Commentary: Dr Donald Greig
The future of diabetes management in the NHS is a constantly changing landscape but technology is pushing the boundaries of what is possible. The UK centric Times newspaper article reflects this. Like many developed countries, the UK and the NHS is on the brink of a technological revolution in healthcare, particularly for those living with diabetes. With advancements in medical technology, the prospect of eliminating the need for insulin injections is becoming increasingly feasible. However, these developments are occurring in Hong Kong in parallel.
The Current Landscape
Currently, millions of people in the UK manage their diabetes through daily insulin injections. This routine can be burdensome, requiring careful monitoring of blood sugar levels and meticulous planning around meals and physical activity. Despite the effectiveness of these methods, the challenge of adherence and the psychological toll of daily injections cannot be overlooked.
In recent years, Hong Kong has witnessed significant technological advancements in diabetes management, revolutionizing how patients monitor and control their condition. The integration of smart devices and insulin delivery systems, has empowered individuals to track their blood sugar levels in real time, facilitating more precise adjustments to their treatment plans. Telemedicine platforms have further enhanced accessibility to healthcare professionals, enabling timely consultations and personalized support. Additionally, the rise of mobile applications for dietary tracking and community support fosters a proactive approach to diabetes care. These innovations not only improve health outcomes but also enhance the quality of life for those living with diabetes in Hong Kong.
Emerging Technologies
Innovative devices, such as continuous glucose monitors (CGMs) and insulin pumps, are already transforming diabetes management. These gadgets provide real-time data and automate insulin delivery, which significantly eases the burden on patients. However, the dream of completely eliminating injections is closer than ever, thanks to research into alternatives like:
Artificial Pancreas Systems: These devices combine a CGM and insulin pump, automatically adjusting insulin delivery based on glucose levels.
Smart Insulin: Researchers are developing insulin formulations that respond to blood sugar levels, reducing the need for manual injections.
Inhalable Insulin: This alternative method offers a needle-free option, making it easier for patients to manage their diabetes without traditional injections.
The Role of the NHS
The NHS has the potential to lead the way in integrating these technologies into routine care. By investing in research and collaborating with tech companies, the NHS can facilitate wider access to these innovations. This would not only improve the quality of life for diabetes patients but also reduce long-term healthcare costs associated with diabetes complications.
Patient Empowerment
Education and support for patients are essential as these technologies evolve. Empowering individuals to understand and utilize new gadgets effectively will ensure they can take charge of their health. The NHS must provide comprehensive training and resources, enabling patients to make informed choices about their diabetes management.
Artificial Pancreas Systems: Hybrid closed loop systems
There are five main licensed hybrid closed loop systems available in the UK on the NHS or for people who can afford to pay for it themselves. More will become available over time. The other hybrid closed loop systems available aren't as automated - so you have to do more yourself.
People with type 1 diabetes using a hybrid closed loop system can have a better quality of life, research shows, because of the benefits it brings. And it can also make life easier for people caring for them. Blood sugar levels may be more stable and there are no insulin injections to do — and fewer finger prick tests.
How does a closed loop system work?
When you have type 1 diabetes, your pancreas can’t make and release insulin like it should. By releasing insulin whenever your body needs it, a closed loop system works like a pancreas. So a closed loop system is sometimes called an artificial pancreas or an artificial pancreas system.
Main hybrid closed loop systems available
These are a handful of licensed closed loop systems available in the UK on the NHS or for sale for people who can pay for one. They are sometimes called artificial pancreas systems. They are regulated by the Medicines and Healthcare products Regulatory Board (MHRA).
These hybrid closed loop systems can do more of the work for you than other systems available. They are usually the ones offered by the NHS.
The first tubeless hybrid closed loop system - Omnipod 5 - is available on the NHS. It works with the Dexcom G6 CGM and the Abbott FreeStyle Libre 2 Plus Sensor.
CamAPS FX
An app which uses the Dexcom G6 CGM or Dana Diabecare RS and DANA-i insulin pumps. Licensed for use from the age of one and over and also for use during pregnancy.
Medtronic 780g
Insulin pump which works with a Guardian 4 Sensor CGM. Licensed for use from the age of seven up.
Tandem Tslim Control IQ
An insulin pump which works with the standard Dexcom G6 CGM. Licensed for use from the age of six.
Abbott, Ypsomed and CamDiab
CamDiab's app algorithm automatically adjusts insulin dosage on Ypsomed's insulin pump, based on real-time glucose readings from a Freestyle Libre 3 sensor. Licensed for use from aged four and over.
Conclusion
The vision of a future where diabetes patients no longer require insulin injections is within our reach. With continued investment in technology and patient support, the NHS and HA in Hong Kong can revolutionize diabetes care, leading to improved health outcomes and a better quality of life for millions. It’s time to embrace this change and put an end to the era of needles in diabetes management.
Article by Eleanor Hayward
 Six per cent of the annual NHS budget is spent on diagnosing and treating diabetes at present Tens of thousands of people with type 1 diabetes will receive artificial pancreas gadgets that mean they no longer have to inject themselves with insulin. The NHS has reached “cost-effective deals” with the makers of the devices, which are worn on the body and constantly monitor how much insulin is needed to keep blood sugar stable. Insulin is then delivered via a pump. About 270,000 people in England have type 1 diabetes, which occurs when the pancreas does not produce insulin, the hormone that controls blood sugar. Patients have to inject insulin every day, using a pen or pump, and monitor their own blood sugar to prevent life-threatening hypoglycaemic attacks. However, the artificial pancreas, or hybrid closed loop system, does this whole process automatically. Dr Clare Hambling, NHS national clinical director for diabetes, said: “The technology behind the hybrid closed loop systems will be completely lifechanging for many people living with type 1 diabetes, promising a better quality of life as well as clinical outcomes.” The NHS spends about £10.7 billion each year — roughly 6 per cent of its budget — on identifying and treating diabetes. The NHS expects the new artificial pancreas to save millions each year by reducing complications such as stroke. Professor Partha Kar, the clinical lead on type 1 diabetes technology for NHS England, said: “This is fantastic news for many people living with type 1 diabetes. NHS trusts can access these devices at cost-effective prices, not only benefiting more patients but benefiting the taxpayer through significant savings to the NHS. “The device detects your glucose levels [and] transmits the readings to the delivery system, which then initiates the process of determining the required insulin dosage, improving medical care but also enhancing the quality of life for those affected.” The mass rollout of the artificial pancreas builds on a successful NHS pilot in which 835 adults and children with type 1 diabetes were given the devices to improve the management of their condition. They included Kate Willis, 45, from Portsmouth, who was diagnosed with type 1 diabetes when she was five years old. She said the device had made a “huge” difference to her life. “Provided I get my morning insulin correct, I usually run fairly consistently within range,” she said. “There is less stress around fear of testing and discovering your blood sugar is high or low. And it’s a lot less mentally draining because the majority of decisions are taken over by the system. Day to day, I have more energy and feel generally healthier. “It is not a magic switch and still takes a bit of work and patience at the beginning, especially, but if you get a good balance of ratios and carb-counting and put in the early hard work, the rewards really come. “The technology has certainly enhanced my life. It makes controlling your diabetes relatively effortless and I’m really pleased that many more people will now have access to it.” |
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