World Diabetes Day 2023: Exploring diabetes technology and healthcare disparities in the UKKeisha Bullock-Singh, Junior Consultant
Today marks World Diabetes Day; an awareness day recognising diabetes mellitus across the globe. This year marks 100 years since insulin – the treatment for diabetes – was produced on a mass scale and made widely available, with the day also celebrating the incredible advancements in diabetes treatment made in recent years.
However, as diabetes care advances and grows, there continues to be the challenge of ensuring equality in treatment. This is due to the significant disparities in who can access vital life-saving or bettering treatment, often dependent on criteria such as postcodes.
This World Diabetes Day, the World Health Organisation looks to put a spotlight on this challenge by highlighting the need for equitable access to essential care, including raising awareness of ways people with diabetes can minimise their risk of complications. Although disparities in healthcare treatment, particularly for chronic illnesses like diabetes, are often viewed through a global lens, the differences in level of treatment on a subnational level vary significantly.
In March 2022, the National Institute for Health and Care Excellence (NICE) issued guidelines recommending the use of Continuous Glucose Monitoring (CGM) for adults and children living with Type 1 diabetes, whilst also expanding the use of Flash Monitoring to the whole of the Type 1 patient population.
As highlighted by Diabetes UK and its Diabetes Tech Can’t Wait campaign however, there is a significant variation in the technology available between local areas. While some Integrated Care Boards have introduced policies to extend access to Flash and CGM systems following the recommendations made by NICE, others have not. This disparity in treatment has been further emphasised by Diabetes UK’s 2023 report ‘Diabetes Care: Is It fair enough?’, which revealed that, in 2022, one in three people in the most deprived areas found it difficult to contact their diabetes team compared to one-in-four in the least deprived areas.
The inability to access necessary and life-improving technology means that Type 1 diabetics across the UK face an increased risk of negative health outcomes, as validated by a 2019 observational study which concluded that there is a marked improvement in HbA1c (the amount of glucose attached to haemoglobin in the body) following commencement of Flash Monitoring in those with Type 1 diabetes.
Numerous MPs, across multiple parties, have reiterated the disparities in treatment faced by diabetics, with the Shadow Minister for Health and Social Care Feryal Clark and her Labour colleague Kevan Jones, in addition to Conservative grandee Sir Graham Brady and Liberal Democrat MP Jamie Stone all questioning the Government on its approach to rolling out access to diabetes technology via the NHS.
Despite this cross-party consensus, in addition to campaigning from industry organisations, the Government is still unable to commit to complete parity of treatment for diabetics across the UK, as is evident by the interim report on its Major Conditions Strategy (MCS).
The Government’s Major Conditions Strategy – which seeks to tackle major health conditions affecting the British population – examined how to prevent, diagnose, treat and manage diabetes. Despite this objective, the interim report on the MCS reveals a continued lack of understanding of why it is crucial to improve care for diabetics, particularly to mitigate the other negative health complications associated with the illness. Discussing the MCS interim report, Diabetes UK additionally highlights how the report is ‘quite light on plans to tackle disparities in health despite the promise that this strategy would replace in part the planned “health disparities” strategy’.
The need to ensure equal treatment for diabetics is needed more now than ever, following a November announcement from NICE stating that more than 150,000 adults and children with Type 1 diabetes will be offered an artificial pancreas on the NHS, which experts are calling a “gamechanger” that will “save lives and heartbreak”, in addition to reducing the risk of diabetic burnout. As detailed by NICE, the roll-out of the artificial pancreas will be across five years with the treatment first offered to women who are pregnant, or planning pregnancy, and people who already have an insulin pump.
It is vital that this treatment is rolled out fairly and with reason, to diabetics across the UK, particularly taking into consideration the challenges to treatment faced by those who live in lower socio-economic areas. Considering the negative health outcomes associated with Type 1 diabetes, including retinopathy, kidney damage and nerve damage, not doing so has the potential to reduce the quality of life for thousands of children, young people and adults with Type 1 diabetes, in the UK.
So this World Diabetes Day, we must bear in mind the challenges still being faced by the diabetic community across the UK and continue to campaign for fair, just and equal treatment for all. Yes, let’s celebrate. But remember, just because the tech is available in the UK, that doesn’t guarantee availability to all. Ensuring UK-wide rollout implementation will be the real “gamechanger”.