Harness education and tech for best diabetes outcomes
Diabetes In The UK New technology to help manage diabetes is promising, but patients and clinicians alike still need to learn how best to apply and use it, says diabetes consultant.
Dr Pratik Choudhary, senior lecturer and consultant in diabetes at King’s College London, believes that there is an education ‘bottleneck’ in the UK which reduces effectiveness of technology at clinical, cost and patient levels.
“Pumps to administer insulin were invented in 1978/9. Uptake in the USA is 50 per cent, in France and Spain about 30 per cent, while here in the UK it’s gone up in recent years from six per cent to 10 or 11 per cent. We have simple, cheap innovations available now but they could be more widely used. Reasons for this are complex, but in parts of the country this is still due to a lack of knowledge or enthusiasm among medical practitioners.”
That said, he is an advocate in the first instance of education over technology: counting carbohydrates and understanding basic calculations is time-consuming for all patients and not easy for many. “The evidence for structured education such as the DAFNE course is overwhelming, but access is still limited. Using insulin safely is complex; courses like DAFNE provide about 30 hours of education. NICE criteria say that people need to have undergone this training before pump therapy, and this is a major bottleneck in the UK for people accessing pump therapy. On the other hand, many people who have done it haven’t needed to go onto pumps because they now understand insulin administration better.”
With a pump costing the NHS £2,500 a year for each patient, better identification of who really needs a pump would also provide improved cost-effectiveness, he points out. “We need to identify those who are struggling on injections, despite education such as DAFNE, and ensure that they go onto a pump. We need to improve access and awareness and remove delays or inertia to action. That’s the real benefit.”
Readings at a swipe
“As someone with type 1 diabetes, you need to prick your finger several times a day to get your blood sugar reading, but in between, it is like walking on a tightrope between too high and too low sugar levels while you’re ‘blindfolded’. Continuous glucose monitors are systems that measure glucose continuously, have alarms that can alert people when glucose levels are out of range, or other devices such as the Abbott Libre device that you can just swipe to find out what the glucose is whenever you want,” Dr Choudhary explains. “Although CGMs significantly improve glucose control, you do still need to understand what to do if for example you get several alerts suddenly.”
The most exciting recent development is the recent commercial availability of ‘closed-loop systems’ that use the information from continuous glucose monitors to control the pump, creating a ‘cruise-control’ effect to ease the burden of diabetes management.
Technology is also helping to reduce medical appointment no-shows by offering travel-free Skype consultations; and using data from patients’ insulin pumps and blood glucose meters to highlight patients at risk or those who are struggling, and provide them with real-time support, or highlighting them to their health care teams.
Ultimately, though technology can make life easier, patients will still need to know how to keep themselves safe, and make the most of their devices.