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Tens of thousands of people living with type 1 diabetes in England are being refused access to devices that could improve lives, an investigation has revealed, with experts claiming that the situation amounts to a “postcode lottery”.
About 400,000 people in the UK have type 1 diabetes – an autoimmune condition where the body does not produce insulin, leading to glucose not being taken up by cells and potentially reaching dangerously high levels in the blood.
Flash glucose monitoring devices involve a sensor, about the size of a £2 coin, that is attached to the upper arm and constantly measures the level of glucose in the fluid around cells in the body, rather than in the blood, by means of fibres that sit under the skin.
Users can access the data by scanning the sensor with a smartphone or digital reader – a feature proponents say is convenient and means that fewer finger-prick blood tests are needed.
The devices have theoretically been available on the NHS for just over a year, following advice that they could improve peoples lives and lead to money being saved, although clinical commissioning groups can develop their own policies about funding for the technology. NHS England has advised that the system should be prescribed only to patients meeting certain criteria, including currently undertaking very frequent monitoring of their blood glucose levels, or having a number of admissions to hospital as a result of low blood sugar or other complications.
Now an investigation by the British Medical Journal (BMJ) in collaboration with diabetes campaigner Nick Cahm has revealed that 25 of 195 clinical commissioning groups in England have not yet issued a single prescription for the system, despite others offering the device to almost 25% of people with type 1 diabetes.
The investigation also found that just 2% of individuals in England with type 1 diabetes had been prescribed the device by their GP, while proportions reached 11% in Scotland, 16% in Wales and 35% in Northern Ireland. The report also claims some individuals are paying for the device out of their own pocket.
Nikki Joule, policy manager at Diabetes UK, said the situation was unacceptable. “As this investigation shows, tens of thousands of people are still being denied access to Flash despite meeting nationally recommended prescribing criteria, purely because of where they live,” she said. “This unfair postcode lottery is preventing thousands of people living with diabetes from accessing potentially life changing glucose monitoring technology.”
A spokesperson from NHS Wakefield CCG – one of those which had issued no prescriptions for the device – told the Guardian that individual funding requests had previously been required for patients to get the device, but said a new policy was approved last month outlining criteria for receiving the prescription.
Meanwhile, Leicester city clinical commissioning group told the Guardian they were in the process of reviewing their previous policy of withholding access to the device, which, they say, was based on there being “not enough evidence to demonstrate that it is effective for monitoring diabetes, compared with the cost”.
Partha Kar, the associate national clinical director for diabetes at NHS England, told the BMJ that if CCGs were following current guidance, at least 20% to 25% of those with type 1 diabetes should have access to the sensor.
“One CCG said to me, ‘We don’t think the evidence is there,’” he said. “And I said, ‘Well, how is the evidence there for London, Manchester, Liverpool, Brighton, but not for you? How does that work?’ That’s just ridiculous.”
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