The fact that the NHS is not providing insulin pumps to enough people with type 1 diabetes – compared to much higher access rates in other European nations – may be exposing them to greater risk of serious health complications, according to two diabetes charities.
Diabetes UK and JDRF expressed concerns as the UK’s first ever audit of insulin pump use, published today, revealed that just seven per cent of the estimated 247,500 UK people with type 1 diabetes use a pump.
These continually infuse insulin into the layer of tissue just beneath the skin and so help control blood glucose levels more tightly. Better blood glucose control is known to reduce the risk of long-term complications such as blindness, amputation, kidney failure and stroke. The pumps also offer a more practical alternative to multiple daily injections and help avoid hypos, which are when a person’s blood glucose level falls too low.
Usage in the UK is thought to have gone up over the last five years. But the report highlights that the seven per cent figure is still much lower than in countries such as Germany and Norway, where over 15 per cent of those with type 1 diabetes use a pump. In the US, use of insulin pumps is even more widespread, with some 40 per cent of people with type 1 having one.
The picture in the UK is slightly better for children, with 19 per cent of under-18s with type 1 using a pump, but this is still much lower than comparable European countries.
The report was published today by Ian Gallen, Fellow of the National Institute for Health and Care Excellence (NICE), and supported by the Association of British Clinical Diabetologists as well as the charities Diabetes UK and JDRF.
Diabetes UK and JDRF are both concerned that some people with type 1 diabetes who would gain maximum benefit are continuing to be denied access to a pump. The report suggests the UK’s poor performance is linked to the low number of healthcare professionals qualified to train people with type 1 diabetes to use a pump, with the lack of diabetes specialist nurses (DSNs) a particular problem.
The two charities are calling on the NHS to ensure that every child with type 1 diabetes is able to access specialist paediatric teams and that adult diabetes teams are commissioned to ensure access to a DSN who is experienced in pump management, which would deliver a big increase in pump usage in the UK.
Barbara Young, Chief Executive for Diabetes UK, said: 'While not everyone with type 1 diabetes wants a pump, it is important that those who would benefit and meet NICE guidance are able to access one, as pumps help some people to maintain a better level of blood glucose control than is possible through injecting insulin.
'This means that, long term, having a pump can reduce risk of complications such as amputation and blindness, can significantly improve quality of life and play a real role in helping people to manage their own condition, which in turn can reduce the number of people with type 1 diabetes who die before their time.
'This new report suggests that getting more healthcare professionals qualified to train people with type 1 diabetes to use a pump is big part of the solution. We now need the NHS to make this happen, as part of its commitment to ensuring everyone with diabetes has the best possible chance of a long and healthy life.'
Karen Addington, Chief Executive of JDRF, said: 'Access to pumps for those living with type 1 has increased over the last five years, but at a glacial pace – from two per cent to seven per cent. JDRF has long pushed the message that increased investment in research to cure, treat and prevent type 1 diabetes and its complications is vital. But furthermore, this report highlights the crucial importance of actual access to the treatments that come from this research. After all, insulin pumps were first endorsed for UK patients by the National Institute for Health and Care Excellence (NICE) 10 years ago.'
Publisher of the report Ian Gallen said: 'Whilst the national picture is improving, we are still a good way from where we should be with pump treatment. There are people who are having problems managing their diabetes who do not have the option of an insulin pump offered to them in a timely way, because of insufficient specialist support services. The commissioners of diabetes services must study our audit so they can ensure they commission appropriate specialist diabetes services, meaning that people can quickly move to pump treatment when needed.'
This was the first comprehensive audit of insulin pump access in the UK, involving the participation of 97 per cent of hospital trusts that provide insulin pump services.
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