Low numbers prescribed "game changing" diabetes technology

CONCERNS have been raised over the low number of people with diabetes who have been prescribed new "game changing" technology following the results of a nationwide investigation. The Free Style Libre System, which spells the end of finger pricking for people with either type 1 or type 2 diabetes needing to monitor their blood sugar levels, was made available on the NHS last November, subject to approval by local, Clinical Commissioning Groups (CCGs).

However, results from Freedom of Information requests carried out by the Charity the InDependent Diabetes Trust (IDDT) show just 30 out of the 144 CCGs who responded have prescribed the system to just 174 people. In response to a question on which criteria decisions about prescribing the FreeStyle Libre system are made, 23 CCGs failed to provide any data.

These figures are at odds with stats provided by Diabetes UK which show 9,690 across Britain have been prescribed the technology since November, which is still a low proportion representing less than 2% of the 500,000 eligible people.  In the IDDT's investigation, just 27 CCGs adhered to either local or Regional guidelines or both. A further 14 followed advice from the Regional Medicines Optimisation Committee (RMOC) and only 1 CCG based their decision on NICE guidelines.

The flash glucose system automatically reads glucose levels through a sensor, approximately the size of a ₤2 coin, worn on the back of the upper arm for up to 14 days, eliminating the need for routine finger pricks and user calibration. It is designed to change how people with diabetes measure their glucose levels and ultimately help them achieve better health outcomes.

2 clinical trials and real world evidence from more than 50,000 users worldwide show that people who use the FreeStyle Libre system scan their glucose levels an average of at least 15 times per day. In real world use, higher rates of scanning to self monitor glucose were found to be strongly associated with improved blood glucose levels and potentially reducing long term complications.

Philip Ramsden, of Gawcott, Buckinghamshire, has Type 1 diabetes. The 74 year old was informed about the Freestyle Libre system by a friend whose 15 year old granddaughter was trialling it. He continued to fund it privately after his attempts to have it prescribed by Buckinghamshire CCG failed. However, the mounting cost of using the equipment resulted in him having to give it up. He said:- "My quality of life improved, the ease of using the system was remarkable. My wife could simply scan my arm whilst driving and towing a caravan, preventing the need to carry out the difficult task of finding somewhere to pull over to prick my finger. Being able to anticipate the rise and fall of blood sugar levels at ease regularly enabled me to do something about it straight away rather than waiting until dangerous levels were reached."

After consistently using FreeStyle Libre for 4 months the physiological benefits of its use were evident, with Philip noticing a reduction to his average blood glucose levels (HbA1c) and body mass index (BMI).

Philip Ramsden:- "Initially I was spending ₤100 per month on sensors, which are used instead of test strips, but had to cut down to ₤35 per month; I don't want to be spending all this money. Now I shall be increasing my use of blood testing strips from 5/6 to 10/12 per 24 hours for close control, so this will probably cost the NHS more than supplying the Abbott. I think the NHS are a little bit blinkered and should review individual cases, especially for those with Type 1 diabetes. The measurable cost of the complications that can arise in later life as a result of diabetes need to be considered. A friend of mine, who was diagnosed with Type 1 in his 20s recently had to have a leg amputated, possibly because he was not testing enough earlier in his life. If they don't provide people, especially youngsters, with these facilities it will affect them in later life"

Martin Hirst, IDDT Chief Executive, said:- "The results show a postcode lottery clearly exists in the prescribing of the FreeStyle Libre system. What is disappointing is the number of CCGs who fail to even recommend this pioneering technology which has the ability to fundamentally change the management of diabetes and improve the immediate and long term healthcare of those who require its use. The FreeStyle Libre clearly improves management of diabetes in many areas of life. It is a substantial step forward in diabetes management but further improvements need to be made."

The InDependent Diabetes Trust is a Northampton-based charity providing vital independent support for people with diabetes, their parents and carers. The Charity formed in 1994 to fight for choice of treatment for all. It now provides a free, confidential helpline and has published many helpful publications. The Trust campaigns and lobbies the Government and professional organisations on behalf of its members.

There are 4 million people who have been diagnosed with diabetes in the UK. By 2025, it is estimated that in the UK 5 million people will have diabetes. In excess of 800,000 people remain undiagnosed with Type 2 diabetes.

A new option for Care and Support Workers in Merseyside

THE challenges faced by care and support workers are well documented. Low pay, rushed client visits and back to back calls are just a few of the problems encountered daily. However, care and support workers in Merseyside now have a different option. Launching in the North West, The Alliance of Independent Care and Support Workers (AICSW) is a new, UK wide membership organisation that directly links care workers with people who need help at home. By making these direct links, care workers can access better paid care work and ultimately improve their working conditions.

The idea for the Alliance was born from a conversation between 2 North West healthcare professionals; a Mental Health Nurse and an Occupational Therapist. Having seen 1st hand the amazing job that care and support workers do, they wanted a way to improve pay and conditions; as well as give increased choice for people who need care.

Traditionally, people who require care or support at home employ the services of a domiciliary care agency. However, this approach often comes with problems of its own. An agency often must send many different care workers who are trying to fit lots of clients into a short space of time. This can result in clients receiving care from workers who are not always known to them; as well as a rushed approach as workers hurry to get from call to call.

Having a small, consistent team who is familiar with the patient's needs is key in ensuring a safe and person centred approach to their care and the direct model improves communication channels. As well as allowing clients to personally select their care worker, this direct link approach is a win win financially for both client and care worker. Without the 'middle man' of an agency, an independent care worker can charge a much higher hourly rate hour, but the client will still normally pay a lower amount than what they would pay to an agency.

When care workers join, they fill out very quick profile questionnaire and then their profile is listed on the site and appears for people who are searching for care workers within their geographical area. The information includes all pertinent information such as qualification, DBS Check information and reference availability. For people searching for care workers, the search facility is free and easy to use; no log in or account creation is required, and they can directly message care workers they think might be suitable.

The Alliance annual membership costs just ₤24; less than the price of a cup of coffee per month. Membership has deliberately been kept so low so ensure as many care workers as possible have the option of joining. Included in this price are a wealth of resources for the care worker. These include a Code of Conduct, clinical documents (such as care plans and body maps) as well as all other necessary documents the care worker may need such as invoices and timesheets. Members will also receive regular news updates and access to discounted offers.

The Alliance comments:- "With an ageing population and an increase in long term conditions the demand for care and support has never been greater and will only increase over time. In many areas the domically agency model is struggling, and this addition provides another option for care workers and more choice for clients. It's a great way forward"

The Alliance is now signing up care workers at:- AICSW.Org.UK.