently benefit from real-time CGM, or continuous glucose monitoring. CGM data-reporting systems are being developed to aid the delivery of rollout by integrated care boards. Alongside this, the data is collected as part of the national diabetes audit. From 2025-26, NHS England plans to publish that data routinely on the audit’s quarterly dashboard, which will provide the insights that ICBs need, including data on CGM uptake, variation and health inequalities.
Lord Rennard (LD)
Many more people with type 2 diabetes could benefit from this technology. People living in deprivation and people of black and south Asian ethnicity are more likely to develop type 2 diabetes, are less likely to receive essential diabetes care and experience worse health outcomes. However, according to Diabetes UK, only 24 of 42 integrated care boards in England have a policy for continuous glucose monitoring for people with type 2 diabetes that is in line with guidance from NICE. How will the Government ensure equal access to such monitors for people with type 2 diabetes?
Baroness Merron (Lab)
The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.
Diets: Fat
Lord Rennard Excerpts(3 weeks, 2 days ago)
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Lord Rennard (LD)
My Lords, I am a type 2 diabetic. I overcome some embarrassment about my weight to say that I have lost more than 30 kilos over the past 30 years. More importantly, I have kept it off.
Self-evidently, however, I need to lose more weight. My diabetic control has been very difficult and required major lifestyle changes, but they were not enough. So, in the past four months, I have been assisted in improving my diabetic control and reducing my weight by a further few kilograms with the help of Mounjaro, a drug from Eli Lilly. Since being diagnosed with diabetes in 1994, I have always had great support from St Thomas’ Hospital. It advised me a few years ago that a typical type 2 diabetic like me, in their 50s and 60s, can be expected to put on an average of between one and two kilos every year. Over a decade or two, that gain of between 20 and 40 kilograms is likely to have catastrophic health consequences requiring significant and costly medical intervention.
For many people struggling with their weight and diabetic control, these new injections give great hope, but we should not see any of the different injections becoming available as a silver bullet to achieve weight loss. We should recognise first that they are helpful in improving diabetic control, which can be very difficult, as your pancreas becomes less and less effective at producing insulin and your sugar levels rise. The associated weight loss with these drugs is also helpful, but such treatment is far from appropriate as a first resort and some people struggle with unpleasant side-effects from them.
However, we should never accept an approach towards obesity or diabetic control which says little more than, “Pull your socks up, make yourself eat much less, but eat more fat”. This approach will lead only to the obesity crisis in many of the more affluent countries becoming even greater. It will result in great damage to the health of their populations, their health systems and their economies. The Atkins diet is now widely discredited after the demise of the author of the books on it.
The British Dietetic Association says that fat plays an important part in our diet and that people need a small amount of it. But it has warned against a high intake of saturated fats, which are often found in processed foods and associated with weight gain, making diabetic control harder, causing joint problems and some cancers.
The questions for us to discuss should be about how to take strong steps to help prevent people becoming obese in the first place and how to help them achieve and maintain healthier lifestyles, manage their diets better, and adopt healthier lifestyles, including regular exercise.
As the excellent report from the Select Committee on Food, Diet and Obesity, chaired by my noble friend Lady Walmsley, suggested last week, we need a broad range of measures to tackle the obesity crisis. I would begin with healthy, nutritious, and free school meals and stopping the proliferation of fried chicken and burger shops in close proximity to schools. We need, as the Select Committee says, to reduce the prevalence of marketing and advertising of unhealthy ultra-processed foods, especially to children. We need also to promote health education and physical activity in schools and after school.
Poverty must also be recognised as a significant factor in many people having unhealthy diets and suffering from health inequalities. Poor parents struggle to provide healthy diets for their families. Healthier foods are more than twice as expensive per calorie as less healthy foods. One of the most important poverty-relieving measures would be to scrap the two-child limit for universal credit or tax credits. I am disappointed that this was not in yesterday’s Budget.
In conclusion, we need to follow medical advice and look at evidence over time about the use of injections assisting diabetic control and weight loss. We cannot simply let people think that they can just resort to expensive weekly injections provided by the state. But nor can the state ignore the tremendous costs of obesity and diabetes.