Diabetes Technologies

Sharon Hodgson Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship today, Mrs Gillan.

I welcome today’s timely debate on access to diabetes technology, which falls in Diabetes Awareness Month. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate and I pay tribute to my hon. Friend the Member for Copeland (Mr Reed), who is not present today, for all his campaigning, work and efforts on the subject over the years.

I also thank the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the Scottish National party, and I commend my right hon. Friend the Member for Knowsley (Mr Howarth) on his excellent contribution on young people with type 1 diabetes, and for highlighting the worrying danger of abuse by young people who skip insulin in order to lose weight. I had heard of that before, but I am grateful that he brought it to our attention today, so that the Minister may respond. As my right hon. Friend said, it is often due to the pressures of society and body shaming and it can, sadly, often be fatal. It is yet another pressure on these young people: aside from having the diabetes diagnosis in the first place, it is something else that they have to deal with.

I also want to disclose from the off that sadly I was diagnosed as a type 2 diabetic just a year ago, but through getting control of my diet and achieving weight loss, which is still ongoing, my diabetes is thankfully very well under control. This debate is therefore very close to my heart.

More than 4 million people and counting in the UK are now living with diagnosed diabetes. Some 400,000 live with type 1 diabetes, and 29,000 of those are children. I am hopeful that in the future, artificial pancreas technology, which we have heard about today, will be effective, safe and accessible to patients, and that eventually, thanks to important research undertaken by the Juvenile Diabetes Research Foundation, Diabetes UK and others, we will create a world without diabetes.

However, until that time comes, it is paramount that we do all we can to support adults and children living with the condition. Patients need accessible and high-quality education and support, and access to technology that will allow them to manage their condition and to achieve positive outcomes. Not only will that have a positive effect upon the lives of those 4 million people, especially including children, but it could also reduce NHS spend on diabetes-related complications.

There have been significant advances and improvements in care for people living with diabetes over the last 15 years or so, but it would be an enormous mistake for us to believe that the job was done. It is far from done and a significant amount of work needs to be undertaken to improve diabetes outcomes. That is because more than 24,000 people a year currently still die from a complication or condition related to diabetes, and many more will encounter life-altering, non-fatal complications. It is worth noting that diabetes-related complications account for a staggering 80% of the £10 billion annual NHS spend on diabetes.

Worryingly, there is also a regional dimension to the challenges presented in relation to positive diabetes outcomes. According to the national diabetes audit 2012-13, diabetes education courses are not being commissioned for people in more than a third of areas in England. Moreover, gateway treatment for both type 1 and type 2 diabetes is undertaken through primary care. However, with a GP shortfall of 40% across the north of England—my region—it is clear that accessibility is limited in certain parts of the country. Meanwhile, some CCGs have particularly large concentrations of people with type 2 diabetes and, it has to be said, there are correlations between those areas and socioeconomic disadvantage. The Government might well approach funding allocations with that in mind.

However, the issue we are discussing, which must be considered alongside the aforementioned points, is supporting patients to access technologies easily that will better help them to manage their condition, from insulin pumps to continuous glucose monitors, to flash glucose meters—a lot of them were spoken about by the hon. Member for St Ives. The technologies to which I refer make monitoring blood glucose more convenient for people than a standard blood glucose meter does, and in turn, those technologies can transform peoples’ lives. Continuous glucose monitors—CGMs—such as the Dexcom device, and flash glucose meters, such as the Abbott FreeStyle Libre device, are considered by many to be a less invasive technique than blood glucose meters for measuring blood glucose. They work 24 hours a day and CGMs can include alarms to indicate when glucose levels are too high. That is particularly important for people who do not know that they are experiencing hypoglycaemia, and children who may be unable yet to communicate it.

It is critical that the House understands the importance of blood glucose readings for people living with diabetes—both types—but it is of essential importance for people living with type 1. With type 2 patients, as I have found, blood glucose is usually monitored and controlled over a long period of time and the scope for immediate blood glucose correction is limited. For people living with type 1—people whose control depends upon the use of insulin delivered through an injection or a pump—accurate, real-time data are essential for blood glucose control.

To put it simply: better blood glucose control will result in better outcomes for people living with type 1 or type 2. It will relieve significant pressure on the NHS and result in a significant and positive long-term financial gain. Access to CGMs and flash glucose meters is limited on the NHS, and National Institute for Health and Care Excellence guidelines do not recommend that CGMs are offered routinely even to adults with type 1 diabetes, but funding should be considered in a small number of specified circumstances. Meanwhile, children and young people must either have frequent severe hypoglycaemia, impaired awareness of hypoglycaemia associated with adverse consequences, or the inability to recognise or communicate about symptoms of hypoglycaemia in order to be eligible for a CGM at the moment.

The guidelines, which can be difficult for health professionals, adult patients, and parents alike to navigate, are an obstacle to accessing life-changing technologies for people living with diabetes. As such, I hope that the Government will take steps to encourage CCGs to increase the take-up of CGMs—I apologise for all the acronyms—and flash glucose meters, and that eventually work will be undertaken, in conjunction with NICE, to look at increasing and improving access to diabetes technologies at a faster rate than patients currently experience.

The running cost of a CGM is around £3,000 to £4,000 a year, whereas a flash glucose meter costs around £1,300 a year. That represents a significant personal cost to many of those who are unable to access these technologies through their CCG, and who therefore have little choice but to self-fund. Lots of parents do this for their children especially. In considering the financial impact of diabetes, we must recognise that diabetic technologies should not be available only to those who can afford to self-fund. Allowing the continuation of the disparity between people with diabetes who can afford to make use of life-changing technologies and those who cannot undermines the principle of a truly national health service.

It is also important to consider that investment in the new technologies could save the NHS vast amounts in the long term. That is because they can help to avoid severe night-time hypos, and severe hypos cost the NHS £13 million a year. In addition, as I have mentioned, diabetes-related complications account for 80% of the total NHS spend on diabetes, and supporting patients to better manage their condition through access to CGMs and flash glucose meters will inevitably seek to reduce that cost. That is a significant saving, before we even begin considering the impact of hypoglycaemia on the UK economy as a whole.

Finally, during Prime Minister’s questions, in response to my hon. Friend the Member for Copeland, the Prime Minister stated:

“There are many youngsters out there, from tiny tots to teenagers, living with type 1 diabetes. It is important that we send a message to them that their future is not limited: they can do whatever they want.”—[Official Report, 20 July 2016; Vol. 613, c. 821-22.]

I am sure that all of us in the Chamber today very much welcome her comments. I hope that they represent a forthcoming commitment by the Government to improve access to life-changing technologies for adults and children to reduce any obstacles that they might otherwise face.

I ask the Government to commit to working to improve access to diabetes management education, support, and access to emerging technologies. We must ensure that emerging technologies reach the public in a timely manner, and that innovation, to make them even more user-friendly and to encourage take-up, is also supported and encouraged by the Government.

A national focus on access to diabetes technologies has its roots not only in clinical, but in financial arguments, as well having national support. So far, more than 26,000 people, from every single constituency in the UK, have signed a petition initiated by my hon. Friend the Member for Copeland calling for CGMs to be made available as a right on the NHS to adults and children living with type 1 diabetes. Moreover, 25 cross-party colleagues have signed an early-day motion in a similar vein. I extend my support to those cross-party calls to ensure that such technologies become accessible to adults and children living with diabetes—especially type 1—so as, ultimately, to improve the lives of those who need those technologies.