Type 1 diabetes patients are denied access to NHS specialists

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 NHS commissioning policies stop people with type 1 diabetes from gaining access to essential specialist services, medical experts have warned.

The proportion of people with diabetes who receive all essential checks is much higher for people with type 2 than type 1.

As a result, a disproportionately high number of patients with type 1 diabetes are receiving avoidable hospital treatment for failures of control.

According to the National Diabetes Audit, whereas 56.4% of patients with type 2 diabetes receive all nine NICE-recommended checks annually, only 38.5% of patients with type 1 diabetes do so.

In addition, the incidence of acute diabetic ketoacidosis in patients with type 1 diabetes is rising.

The reason, the Association of British Clinical Diabetologists said, is that type 1 diabetes (which always requires insulin therapy) needs a collaborative care pathway involving primary care and specialist teams.

Current NHS commissioning policy makes this difficult: payment by results attaches a specific cost to each referral, while the ‘Nicholson challenge’ is driving tighter referral management.

However, patients receiving specialist guidance to manage their insulin regimes better could avoid severe hypoglycaemia and ketoacidosis, as well as diabetic foot and eye damage.

Chris Walton, Chairman of the Association, said: “We would like specialist care to have more of a leadership role and to be more accountable. There are alternative ways of commissioning which should enable a more inclusive collaborative arrangement between specialists and generalists.”

For example, he argued, all patients with type 1 diabetes should have access to insulin pump provision; and all areas should have pathways to involve a specialist team when a severe episode of hypoglycaemia or ketoacidosis occurs.