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Increased adoption of the latest technologies for managing type 1 diabetes is being held back by a lack of awareness of the benefits among clinicians in certain areas of England and Wales, leading to wide variations in access, say UK experts. United.
They argue that this irregular assimilation, despite good evidence showing that patients experience reductions in HbA1c levels and hypoglycemic episodes, is in turn holding back the introduction of modern “closed-loop” insulin delivery systems.
The experts spoke during a session dedicated to access to technology at the Diabetes Professional Care Virtual 2020 meeting on November 11.
Slow start
Session chair Pratik Choudhary, professor of diabetes at the University of Leicester, said that, from a slow start, there has in some cases been “rapid” adoption of diabetes technology.
However, this has not been generalized for all technologies. He noted that the first use of insulin pumps was in 1979, and “we have not yet reached 30% use” of the technology in the National Health Service.
By contrast, the adoption of Abbott FreeStyle Libre The glucose monitoring system has been much faster, particularly in recent years, thanks to the device becoming available by prescription on the NHS in April 2019.
As reported by Medscape UK News, subsequently there was an increase of more than 60% in its adoption by eligible patients with type 1 diabetes until August of that year, from 10.7% to 17.6%.
Session panel member Conn O’Neill, chair of the diabetes group of the Association of British HealthTech Industries (ABHI), the UK diabetes management industry body and public affairs leader for Roche Diabetes Care , said that, since then, adoption has reached 30% of eligible patients.
He thinks this is “a good story not only for Free but also for all other technologies, “from the simplest devices that are” used by all patients with diabetes “, such as needles and test strips,” to the most advanced technology available. “
DT1 ‘100 times easier’
Expanding on this topic, Dr. Emma Wilmot, consultant diabetologist, University Hospitals of Derby and Burton NHS Foundation Trust, said that living with type 1 diabetes in 2020 is “definitely 100 times easier than it was 50 years ago.”
This is due to a variety of technologies, “but that comes with a lot of challenges.”
He pointed to research commissioned by Roche that showed that only 21% of the 205 commissioned clinical groups in England, surveyed under a freedom of information request, offer continuous glucose monitoring (CGM) in accordance with National Institute of Health guidelines and Excellence in Service (NICE). .
Dr. Wilmot also noted that 12 years have passed since the publication of an evaluation of NICE technology that establishes recommendations for insulin pump therapy in people with type 1 diabetes.
However, more recent data showed that adult patient acceptance of insulin pump therapy is 18% in England, 10% in Scotland and Northern Ireland, and 6% in Wales, compared to 21% in Denmark and 37% in Germany and Austria.
Audit
Data from the 2017-2018 National Insulin Pumps Audit for Diabetes also showed that there was a more than 10-fold variation in device absorption among adult patients in England and Wales, ranging from more than 45.0 to less than 5.0%.
The audit also showed that there is great variation in the provision of insulin pumps for children and young adults with type 1 diabetes, ranging from less than five percent of patients in some specialty services to more than 80% in units with better performance.
“If you had a brother, a sister, a mother, a father with type 1 diabetes, would you want them to attend a service that has less than five percent of people with pumps or do you want them to attend a service that has more than forty percent? hundred people with bombs? “asked Dr. Wilmot.
He added that “we know” that insulin pumps reduce HbA1c levels and the incidence of hypoglycemia, and “the fact that there is a variation is completely unacceptable.”
Dr. Wilmot went on to say that staffing is an important issue for the adoption of diabetes management technology.
Audit data showed that 24% of 115 specialty services had to stop insulin pump start-up in the previous 2 years, and 70% cited staffing issues as the main reason.
“But that was before COVID-19,” he said. “Think where we are now.
“Our services have been suspended, we are in crisis mode and I suspect many services across the country will take months, if not years, to catch up with the backlog of pump upgrades and new starts.”
Barriers
He went on to say that the barrier to adoption is not the technology itself, as Freestyle freestyle It has been adopted much more rapidly than insulin pumps since its introduction in 2017.
While there are big differences between the two technologies, she believes the history of CGM adoption “shows that when everyone pushes in the same direction, the technology that is needed can be accessed.”
Dr. Wilmot continued: “For me personally, one of the fundamental differences between access to pumps and access to Free is the person with diabetes.
“The fact that they were able to take samples Free, understanding the benefits and then fighting with Diabetes UK for access, I think it fundamentally started a roller coaster here, and we’ve all been pushing since then. “
This is so despite the fact that insulin pumps have a higher level of evidence for lowering HbA1c and reducing severe hypoglycemic episodes.
His experience is that patients report that “it changes their lives, in the same way that people come back to the clinic and say that [Libre] it’s life changing. “
He added, “The difference is that there is a barrier to pump therapy,” and that is the lack of understanding of insulin pump technology and its benefits among healthcare professionals.
For Dr. Wilmot, this is a concern because “closed-loop” automated insulin delivery therapy, which uses an algorithm-based system to combine an insulin pump and CGM, is “certainly the future of patient care. type 1 diabetes. “
“When you talk to people in these systems, they say their lives have fundamentally changed for the better, but if we want to achieve this in the UK we need to reflect on where we are and how we tackle the barriers.
“If we can’t get people to use pumps, if we can’t get people to use CGM, we can’t get [them] in closed circuit systems.
“In general, as we did with FreeAs a community, we must address this and work hard to get these technologies to the people who need them most. “
Technical formation
This dovetails with a recent report from the Juvenile Diabetes Research Foundation, which states that not only should type 1 diabetes patients have more time with specialized healthcare professionals at appointments, but that specialists should also receive mandatory training in diabetes technology. diabetes.
Accordingly, Dr. Wilmot urged that at every possible visit, “think, ‘Does this person meet the NICE criteria?’ If they do, talk about the pump.”
If doctors aren’t comfortable doing that, they should learn about diabetes technologies, he said, “or ask a colleague who sees them to understand the pumps.”
Health professionals should also ask themselves if they can have an “informed discussion” with patients about closed-loop systems.
Dr. Wilmot added: “Playing devil’s advocate, should we move to a point where, if you’re working on type 1 diabetes, you need to have a basic level of training in pump therapy, CGM … in order to provide that service? “
No funding declared.
Dr. Wilmot declares speaker fees, research and education grants from Abbott Diabetes Care, Dexcom, Diasend, Eli Lilly, Insulet, Medtronic, Novo Nordisk, Sanofi Aventis.
Mr. O’Neill is an employee of Roche Diabetes Care.
Diabetes Professional Care Virtual 2020: Summary Access to digital technology for diabetes. Presented on November 11.
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