Diabetes: Artificial Pancreas

Sandy Martin Excerpts

Wednesday 12th December 2018 Commons Chamber

[Mr George Howarth (Knowsley) (Lab)]

I would like to begin with some acknowledgements to those who contributed towards the material that I will be using today, so let me place on record my thanks to Dr Jacq Allan from Birkbeck University and the charity Diabetics with Eating Disorders; Sandie Atkinson-Goulding; Dr Weston and Dr Zaidi from the Royal Liverpool University Hospital; the Juvenile Diabetes Research Foundation; Incisive Health; and Diabetes UK. I thank them all for sharing their expertise, briefing notes and academic work with me.

I intend to highlight the technology that is available for people with type 1 diabetes, point out some issues surrounding access to technologies and say a few words about the lack of structured education and psychological support available for type 1 diabetics. To conclude, I will make some suggestions to the Minister on what the Government can do to progress towards artificial pancreas systems.

Type 1 diabetes is an autoimmune condition, where an individual cannot naturally produce insulin. According to JDRF, this condition affects 400,000 people in the UK, of whom 29,000 are children. JDRF is leading on and funding the design of an artificial pancreas, which will change the lives of those affected by type 1 diabetes considerably. The artificial pancreas is in advanced human trials and the work in the UK is being led by Professor Roman Hovorka at the University of Cambridge, with funding from JDRF. Artificial pancreas systems automate blood-sugar management, dramatically reducing type 1 diabetes-related risks and improving the lives of people who have the condition. The artificial pancreas consists of a continuous glucose monitor, a computer programme and an insulin pump that work together to automatically control background insulin levels. These artificial pancreas systems, which may be a combination of existing or newly developed continuous glucose monitoring systems and insulin pump technology, have been termed the “artificial pancreas” because they monitor and adjust insulin levels just as the pancreas does in people who do not suffer from diabetes. Artificial pancreas systems have the potential to transform lives, particularly for those who find it difficult to maintain good blood-glucose control.

[Sandy Martin (Ipswich) (Lab)]

Does my right hon. Friend agree that simple continuous glucose monitors that are already available—I believe the Prime Minister wears one—are still not being allowed to children and young people who would benefit from them because some clinical commissioning groups do not prescribe them? When I asked the Secretary of State about this affair, I was told that the Department has no intention of monitoring what CCGs measure. Does my right hon. Friend agree that that is not a satisfactory state of affairs?

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. He is right in what he says, and I will be covering precisely that point later in my speech.

A recent JDRF-funded trial found that the artificial pancreas is better at helping people to manage their glucose levels than the best currently available technology. People who used the artificial pancreas spent 65% of time with glucose levels in range, which compares with 54% of time for people using a continuous glucose monitor and an insulin pump. Unfortunately, as my hon. Friend mentioned, there are significant regional variations in access to existing diabetes technologies, such as insulin pumps, in many parts of the country. The most recent national diabetes audit, published in July 2018, shows that although the overall uptake of insulin pumps has increased, the proportion of people with type 1 diabetes attending specialist services who are treated with pumps varies from a pitiful 5% to 40% at best.

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[Mr Howarth]

My hon. Friend is right, and I did highlight earlier that I was unable to get statistics, either centrally or at CCG level. It is important that we collect more data, interpret it properly, and use it to inform policy.

Secondly, there should be mandatory funding accompanying any positive guidance from the National Institute for Health and Care Excellence as part of a technology appraisal, and a national clinical consensus pathway that covers artificial pancreas technology, with NICE incorporating that into commissioning guidance. That sounds very bureaucratic, but if it was taken seriously, it could have a major positive impact.

Thirdly, there should be progressive procurement policies that recognise the value, within the foundations of artificial pancreas policy, of innovations such as continuous glucose monitoring and insulin pump therapy. We should encourage continuous glucose monitoring with integration capacity, and insulin pumps that have artificial pancreas potential. I would also encourage continued innovation in diabetes technology. If we are to progress towards an artificial pancreas, the foundations need to be better established across the country; that is in addition to the changes I have highlighted. A 2018 audit of the use of insulin pumps showed a positive increase in usage, but also highlighted a wide disparity between specialist services, which we have already mentioned.

[Sandy Martin]

Is it not the case that in CCG areas where specialist pumps and continuous glucose monitors are prescribed regularly, the amount of emergency care needed for people with type 1 diabetes is reduced? Not investing in those things makes no financial sense whatever.

[Mr Howarth]

My hon. Friend is right. This is not just about technology, important though that is. Anyone with diabetes who manages it well—and technology will help to do that—will have fewer hospital emergency admittances. I do not have the statistics to hand—I am not even sure they exist—but those people will clearly have fewer hospital admittances and fewer complications with their diabetes, and therefore cost the NHS less. As I am sure the Minister will acknowledge, however, the NHS is not very good at doing cost-benefit analysis. It needs to get smarter at it, because the point that my hon. Friend makes is right, not only as regards the support we give to people with type 1 diabetes, but about the cost to the NHS of dealing with the consequences.

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[Keith Vaz]

Indeed. Before anyone else jumps up with another name, I include all diabetics in what I am saying.

The Prime Minister and others such as myself talk about diabetes, and we are not cowering in corners; we are debating it openly. Because of technological advances, we are able to do our jobs and continue with our lives in a way that was not possible when diabetes was first discovered 100 years or so ago.

The first artificial pancreas, which was developed by Sir George Alberti through funding from Diabetes UK, was the size of a filing cabinet. Madam Deputy Speaker, can you imagine walking around with an artificial pancreas of that size? We should always acknowledge the research and innovation of which my right hon. Friend the Member for Knowsley spoke and the power of science to change people’s lives.

I want to give a few examples from my own city of Leicester of the work that has been done on diabetes. There is the work done by Professor Kamlesh Khunti and Melanie Davies of the University of Leicester; my own general practitioner, Professor Azhar Farooqi, who diagnosed me with diabetes—had I not been diagnosed, I might not be standing here today, because I did not know what the symptoms were—and Professor Joan Taylor from De Montfort University, who began developing her own version of the artificial pancreas.

It was very interesting to learn from my right hon. Friend’s speech about all the other clever people—probably much cleverer than all of us here—who have been able to develop their own artificial pancreas. Not all of them will be able to fly, so to speak, but it is amazing that people are putting their minds to it, and Professor Joan Taylor at De Montfort has done the same. There is also Professor Hovorka of Cambridge University who, like George Alberti, was funded by Diabetes UK in developing the artificial pancreas. These people deserve our respect and admiration for what they do, because they spend day after day trying to make the medical breakthrough that will help people and save so many lives. I want to thank them for what they have done, because their work has enabled us to get to the position we are in today.

There are also the private companies. Members do of course criticise, as we are entitled to do, the profits made by drugs companies. The Minister will know because she has to sign the cheques—perhaps she does not sign the cheques, but she sends them to the Treasury to get them signed—when the bills come through for the artificial pancreases and the metformins or Glucophages and all the other things that we take. The cost has gone up and there is no doubt that the drugs companies do make very big profits, but they should be commended for putting back so much of their profits into research and development. That is something that the Government cannot do, but it is something that those companies do every single day.

In acknowledging the huge cost of drugs, we also have to acknowledge what companies such as Novo Nordisk do. I declare an interest in relation to Novo Nordisk, because it has worked with the all-party group on diabetes, which I chair, for a number of years. Roche Diabetes Care is another such company, and there are many more. There are so many of them that I cannot name them all, but they have all been involved, and they will all invest and research until the breakthrough comes.

We know from FreeStyle Libre what Abbott has done. I remember the former Prime Minister—it is of course based in David Cameron’s old constituency—telling me five years ago about Abbott and the work it was doing on FreeStyle Libre. Now, thanks to the decision of Ministers, FreeStyle Libre is available, as my right hon. Friend the Member for Knowsley has said. That is why, when we have that breakthrough, it is vital that such a facility and such equipment is available to all, irrespective of where they live.

We did not have access to FreeStyle Libre in Leicester, even though we have so many experts at Leicester University and De Montfort, until the decision taken by the Government. Actually, we will not get access to it until next April, so my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) and others will have constituents who still want to get FreeStyle Libre, but cannot do so. We do not want that to happen for those who need pumps and artificial pancreases, because it is vital that they get such equipment straightaway. If they do not, it will affect their lives.

What my right hon. Friend the Member for Knowsley said about wellbeing or mental health and diabetes was interesting. That is something that people very rarely recognise, and I have only myself recognised it, having been a sufferer, in for the past two years or so. They do not actually know it because they think it is part of their condition. For type 1 diabetics, it is even worse. We can just have our pills—I take six in the morning and three at night; some people take more—but the fact is that they live with the injection of insulin for this condition for the rest of their lives.

The deputy leader of the Labour party, my hon. Friend the Member for West Bromwich East (Tom Watson)—obviously, he is not in his place today, because he has other things to do—has reversed his type 2 diabetes. Anyone who sees him in the Division Lobbies will know that he looks a completely different man from the person I knew when I voted for him to be the deputy leader, because he has adopted the Pioppi diet and changed his lifestyle. He does all the things that I do not, because I do not manage my diabetes particularly well. However, people cannot do that with type 1—it is with them forever. The right hon. Member for Hemel Hempstead (Sir Mike Penning), who obviously has gone to Committee Room 14, mentioned that there is that fundamental difference. Sometimes when we talk about the thousands —or the millions, now—who have type 2 diabetes as opposed to type 1, we talk about people changing their lifestyle, their diet or their wellbeing, but that does not apply to the type 1s.

[Sandy Martin]

Does my right hon. Friend believe that it would help an awful lot of people with type 1 diabetes if we changed the name of the disease, given that it is completely different from type 2?

[Keith Vaz]

Of course. There is the possibility of doing that—as we do with cancer, for example, which is a much more emotive illness. Of course, people can die from diabetes complications. My mother died from diabetes complications. What I am noticing from the correspondence that I get as chair of the all-party group is that people are writing to say that their relatives have died of diabetes complications and that clinicians are now putting that on death certificates and, in some cases, voiding insurance. I had a very interesting meeting with an insurance company recently that wanted to void the insurance of a particular individual because they had not notified it that they had type 2 diabetes. I asked its chief executive, “If you cross a road and you are knocked down by a car, and you have type 2 diabetes but didn’t know it and had not notified the company, would you still have your insurance voided?” and he said, “Yes,” which is outrageous. The implications are huge. This is a wide area, Madam Deputy Speaker, and I do not want to try your patience by talking about the whole, global aspects of diabetes. We could be here all night. Forget about the 7 o’clock Adjournment motion—we would be here forever, but actually, we need to be specific about type 1.

In answer to the question from my hon. Friend the Member for Ipswich (Sandy Martin), perhaps there is a case for doing what he suggested, because “type 1” and “type 2” are still very technical, whereas with cancer, there is the type of cancer that someone is suffering from. People may not understand that, so it is worth exploring, and we could certainly do that at the all-party group. The vice-chair, my hon. Friend the Member for Heywood and Middleton, is here—we will be able to look at it—and my right hon. Friend the Member for Knowsley is a frequent visitor. Let us see what we can do about it in future.

I want to end with three asks of the Minister through the good offices of my right hon. Friend. We have talked about CCGs, but we do not have the capacity in CCGs for diabetes champions. We still do not know how many specialist diabetic nurses there are in regions or even in constituencies. The hon. Member for Gosport (Caroline Dinenage) is a Health Minister, so I am sure that everyone will jump about when she goes back to her constituency, but if she asks the question, “Do we have a list of specialist diabetic nurses?” the answer is no. Do we have a list of those doctors such as David Unwin and others who are doing incredible work on diabetes—even if that work is not shared elsewhere? The answer is no.

In answers to parliamentary questions, I have a list of “don’t knows” coming back from Ministers. That is no criticism of the Minister—it is just that Ministers do not know. They do not keep that information centrally. My right hon. Friend the Member for Knowsley and I, as former Ministers, know that we had to sign PQs like that, too, when we just did not have the answers, because the information is not kept centrally. However, some of this information should be—there should be information about who the specialist nurses are—so could we get the CCGs together in some way to talk to them about the issues raised by my right hon. Friend, because lives are time-limited if they do not have access to the equipment that he is talking about?

The second issue is that the Government must be prepared to make a commitment, although not to providing additional funding, because the NHS is stretched. Where private sector companies, such as Roche and others, are investing and doing research that will benefit the public, is there any way to assist them by providing them with greater capacity to research, whether through encouragement, incentives or some other means? We need to do that because we do not have the money to do the research ourselves.

The third issue concerns personnel in the Department. I was astonished to learn that the Secretary of State had still not met the diabetes tsar, Professor Jonathan Valabhji. I tabled a question asking when he last met him, and it turned out he had never met the very expert appointed by the Government to assist in these matters. He is an outstanding diabetes tsar—probably the best the country has ever had—a frequent visitor to our meetings and a professor at St Mary’s, but he has not met the Secretary of State. Please will the Minister talk to her colleagues and ask that one of them meet with Professor Valabhji? It would be helpful if it was the Secretary of State, though, and would be of some assistance to him.

My final point concerns that made by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley. Diabetics such as myself—the same applies to type 1 diabetics—have to see nine different professionals, but we see them on different days, at different times and in different places. When we have our bloods done, there should be someone to help us with structured education, which is vital—we should not be made to book another appointment for another day when perhaps we cannot make it; there should be someone to check our eyes, too; and all this at the same time.

In Leicester, we are developing the first diabetes village, where a patient can do the lot on a Saturday morning—all eight of the main functions, including wellbeing, mental health and lifestyle. If someone with type 2 diabetes goes to the doctor in Doha and gets a prescription, before they get their medication, they are sent to a gym to make sure they make the necessary lifestyle changes before their medication kicks in. They have medical centres there with the panoply of services diabetics need.

Tomorrow, we will be holding an international diabetes summit in Committee Room 14, if it is vacated in time. In that respect, my message to Conservative Members is: get on with it, as the Prime Minister would say, and finish it off tonight—I do not have a vote in that election—so that we can have Committee Room 14 back. The Diabetes Minister, the hon. Member for Winchester (Steve Brine), and people from China, Denmark and Italy, are coming to share their experiences, and type 1 diabetes will be high on the agenda. The more of these meetings we hold in this place, the better it is to keep diabetes on the agenda.

Once again, I thank my right hon. Friend for securing this debate and for making sure we talk about these issues, and I thank my hon. Friend the Member for Heywood and Middleton, too, for her last debate on diabetes. We should keep putting in for these debates to make sure this is the highest possible priority for the Government.