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Diabetes: Does type matter?

With diabetes being a focus of the NHS Long Term Plan, diabetes care in the NHS continues to evolve at pace. The team has painstakingly been conscious of the need to ensure the correct type of diabetes is referred to in the appropriate policy area. For example, when it has come to the area of prevention, we clearly reference Type 2 diabetes, whilst when we look at the use of technology such as Continuous Glucose Monitors, the reference has been towards Type 1 diabetes.

It may raise the question as to whether diabetes policy should be one homogenous issue – but that fails to take into account the differing pathology of different types of diabetes, whether it be Type 1, Type 2 or genetic causes such as Maturity Onset Diabetes of the Young (MODY).

With Type 2 diabetes being much more in the public consciousness due to the scale of it – as well as the wider drive to improve healthy lifestyle, tackle obesity and discuss modern sedentary, carbohydrate-rich environments, there has been a tendency for policy at local levels to also shift more towards Type 2 diabetes. Another reason may be the oft held view that Type 1 diabetes is a “disease of the young” even though data sets continue to show its presence and even diagnosis at much older ages than traditionally held views. As a consequence, paediatric departments have benefitted from a separate tariff – yet the same impetus has lacked within adult departments.

If one looks at outcomes, the proportion of the Type 2 diabetes population achieving HbA1c<7.5% stands at nearly 66%. This is testament to the work done by primary care. It is also an outcome which other countries would struggle to achieve – especially when one factors in added issues such as frailty, multi-morbidity – where higher HbA1c would be clinically appropriate.

However, when one looks at Type 1 Diabetes, the achievement is around 30% which reflects not only the different pathophysiology, but also the need to clarify to all concerned the need to improve outcomes in this group whose pathology, treatment and care can all be fundamentally different.

The NHS Right Care document thereby highlights the importance of this with clear messaging to CCGs about the need for different treatment and pathways for Type 1 and Type 2 diabetes. References are also made about getting the initial diagnosis right and the relevance of genetic screening, where appropriate. The aim of all this is to focus the mind on local policymakers and to ensure the same attention is given to Type 2 diabetes as to all other types. There is also the nudge to ensure technology gets as quick access as any relevant oral medication, as well as highlight specific areas to improve care and outcomes.

It is important to note that all diabetes care is, however, encompassed by the same principles of support, access or indeed language used by healthcare professionals.

The NHS Long Term Plan is an excellent example of this with appropriate focus and increased investment in prevention of Type 2 diabetes and self-care of Type 2 diabetes through a new online digital education programme, but also ensuring technology access is increased for Type 1 diabetes via flash and Continuous Glucose Monitors.

The intention is to ensure that all types sit on equal footings – and if we can replicate the outcomes in Type 2 diabetes across the board, we all stand to benefit as a nation.

So, does type matter? Yes – especially to the person whose care could be better if we as policymakers and healthcare professionals remember that diabetes is an overarching term yet it covers many different types, all of whom deserve equal attention and support.

Partha Kar

Professor Partha Kar is National Specialty Advisor, Diabetes with NHS England and co-lead of Diabetes GIRFT with NHS Improvement.

He has led and delivered so far on (April 2016- till date):

  • Freestyle Libre being available on NHS -across country
  • NHS Right Care Diabetes pathway
  • Diabetes “Language Matters” document
  • Type 1 diabetes NHS England web-resource – on NHS choices
  • Introduction of Frailty into QoF treatment targets for diabetes care in NHS
  • Availability of CGM to all T1D pregnant patients
  • Diabetes Technology pathway development with multiple stakeholders
  • Setting up pilot projects for diabulimia treatment in London & Wessex
  • Introduction of Low Carbohydrate App into NHS Apps Library

Other work has involved input in updating of driving guidelines in relation to use of technology in those living with diabetes, helping to develop a virtual reality programme to improve hospital safety and starting work on increased mental health access for diabetes patients across the NHS

Dr Partha Kar has been a Consultant in Diabetes & Endocrinology at Portsmouth Hospitals NHS Trust since 2008. He has been the Clinical Director of Diabetes from 2009-2015, being part of a multiple national award-winning department (HSJ Awards / BMJ Awards) due to its services and care provided.

He is the pioneer of the Super Six Diabetes Model which aims to deliver diabetes care differently and is recognised as one of the good examples of integrated care.

An avid user of social media such as twitter (@parthaskar) to engage with patients – and been recognised as a “Social media Pioneer” by HSJ in 2014.

He also writes a monthly blog for the BMJ, has a personal blog (“Sugar and Spice: Wish all things were nice”) and a podcast (“Sweet Talking”)

He has also been:

  • Co-creator of TAD (Talking About Diabetes) – TED talks from those with T1Diabetes
  • Co- creator of Type 1 Diabetes comic (Volume 1 and 2)
  • Setting up Type 1 Diabetes: Rise of the Machines – event on Closed Loops/DIY tech

Follow Partha on Twitter: @parthaskar

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