It's time to get diabetes right

In recent months the NHS has taken a series of regressive steps on funding innovative medicines. Before Christmas treatments for rare diseases were targeted with the controversial and now halted Clinical Priorities Advisory Group (CPAG) scorecard. In past weeks, many patients and pharmaceutical companies have been impacted by decisions to delist medicines from the Cancer Drugs Fund. All with negative implications for patients – but to date focusing on specialist medicines. What if that approach was to move on to more commonly used innovation? This is the situation the ABPI Pharmaceutical Diabetes Initiativeⁱ now see happening in diabetes.

Diabetes should be a major success story. As well as a growing emphasis from public health officials on diet and exercise, there has also been considerable innovation in diabetes medicines and devices in recent years which have offered a greater range of options to personalise treatments, reduce side effects and improve the lifestyle of people living with the condition. We believe modern medicines are part of the solution to manage and reduce the personal and financial costs of poorly controlled diabetes, and that more could be done to help people living with diabetes to get the most out of their medicines.

However, it is becoming increasingly obvious that clinical decisions are being overridden by short term cost-cutting policies – potentially to the detriment of patient outcomes. The ABPI Pharmaceutical Diabetes Initiative recently published a report which brings together research from clinicians, policymakers, and patient groups on the frontline of NHS diabetes care. The collection of 50 in-depth interviews, commissioned from independent market research firm ComRes, produced some concerning findings.

GPs across the country responded that they are being prevented from prescribing clinically effective newer medicines due to pressure from CCGs and local prescribing bodies to prescribe the cheapest treatment.

A number of type 1 and type 2 NICE diabetes guidelines are currently out for consultation. The NICE type 2 diabetes guideline in particular shows clear evidence of cost-cutting tactics at the expense of coherent clinical guidance and treatment options based on the individual needs of patients. Diabetes specialists concur that some of the recommendations included in the type 2 guideline are ‘paradoxical in the extreme’ and demonstrate a ‘distinct failure of common sense’.ⁱⁱ If put into practice, the guideline would take diabetes treatment back by a decade with real consequences for patients.

Our research suggests GPs are already facing major issues dealing with this condition. Preventing complications and the ill health of the growing number of diabetes patients is not just good for them, it also saves costly acute hospital care. The proposed approach of the guideline, which appears to ignore and restrict the use of modern medicines will not help; just at the moment where the NHS needs to get on top of diabetes care at every level.

But cost cutting is not the only factor affecting patient outcomes. Our research also suggests a lack of GP confidence and knowledge to be able to prescribe the best treatments for their patients. The GP group responded that non-diabetes specialists are not always aware of newer medicines or technologies and often lack the confidence to push back against prescribing barriers.

It is clear that the medicines optimisation agenda is of more importance now than ever. While the government and NHSE are giving clear messages about patient-centred quality care which bring the right medicines to the right patient at the right time and agrees that we should be investing in the best medicines to save NHS funds on the avoided episodes of ill health, the system is clearly telling us that this isn’t happening. This report suggests that the funds from industry included in the latest Pharmaceutical Price Regulation Scheme (PPRS) agreement to support the NHS in delivering innovative medicines during times of austerity, are not currently changing local prescribing behaviour and ensuring treatments are available for patients.

Other key findings from the report include a general agreement that diabetes has fallen down the political agenda, taking a back seat to conditions like cancer and dementia. It was also felt by respondents that there is a local and national leadership vacuum, resulting from the dissolution of NHS Diabetes and the expanding remit of the National Clinical Director role to include obesity. Primary care clinicians in particular felt that poor policy frameworks were part of the problem, as NICE guidelines are perceived as complicated, hard to find and unaccountable, and that there are a number of perverse financial incentives with not enough focus on outcomes.

To underestimate diabetes would be a mistake. When poorly managed it is the cause of 24,000 early deathsⁱⁱⁱ (2011). If ignored, type 1 and type 2 diabetes will cost society £39.8billion by 2035^iv (2013).

While prevention and lifestyle policies have dominated the headlines, diet and exercise must not be the sum of our efforts. We cannot forget those living with diabetes now, and who are at risk of developing potentially devastating complications if their condition is not well-managed.

We believe that, no matter how complex a person’s condition might be, no matter where in the country they live, it should be possible for them to access to the right treatment and care, at the right time. The challenge is the consistent and timely application of what we know to be good clinical practice.

That is why now is the time to get diabetes right, for the benefit of people living with diabetes now and in the future.

The ABPI PDI received editorial support in the drafting of this article from Portland PR Ltd.