Minister proposes minimum standard for diabetes treatment

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by Jolene Cargill

Health Minister Shona Robison has promised to look into setting a minimum standard for a treatment that can transform the lives of patients with diabetes if the SNP is re-elected.

Responding to patient concerns about the lack of insulin pumps available on the NHS, Robison admitted more needed to be done to end the postcode lottery of pumps, which can lower the risk of complications in patients with type one diabetes.

According to patients, major health boards in Scotland are denying them insulin pump treatment.  Sufferers from Greater Glasgow and Clyde confronted politicians about the issue at an event in Edinburgh last night, saying it was unacceptable that patients from Scotland’s largest health board were being advised the waiting list for pumps had been suspended.

Scotland has 240,000 diabetic sufferers, the highest rate of diabetes in Europe and the numbers have almost doubled in ten years. But it is bottom of the league table in terms of the percentage of patients who have access to an insulin pump, a portable device, attached to patients, which delivers a flow of insulin according to a programmed dosage, in the same way insulin is produced by the pancreas in people without diabetes.

Pumps can reduce the likelihood of potentially dangerous and debilitating low blood sugar episodes, known as hypos, allowing them to alter the dose instantly to take account of what they have eaten.  According to Robison, many clinicians prefer not to use pumps for medical reasons and she said she would be uncomfortable ‘forcing’ them to use pumps.

Diabetes UK backed patients who said the decision to administer pumps should be based on what’s best for patients and not on the opinions of clinician’s or budget constraints.  A clinician who lives in Forth Valley told Robison and the panel how he was paying privately for a pump for his ten-year-old daughter.  He said: “The local authority said there was no support available for children on pump therapy.  The action plan on the Scottish Government website is totally useless.”

The Scottish Government published a diabetes action plan last year, which said the pumps should be considered a mainstream therapy and promised people who would benefit that they would promote the pumps.

Both the National Institute of Clinical Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) which develops evidence based clinical practice guidelines for the National Health Service, recognise pumps as best practice and recommend a target of 5%.

Access to pumps varies widely across Scotland with nearly 5% of people with type one diabetes in Tayside using pumps, compared to 3.5% in the Lothians and 0.9% in Glasgow and Clyde, according to figures from 2009.

Pumps cost up to £3000 to buy and infusion sets, inserted under the skin to deliver the insulin, need to be replaced every two or three days.  These, and other consumables such as batteries, can cost between £1000 and £2000 a year.  In addition, patients need to be trained to use the pumps, often requiring intensive staff support.

The total cost of insulin pump therapy costs more than the syringe system, the most common therapy prescribed for diabetes patients.  But Diabetes UK said cost shouldn’t be a barrier to accessing the therapy.

Jane-Claire Judson, Director of Diabetes UK Scotland said, “Pump therapy is not just a medical issue, it’s also a human rights issue that’s been highly politicised.  We have fought hard on this issue.  Health Boards must be accountable.  We will not rest until the same levels of insulin pumps available match the recommendations of NICE.”