New decision support tool marks important step in care for people living with type 1 diabetes

Type 1 diabetes is going through something of a global revolution – especially with the advancement of technology in aiding self-management.

In recent years, the NHS has made big strides in giving access to new technology to the vast majority of people living with type 1 diabetes. Alongside access to technology, it’s vital that people living with type 1 diabetes feel empowered and have knowledge and understanding about their care options.

Good type 1 diabetes care is formed via three pillars:

  • Self-management
  • Peer support
  • Access to trained professionals

Technology has emerged as an enabler of all three principles, making it even more important about access to relevant pathways, as recommended by the National Institute of Health Care and Excellence (NICE), the independent body who decides about cost-effective use of medicines or in this case, technology.

The new decision support tool has been designed to support people to understand what is available in the NHS, providing a resource to support discussions between someone living with type 1 diabetes and their healthcare professional about appropriate steps in their care, which they are eligible for and come to a shared decision about the person’s care in managing type 1 diabetes.

The aim is to ensure it can be used as a shared decision-making tool which incorporates the latest NICE guidelines (NG17, NG18, TA943), along with the ones which map out access to different parts of technology accessible in the NHS.

One aspect with technology which is always worth bearing in mind is the differential access that may occur based on deprivation or ethnicity. The national and local NHS diabetes teams have worked hard to ensure this gap is minimised, as shown in the pregnancy data sets around use of Continuous Glucose Monitoring (CGM), as well as use of Libre in the overall type 1 diabetes population.

NHS England has type 1 diabetes in children and young people as a key area of the CORE20PLUS5 approach to reduce health inequalities.  Even though there have been improvements, as highlighted, access to insulin pumps certainly needs levelling up with continued collective effort to minimise deprivation gaps for children and young people from the most deprived areas and from ethnic minority backgrounds.

The document will be made available in several languages to help with uptake and accessibility. The tools will also help drive further peer support in the world of type 1 diabetes, based on previous work by NHS England.

We hope that this decision support tool will enable further involvement for a person living with type 1 diabetes in their own care through access to life-changing technology. Over the last few years, the greater access to self-management via technology has resulted in the best improvements in glycaemic control since records began and hopefully this tool will continue that progression in the future.

Professor Partha Kar

Professor Partha Kar is National Specialty Advisor, Diabetes with NHS England and co-author of the national Diabetes GIRFT report.

He has been a Consultant in Diabetes and Endocrinology at Portsmouth Hospitals NHS Trust since 2008- and pioneer of the Super Six Diabetes Model which is recognised as one of the good examples of integrated care.

He has helped to expand use of technology in Type 1 Diabetes- namely use of Flash Glucose in Type 1 Diabetes and CGM in Type 1Diabetes pregnancy along with online digital self-management platforms- while recently leading on real world data collection on Closed Loops for subsequent NICE review. He has worked subsequently with NICE on updating relevant guidelines in non-invasive glucose monitoring access in Type 1 and Type 2 Diabetes.

His other work has involved introduction of frailty into QoF treatment targets, Diabulimia pilot projects in the NHS; championing “Language Matters” and helping to create an overview of Diabetes care in Primary Care Networks. Recent work has focussed on transitional care models- as well as tackling inequalities in technology access based on deprivation and ethnicity.

He is one of the leading users of social media in diabetes care – and writes a monthly blog for the British Medical Journal.

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 to 4)
  • Co-creator of DEVICES (Virtual Reality educational modules in diabetes)

Beyond diabetes, he also recently taken a role in tackling issues of racial disparity in the medical workforce as the Medical Workforce Race Equality Standard lead for NHS England. He has also been named as one of the most influential BAME individuals in healthcare in 2020,2021 and 2022.

Follow Partha on Twitter: @parthaskar