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Innovations in diabetes care

How are two new initiatives changing the management of diabetes for the better?

Diabetes costs the NHS an enormous amount of money. In fact, it spends around £10 billion a year on the disease – that’s 10 per cent of its annual budget

It’s not surprising then that the Government is keen to reduce the burden the disease places on the healthcare service, and two exciting new initiatives certainly look likely to help it achieve this aim.

The initiatives are mainly targeted at those with type 1 diabetes, a serious, life-long condition that affects around 400,000 people in the UK.

We still don’t know exactly why type 1 diabetes occurs, although unlike type 2 diabetes, it is not triggered by diet or lifestyle choices. Currently, there is no known cure for type 1 diabetes and people with the condition are reliant on taking insulin – either by injection pen or via an insulin pump, a battery-operated device that provides insulin regularly throughout the day. 

Why is insulin important?

Insulin is a hormone made in the pancreas, an organ in the body that supports digestion and helps the body to use glucose (sugar) for energy. 

When a person has diabetes, their pancreas may not make any insulin. Alternatively, it may not make enough insulin, or the insulin it makes doesn’t work properly. Insufficient insulin can cause the level of glucose in the person’s blood (their blood sugar level) to become too high.

Everybody with type 1 diabetes, and some people with type 2 diabetes, needs to take insulin as a treatment so that their blood sugar levels remain stable.

Type 1 diabetes causes the level of glucose in the blood to become too high. This happens because the body attacks the cells in the pancreas that make insulin, so they can’t produce any insulin at all.

Over time, high blood sugar levels can damage the heart, eyes, feet and kidneys. Very high blood sugar levels can lead to a serious problem called diabetic ketoacidosis, where the body starts to break down fat for energy leading to a build-up of acid (ketones) in the blood. This can be life threatening and needs to be treated in hospital.

Blood sugar levels that are too low (hypoglycaemia) can also cause problems if not treated quickly enough.

Flash monitoring

It is very important that people with diabetes are able to monitor their blood sugar levels so that they can remain healthy. And the first new NHS initiative is aimed at helping people to do just that more easily than ever before. 

Under new guidance just published by the National Institute for Health and Care Excellence (NICE), everyone in England with type 1 diabetes and everyone with insulin treated type 2 diabetes who has a learning disability and is on their GP’s learning disability register is being offered the opportunity to have their own flash glucose monitor. Described as "lifesaving", these wearable gadgets let users check their blood glucose levels easily, without the need for finger prick blood samples, which are required by other blood sugar monitors.

The size of a £2 coin, a flash glucose monitor works via a sensor that is worn on the back of the upper arm. The sensor continuously measures the glucose in the interstitial fluid, a thin layer of fluid that surrounds the cells of tissue below the skin. The monitor sends this data to a Smartphone app, where patients can view their blood sugar patterns over time. As well as showing current and previous blood glucose levels, the gadgets also predict what they may rise to.

Already, 60 per cent of people with type 1 diabetes in England are using flash glucose monitors, says the NHS. Research shows that they not only help to improve blood glucose levels in people with type 1 diabetes, but they also have a positive effect on their quality of life.

Professor Partha Kar, national NHS specialty adviser for diabetes, called the move to make the monitors available to all patients "the biggest step forward for type 1 diabetes care in years". And he added: "These monitors are a win, win – they support diabetes patients to live healthier lives, reduce their risk of hospitalisation while also helping to reduce pressure on NHS services and provide better value for money for taxpayers".

Olivia's story

25 year old Olivia, who lives in Essex, was diagnosed with type 1 diabetes at the age of seven. Before she started using a flash glucose monitor, she had to carry a finger prick blood glucose testing kit with her everywhere she went, and would have to test up to eight times a day. 

"I was pricking my finger and testing my blood sugar before breakfast, before lunch, before dinner and before bed," she says. "Before driving in the car I would need to test, and after driving for two hours I would need to stop to test – endless testing!"

Growing up with diabetes, Olivia says she would never have dreamed that a device like a flash glucose monitor would be developed in her lifetime. "When I first started using one," she says, "I couldn’t quite believe something so small had such an impact on managing my diabetes."

Since she has been using her flash monitor, Olivia says she has seen a huge improvement. "I can make informed decisions when taking my insulin by looking at trends," she says. "But, most importantly, it’s helped me have more confidence and improved my mental wellbeing."

Artificial pancreas

Under the second – somewhat more radical – new initiative, almost 1,000 adults and children with type 1 diabetes in England have been given a potentially life-altering artificial pancreas. 

Around 35 NHS diabetes centres are piloting the system, which uses revolutionary hybrid closed loop technology to monitor blood glucose continually and automatically adjust the amount of insulin the person receives via a pump. Again, there is no need for finger prick blood glucose tests.

Experts want to discover whether the technology can help people of all ages to safely and effectively control their condition, in a real-world setting.

Charlotte's story

One of the children who has received an artificial pancreas from the NHS is six-year-old Charlotte Abbott-Pierce. Just over a year ago, she was diagnosed with type 1 diabetes after having to attend A&E because of a significant increase in thirst and need to urinate. Charlotte’s mum has type 1 diabetes, so had recognised the symptoms.

Since Charlotte was young and unaware of the potentially dangerous consequences of unmanaged blood sugar levels, her clinician recommended her for the hybrid closed loop (HCL) pilot. It was hoped that it would improve Charlotte’s blood sugar control, support her parents with her diabetes management and potentially improve her long-term health.

Now that she is using the system, Charlotte has fewer blood glucose highs, and since her parents know the pump is working in the background, they don’t have to set alarms all the time.

"Before the HCL was fitted," says her mum Ange, "my husband and I would be up every two hours every night having to check Charlotte’s blood sugars and most times giving insulin, sometimes doing finger pricks or dealing with ketones due to quick rises in blood sugar. This was really hard as we both work full time.

"The HCL has given us tighter control as the continuous glucose monitor is monitoring Charlotte’s blood sugars and the pump is reacting before we even know there’s a problem. Hormones are a big factor at the moment, so interventions are still needed, but this system is a god send to us as we were at our wits' end with worry, not being able to catch the highs before they got dangerous."

"Having machines monitor and deliver medication for diabetes patients sounds quite sci-fi like," says Professor Kar, "but when you think of it, technology and machines are part and parcel of how we live our lives every day.

“A device picks up glucose levels, sends the reading across to the delivery system – aka the pump – and then the system kicks in to assess how much insulin is needed.

"It is not very far away from the holy grail of a fully automated system, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication."

Estimates show that only a third of children with type 1 diabetes are currently able to achieve good control of their blood glucose levels. Figures also show that a five-year-old child diagnosed with type 1 diabetes faces up to 23,000 insulin injections and 52,000 finger prick blood tests by the time they are 18 years of age.

As well as the physical benefits, using the artificial pancreas system can also help relieve some of the mental burden on people with type 1 diabetes and their carers, who otherwise must remain constantly vigilant to blood sugar levels, says the NHS.

The pilot includes a representative mix of adults and children from all backgrounds. The data collected, along with other evidence, will be considered by NICE, who will make a recommendation about wider adoption of the technology across the NHS following its review.

Yasmin's story

Yasmin Hopkins is 27 years old and lives in London. She also received an artificial pancreas as part of the NHS pilot. 

Yasmin has been living with type 1 diabetes for 16 years. She started pump therapy six years ago. However, she still suffered from peaks and troughs, diabetes burnout and general fluctuations of glucose levels. But since enrolling on the pilot study, she says she hasn’t looked back. 

Yasmin’s continuous glucose monitor has been able to communicate with her insulin pump and reduce the fluctuations that were taking over her life. This has not only brought Yasmin physical benefits but has also supported her mental health. “The connection between the monitor and insulin pump means that I can enjoy my life, whilst limiting the highs and lows, changing my life for the better,” she says.

“This amazing innovative technology hasn’t just benefitted me, it has also benefitted my family and friends. My boyfriend constantly emphasises that this technology will change lives the way that it has changed mine – even if it does beep extremely loud at 4am!” 

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