BBC Radio’s File on 4 warns that patchy and under-funded diabetes care is depriving patients of access to essential tests and treatments. Maxine Vaccine looks at the vital importance of the integrated care model for patients, doctors and the drug industry.
A recent Radio 4 programme looked at the reasons why people with diabetes die an average of 10 years (for type 2) or 20 years (for type 1) earlier than the rest of the population. It identified the core reason as being financial pressure on GPs to cut costs on diagnostic tests and specialist referrals.
The programme said that fewer than 50% of patients receive all of the diagnostic tests recommended by NICE – and that, even where patients are failing to control their diabetes, GPs routinely fail to refer them for specialist advice until it’s too late and they are facing blindness, kidney failure or limb amputation.
Diabetes is the most prevalent chronic disease in the UK, and the one whose prevalence is growing fastest, due to poor diet and lack of exercise. Typically of long-term condition management, diabetes care requires a combination of diagnostic testing, self-monitoring and medication adjustment. The days when the only treatment question was ‘Insulin or pills?’ are long gone. Many type 1 and type 2 diabetes patients are on combination drug therapies, even if they have no comorbidities or complications.
And diabetes does not stay the same. Blood glucose levels change progressively, and there are cyclic changes within the day and the year. The ABC of diabetes control is dosage adjustment. Just being on a fixed dose of a single medication, or even of multiple medications, is never a long-term answer. If you sell diabetes products, you know that optimal use depends on continuous monitoring and frequent guidance. And sub-optimal use delivers poor outcomes.
In other words, drug use in diabetes care – as for other long-term conditions – only works as part of an integrated care model where crucial variables are monitored and complications are diagnosed early. Not all GPs understand this well, and NHS financial management appears not to get it at all.
On the radio 4 programme, a GP was asked why so many diabetes patients die or suffer disability due to a lack of timely diagnostic tests and referrals. His answer was: “Money.”
Speaking to Diabetes UK, Baroness Young said: “A colossal amount of money is already being spent on diabetes – about 10 per cent of the NHS budget – but too much of it is being used to treat the complications of diabetes rather than to prevent those complications developing in the first place.
“It is time to stop just talking the talk on diabetes healthcare and start walking the walk.”
Pharma companies can help by being proactive when it comes to helping healthcare providers think constructively about dosage adjustments, drug combinations and long-term outcomes. Novo Nordisk is a leading diabetes care product supplier partly because it pays so much attention to the relationship between drugs and monitoring, and making sure that both sides of the equation are delivered in a user-friendly manner. Its reps are working overtime (Don’t push it – Legal Ed.) to explain these issues to doctors and nurses.
Needless to say, the Government’s vision of integrated care is a system where the local foundation trust says “Social services will cover this” and the local authority says “The NHS will cover this” and community-based healthcare goes down the toilet. I’m sorry, but that’s how it is.
In a bygone era, diabetes was known as “the pi**ing evil” because polyuria was its defining symptom. In this era of NHS rationing and atomised healthcare, it could be termed “the taking the pi** evil” – and diabetes drugs, no matter how well developed and sold, could be termed “the therapy pi**ed up the wall”.
For the sake of future generations, don’t let it be that way.
Maxine’s views are not necessarily those of Pharmaceutical Field.