Diabetes: Artificial Pancreas

Steve McCabe Excerpts

Wednesday 12th December 2018 Commons Chamber

[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.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I do not know whether my right hon. Friend is familiar with a group called #WeAreNotWaiting. They are people who are developing their own equipment, pumps, monitoring system and computers, because they are not prepared to wait for technology that could be made available to help them.

As my right hon. Friend says, the pumps are available but not widely available on the NHS, despite being a leading British technology. Of course, the other problem is that there is no push from the Government for concerted commercial development of these systems in this country.

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. I am aware of the #WeAreNotWaiting group and as recently as earlier today I had an email from one of them. I will not name them, because I do not have permission to do so.

--- Later in debate ---

[Mr Howarth]

My hon. Friend may have been late, but he is never behind. Of course I agree with him.

In October, I tabled a written parliamentary question to the Secretary of State for Health and Social Care, asking how many patients with type 1 diabetes had been referred for psychological support, psychiatric support, and treatment for an eating disorder or diabulimia in the last 12 months. I was told that the information is not held centrally. I then took the matter up with Knowsley clinical commissioning group, but it turns out that it does not hold that information either.

The lack of psychological support for adults and young people with type 1 diabetes is a real and important issue. It was one of the key points in the national service framework for diabetes when that was first brought into being. Most patients on Merseyside, which is my part of the world, still cannot get the support that they need.

Diabulimia, which is a syndrome, rather than a condition, is an eating disorder present among those with type 1 diabetes. It involves the omission of insulin doses, which leads to high blood glucose levels and the body’s cells being deprived of oxygen and energy. The available research suggests that around 40% of females between the ages of 15 and 30 with type 1 diabetes deliberately induce hyperglycaemia and diabetic ketoacidosis in order to bring about weight loss. Anyone can go on the internet and quite easily find out that if they omit to use their insulin, they can probably lose half a stone in a week, but of course the risks in involved in doing so, including damage to vital organs, should not be taken at all.

According to the charity Diabetics with Eating Disorders, 60% of all females with type 1 diabetes will have experienced a clinically diagnosable eating disorder by the age of 25, and new research suggests that 11% of adolescent males also engage in insulin omission for weight loss. I just want to pause at this point and say a word: although I am describing something that affects type 1 diabetics, it is all part of a wider problem of body image and an obsession with a particular type of weight range. Although diabetics, because of their condition, have a different means of achieving that weight loss, it is an issue that has to be addressed nationally. I know that the fashion industry, for example, has started to make some moves in that direction, but it is a national problem, particularly for many young women who feel that they have to look a certain way to be acceptable. That is, of course, nonsensical, but, nevertheless, it is the way that some of them feel.

Sandie Atkinson, a PhD candidate at Liverpool John Moores University, believes that there is a lot more that clinics can do to reduce the psychological impact of type 1 diabetes and, as a consequence, reduce the prevalence of diabulimia. She says:

“By being empathetic to the issues that impact blood glucose level outside of the realm of an individual’s ability to manage and having realistic expectations of them in light of these uncontrollable factors, individuals might feel less inclined to hide their true condition from Healthcare Professionals.  The likelihood of them being more open would undoubtedly be in the best interest of the patients and the NHS at large.”

While conducting her research, those whom Sandie spoke to described the problems that they had in accessing support in clinics. One participant said:

“Eating disorders thrive on secrecy and yet people feel with diabetes they can’t be honest about the expectations of where they are with control so there’s two lots of secrecy there that really does a lot more damage”.

A second interviewee said:

“There’s something about the way that we treat diabetes and I don’t know if it’s maybe because there is some internal stigma, but there’s something needs to be done…I just kind of feel like we’ve got it all wrong…right from the off you should have a psychologist…at least for the first year. I mean the research is all there, suicide risk goes up, self-harm risk goes up, mental health declines…We know this but we’re like, ‘oh yeah, we’ll see you in six months’ time’.”

To progress towards artificial pancreas systems, there are a number of things that the Government must do. The NHS needs to establish a new national framework that encourages innovation. The framework could include some of the following elements: first, a national strategy, with allocated funding, for diabetes technology, allowing all people with type 1 diabetes to self-manage their condition by considering individual medical need and the potential to improve quality of life and psychological aspects of care.

[Steve McCabe]

If the NHS were to develop that approach, would it not, as well as giving people much more freedom, autonomy and control over their life, produce massively more data—the strongest commodity in the NHS at the moment—which would mean that we could predict this condition, and look at other possible methods of controlling or treating it?