Diabetes: Tailored Prevention Messaging

Debate between George Howarth and Liz McInnes

Thursday 24th October 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairwomanship, Ms Buck. I am grateful to the hon. Member for Strangford (Jim Shannon) for bringing this important debate to the Chamber today and for his comprehensive introduction to the subject, which included his own personal experience. I speak in my capacity as co-secretary of the all-party parliamentary group for diabetes, and I recognise the hon. Gentleman’s active role as vice-chair of the group.

My interest in diabetes comes from my background as an NHS clinical scientist, as well as the major health issues presented to our communities by the prevalence of diabetes. My constituency has a higher than average incidence of diabetes—8.5% of the population compared with 6.7% overall in England—so I am always interested in what steps can be taken to improve control of the condition and what preventive measures can be taken to lessen the risk of type 2 diabetes developing.

I want to draw attention to the difference between type 1 and type 2 diabetes, and I sometimes think it would be helpful if we considered them to be two completely separate and distinct diseases. I stress that while being overweight or obese is a major risk factor in type 2 diabetes, type 1 is caused by the body not being able to produce enough insulin and is an autoimmune disease. Although diet and exercise have a role to play in type 1 diabetes management, they cannot reverse the disease or eliminate the need for insulin. It is important to stress that, because of the number of times I have stood in this Chamber and listened to MPs saying, “If only people would lose weight their diabetes would be cured.” It is misleading, and it is unfair to people who are unfortunate enough to suffer from type 1 diabetes.

[Sir George Howarth]

I am grateful that my hon. Friend made that point. She knows that I, too, insist that we deal with them as two separate diseases. There are consequences to the myth that everyone’s diabetes is lifestyle-related. In some cases children are bullied at school for having an autoimmune condition that they have no control over. Yet people believe they have caused it themselves.

[Liz McInnes]

My right hon. Friend is absolutely right. There is an unfortunate blame culture and children can be quite cruel to each other at times; we, as adults, must be careful about the language that we use about diabetes. If I achieve one thing in this place, I would like to get people to understand the difference between type 1 and type 2 diabetes—then I would feel as though I had achieved something.

Despite the growing public pressures associated with both type 1 and type 2 diabetes, a person living with diabetes only spends, on average, three hours a year with a clinician. People with diabetes are often put under a great deal of stress, because of the challenges and complexity in managing the condition and the multiple day-to-day decisions they have to make. In order to allow them to develop the necessary skills to manage their own condition, further support is required—including, but by no means limited to, weight management support.

This debate is very timely and follows a meeting we held in parliament in June of this year, which was attended by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley (Sir George Howarth), among other MPs. The meeting was about realising the potential of health coaches in diabetes care, which the hon. Member for Strangford has already mentioned, and it was supported by Roche Diabetes Care—although of course I have to say that other diagnostic companies are available.

The meeting heard from health coaches about how they support participants in a lifestyle management programme, using their professional expertise as qualified nutritionists to support people to better manage their weight.

Diabetes: Artificial Pancreas

Debate between George Howarth and Liz McInnes

Wednesday 12th December 2018 Commons Chamber

[Mr Howarth]

I am grateful to the hon. Gentleman, who must be psychic, because that is the very next point I was going to make.

There have been, as the hon. Gentleman says, postcode lottery-style problems with accessing the technology. For example, with FreeStyle Libre, a flash glucose monitoring device, patients in Liverpool are able to get it on prescription if they meet the criteria. That is very welcome, but many patients from outside the area cannot get one, as up to 30% of CCGs do not fund them. There needs to be more work done on that and I know the Government have made an announcement, which I will refer to in a moment.

Thanks to Diabetes UK’s campaign on 14 November, World Diabetes Day, NHS England announced that from April 2019 the FreeStyle Libre will be made available to all who meet the clinical criteria regardless of where they live. That is a very welcome development. I do not think it will apply to Northern Ireland, but I hope a similar policy is adopted in Northern Ireland. Innovation in diabetes technology is evolving rapidly in exciting ways.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank my right hon. Friend for giving way. To go back to the postcode lottery of funding, I wonder whether the Minister will talk in her winding-up speech about the work of the Scottish diabetes technology improvement plan, which was supported by £12 million of funding and has resulted in increased insulin pump usage in Scotland. I wonder whether we might emulate that scheme.

[Mr Howarth]

The common-sense approach is to look at what is going on elsewhere—in Scotland and in other parts of the world—to get the best of what is available and use it in the most effective way. My hon. Friend is quite right about that.

It is pointless giving type 1 diabetics the latest technologies, such as an artificial pancreas system, if they are not given structured education to support them to use the technology that is available. The limited uptake of educational programmes is a matter of great concern, and I hope the Minister shares that concern. Despite guidance from the National Institute for Health and Care Excellence, in 2014-15 only 2% of people newly diagnosed with type 1 diabetes were recorded as having attended structured education courses. For some, that lack of knowledge of the key principles of self-management is a major barrier to the use of technology, because without sufficient education, type 1 diabetics are not equipped to get the best results from the technology available.

--- Later in debate ---

[Mr Howarth]

My hon. Friend is right. This is not just about technology, important though that is. Anyone with diabetes who manages it well—and technology will help to do that—will have fewer hospital emergency admittances. I do not have the statistics to hand—I am not even sure they exist—but those people will clearly have fewer hospital admittances and fewer complications with their diabetes, and therefore cost the NHS less. As I am sure the Minister will acknowledge, however, the NHS is not very good at doing cost-benefit analysis. It needs to get smarter at it, because the point that my hon. Friend makes is right, not only as regards the support we give to people with type 1 diabetes, but about the cost to the NHS of dealing with the consequences.

[Liz McInnes]

I want to echo the point about cost-benefit analyses and how bad the NHS is at joining up different departments’ budgets. It really needs to get better at being able to identify that spend in one area leads to a huge reduction in spending in another.

[Mr Howarth]

My hon. Friend makes the point more clearly and eloquently than I did.

A new device that takes us closer to the artificial pancreas has been developed by Medtronic: the MiniMed 670G. A number of people with type 1 diabetes have started using the system in the UK in a pilot phase before it is rolled out more widely across the country. However, only 15.6% of those with type 1 diabetes are using insulin pumps, and it is potentially a concern that healthcare professionals would be unlikely to recommend an artificial pancreas if someone was not already using a pump and continuous glucose monitoring. If the issues to do with NHS access to today’s type 1 diabetes technology can be addressed, a path can be cleared towards adoption of the artificial pancreas.

We need to ensure that people living with diabetes are equipped with the skills to self-manage. That would support patients in using current technologies effectively, and ultimately in using artificial pancreas systems. Structured education is central to enabling people living with type 1 diabetes to best manage their condition through effective use of monitors and insulin pumps. The NHS can support type 1 diabetics to do that by increasing the provision and uptake of diabetes education. To do that, it needs to make diabetes education courses more accessible and convenient, possibly through digital solutions.

A recent survey by Dexcom revealed that more than three quarters of people with diabetes suffer from stress, anxiety attacks or bouts of deep depression. While healthcare teams help, and teach people how to manage their blood glucose levels, type 1 diabetes is largely a self-managed condition. The NHS needs to ensure that the resources and community support that people with type 1 diabetes require are well advertised, well recognised, well understood and well invested in. I believe we are on the threshold of being able to make type 1 diabetes not a thing of the past, but a thing that can be well and easily managed, and I hope the Minister will take these words seriously and do everything she can to advance that day.

Diabetes

Debate between George Howarth and Liz McInnes

Monday 26th February 2018 Commons Chamber

[Liz McInnes]

The hon. Gentleman makes an important point. I will talk about the technologies that are available for the treatment of diabetes and about education and information, so I hope I will answer his question later in my speech.

The hon. Gentleman emphasises the point that I was going to make, which is that it is really important that we listen to the voices of those living with diabetes. The charity Diabetes UK recently published a report entitled “The Future of Diabetes”, based on a consultation with more than 9,000 affected people. Those people said that, as well as a need for a better understanding and awareness of diabetes, there are a number of ways in which diabetes care can be improved.

In 2016 the Care Quality Commission produced a report entitled “My diabetes, my care”, based on a survey of a smaller number of people, but it came to very much the same conclusions. People living with diabetes want more support for their emotional and psychological health. The effect of varying blood sugar levels on mood and the relentless need to manage the condition can affect mental health.

[Mr George Howarth (Knowsley) (Lab)]

I am grateful to my hon. Friend for giving way; she has been very generous. Is she aware that some young type 1 diabetics manipulate their insulin to get rapid weight loss, and that they struggle to get treatment because on the one hand, they need psychological support, and on the other, they need advice from diabetologists? Does she agree that, if we started to bring all those different support services under one roof, it would make the route to dealing with young people who have that problem much easier?

[Liz McInnes]

My right hon. Friend makes a very important point. In the APPG on diabetes, we have discussed the issue of young diabetics self-medicating with insulin to keep their weight down. That emphasises the point I was going to make, which is that all healthcare professionals should receive training so that they can routinely support emotional and mental health and, importantly, know when to refer to specialist support.