NHS artificial pancreas roll out.

[In Response]

I am confused why this was in the press yesterday when it is a repeat of news that was made last year.
And the other thing I don't know is where the money is going to come from to fund the HCL systems and train the staff, especially given the lack of knowledge about CGM limitations upon which HCLs depend.

Can anyone enlighten me?

 

[EllieM]

Can anyone enlighten me?

Looks to me like it's an article from Sky News?

Thousands with Type 1 diabetes in England to receive 'artificial pancreas'

NHS England says the mass rollout of the artificial pancreas builds on a successful pilot of the technology, which saw 835 adults and children given devices to improve the management of their condition.

news.sky.com

A cynical person might think that someone had just heard of insulin pumps and decided to do a puff piece.

There are currently more than 269,000 people living in England with the condition.

Identifying and treating it costs the NHS in England around £10bn a year, or 10% of its entire budget.

Not desperately accurate I think, they are claiming that 10% of the NHS budget is spent on T1. I'm pretty sure that's the amount spent on diabetes as a whole, and T1s make up less than 10% of the diabetic population. 10 billion divided by 269,000 is roughly 37000 a head.

I wonder if the author knows the difference between T1 and T2 diabetes, or has heard of any other types?

 

[In Response]

Looks to me like it's an article from Sky News?

Sorry, I was not clear.
This news seems to have been released all over - the BBC also reported it, yesterday.
But they also published a similar article last year and nothing seems to have changed since then.
I think it comes from a press release from NHS England https://www.england.nhs.uk/2024/04/nhs-rolls-out-artificial-pancreas-in-world-first-move/

So, my questions were
- why did NHS publicise this again with no change?
- where is the magic money tree that will fund HCL?

 

[EllieM]

Thanks for that @In Response , I just googled and got the Sky News article first.

Maybe this is the critical paragraph

Local NHS systems will start identifying eligible people living with type 1 diabetes who health chiefs believe could benefit from the Hybrid Closed Loop system- sometimes called an artificial pancreas – from today. There are currently 269,095 people living in England with type 1 diabetes.

They've found 2.5 million.

I reckon running costs for my pump are (in NZ dollars so you need to divide by 2)

8000 pump /4 as over 4 years
13* 250 (cartridges + cannula) per year

= 5250 a year

so about GBP 3125 (as a ball park figure) ignoring the cost of insulin and cgm

The cost of education and training is likely to be very significant though, call it a total of 5000 a head???
I make that 500 diabetics???

Or maybe the 2.5 million is just the training?

 

[Zinadane]

With the budgeted numbers, I'm curious as to how many of 300,000 uk T1s they are expecting to able to fund?

 

[CheeseSeaker]

Press has to have a headline - essentially the rollout starts on April 1st, and while limited funding (hence staged rollout) means we won't all get it 'now' we will get the option to choose it at some point in the near future (near could be a 1-3 years)

Not everyone has the chance of CGM and pumps yet - so any new technology will take time to fund, train HCLs, purchase the medical devices needed, and get them on prescription (as thats an huge on-going cost too)

Its life changing stuff - we just need to wait, but totally understand why some are disappointed as T1D is such a huge impact to quality of life.

 

[CheeseSeaker]

With the budgeted numbers, I'm curious as to how many of 300,000 uk T1s they are expecting to able to fund?

Depends on which years spreadsheet the funding is spread across - I imagine rollout has been justified on long-term saving to the NHS so those that are 'within parameters' today will be at the end of the list

 

[jaywak]

To be honest I’ve had diabetes that long now I don’t find it a pain any more , I’ve got plenty of complications but it doesn’t get me down I just move on and deal with whatever comes my way . My hb1c is ” healthy “so that’s fine for me, probably too stuck in my ways now . It’ll be good for future generations though , just hope “ we” don’t have to go through the old hoop jumping process again

like you say Ushthetaff this is fantastic news for young and newly diagnosed type 1s , in my day the future sounded bleak and I was afraid of the complications that would get me , but here I am nearly fifty years later with what was poorly controlled diabetes with the tech that was available then and i'me still fine so with this new tech I would say to newly diagnosed your future is as good as you want it to be .

 

[Zinadane]

I realise that for some people t1 management may be a lot more of a challenge due unpredictable insulin behaviour from day to day etc.
But are there many people that are above the 58mmol threshold?
I guess they will end up moving that goalpost as needed in order to take up the available funding per area.
So if your in an area of very well controlled T1s the take-up threshold hba1c level may be a lot lower?
What is the appropriate cost should you wish to take the closed loop pump route and sell fund, assuming you're already cgm prescribed?

 

[CheeseSeaker]

What is the appropriate cost should you wish to take the closed loop pump route and sell fund, assuming you're already cgm prescribed?

Taking the DIY approach - assuming you have a PC to compile the code, time to understand it, a phone and a watch (optional), one of the supported pumps, supported CGM the only cost is lots of time

For commercial systems - you'd need the HCL software (say CAMAPS) at £840 per year (they only have a limited number of supported phones though, so might be a requirement to upgrade) and a matching supported pump.

Other options will cost slightly more or less and may not all support the CGMs on NHS funding (Libre 2 and Dexcom One) so that might be additional costs to self fund for a Dex 6 or 7 etc

 

[Daibell]

Basically, though, the media hype is just saying that the closed-loop pump that lots of people are already on will be rolled out to more people, rather than some groundbreaking new tech that's been launched. Is that right?

Yes, I was looking for the new news and there wasn't any. I was offered a pump 2 years ago but chose not to at that time as the hassle factor outweighed it's advantages for me. Mind you with an HBA1C currently of 67 mmol despite low-carbing, slim and low insulin resistance and endless correction doses I may need to re-consider.

 

[CheeseSeaker]

Yes, I was looking for the new news and there wasn't any. I was offered a pump 2 years ago but chose not to at that time as the hassle factor outweighed it's advantages for me. Mind you with an HBA1C currently of 67 mmol despite low-carbing, slim and low insulin resistance and endless correction doses I may need to re-consider.

Back in t'old days I resisted pumping for a good few years, then had a 'bit of a bad-un' and decided something needed to change.

Switched to a pump and it changed my life (for the good) - remember you can always go back to MDI if you want to, hopefully you'll find loads of benefits to pumps - worth the consideration at least (obviously accept that one-size doesn't fit all, so its personal choice)

 

[JaneC]

I have recently been refused a pump anyway. Too well controlled and far too fit. Endocrinologist couldn't understand why I had been referred. But then I suppose I am nowhere near a priority. 66 years old.Type 1 for 57 years. HbA1c of 37. BMI of 21.5.

Are you my twin? Same age, HBA1c, BMI, but 38 years in and park run time not as good as yours! I had a go at trialling the Omnipod 5 two weeks ago at the review but told children, pregnant women and those with bad control will get it first which I can live with after all this time. As others have said it’ll be like the Libre rollout, we'll get it eventually maybe.I was picked up though for being 1% below 3 for blood results but I had to tell registrar that being a full time pancreas isn’t easy!

 

[Fern Hopper]

It does seem like the NHS are prioritising others. I run with a GP who thinks it's all slightly odd regarding those that are well controlled. Have you been told to increase your HbA1c?

 

[Jaylee]

I got chatting with a DSN a couple of months back & this subject came up…

Her view in short aligned with mine.

The “news” is writing a cheque that the NHS can’t cash.

 

[JaneC]

It does seem like the NHS are prioritising others. I run with a GP who thinks it's all slightly odd regarding those that are well controlled. Have you been told to increase your HbA1c?

Oddly no not last appointment as I have been in the past but having been horrified by all the dreadful things that would happen with high sugars I‘m committed to keeping them low but sugars above 10 are never commented on these days, the risk must still be there?

 

[becca59]

I got chatting with a DSN a couple of months back & this subject came up…

Her view in short aligned with mine.

The “news” is writing a cheque that the NHS can’t cash.

From following Partha Karr on Twitter, who has driven this and also written many articles on it, the money is already in place and ring fenced.

 

[EllieM]

From following Partha Karr on Twitter, who has driven this and also written many articles on it, the money is already in place and ring fenced.

Any idea how much money? And does it include all the people needed for pump education?

 

[Fern Hopper]

Yes. That's one of the reasons I like to keep mine low. It seems that there is more concerns regarding low blood sugars. It's been said to me that I must be hypo all the time - I'm not! It was also said that at my horribly advanced age I might fall down the stairs whilst hypo.
Personal best at Parkrun followed by a blood sugar spike. But it nearly always does.
Started with BG of 5.6. Finished 24 minutes later at 11.0. Slow, long, warm down didn't help much.
Slow walk with dog has now taken BG down to 6.6. Higher than I would like.

 

[Jaylee]

From following Partha Karr on Twitter, who has driven this and also written many articles on it, the money is already in place and ring fenced.

From the posts I’ve seen he does suggest (nay prophesies.) access for all.

But on closer inspection. Mainly children (under 18?) & family planners..?

From what I can gather, the NHS is still strapped for cash. (Not wishing to mention the “B” word.) with a fair bit of what’s pumped into it being borrowed?

This is a reasonable summary from last year, here.. https://ukandeu.ac.uk/what-has-brex...e NHS budget (in England,a week in real terms.