Do you think it’s right for the NHS to ration new and expensive equipment, such as the latest pumps or CGMS? Or do you think it’s a sensible way of saving money and making sure that only those that really care enough about their diabetes to fight for said equipment get it?
No and no, I think the general consensus on this blog is that pumps and CGMS are a good investment over the lifetime of most T1s, as better control means less intervention at a later date. On the other hand, a certain amount of screening is necessary, pumps and CGMS are not a universal panacea.
1. No, 2. no. As @teloz says, screening is needed, and no therapy should be forced onto those who don’t want it, but sometimes it takes an external eye to see that a certain therapy (eg pumps) would suit someone who wouldn’t be able/wouldn’t want to fight for it. Not everyone has the character to take on their local healthcare providers, after all…
As someone who likes the IDEA of a pump, but don’t think I’d like the practicalities, I still say no and no. The CGMS would be especially handy for me – what is more useful for good control than a record of where you go high during each day?! Can’t wait until they merge that into a pump, then I might get over the dislike of having something attached to me all day/night for the usefulness
no & no here too! Most people achieve better control (a reduction in HbA1c and/or less swings) on a pump which equals a better chance of a longer and healthier life…. pumps should be personal choice and available to everyone who is able to use one.
As a parent I would love CGM’s to be available and Marc to use them, but he wouldn’t. Maybe he will in the future, but I still think they should be available also as they must help control and quality of life. My chemist told me pumps are not expensive compared to other medications and the Royal College of Physicians said that too in defence of pumps. We are being brain washed to believe we are asking the world by wanting and ‘expensive treatment’ when they really aren’t that expensive at all.
@neobrainless as @annette said, the Veo is a combined device however I don’t see why that would swing it for you?
You’re still going to have to have two things connected to you permanently, the only benefit of integration is one box in your pocket rather than two. CGM solutions are all (that I have seen) wireless sensor attached talking to a box.
Back to @tim ‘s trolling, yes it’s completely unfair. However, I suspect all areas of healthcare suffer from it. Look at all the press in the past couple of years about cancer medication. Sorry but if I had to choose between me getting my pump or someone else’s child getting their cancer medication that is proven to give them the greatest chance of living longer, I’d pass (Do unto others ….)
I have to hope (for my own sanity’s sake) that someone in the NHS is dolling out the cash evenly and fairly (as such limiting access to pumps / CGM,) else I’d emigrate to the USA and get some decent medical cover.
@stephen – I think you’re looking at the American health system through rose tinted spectacles. It’s only a small percentage of people that can afford the type of cover you’re envisaging, nearly 50% of Americans have to rely on the substandard offerings of the state. Of the others the majority have their insurance paid by their employer, so no job, no insurance. There’s also no guarantee that the insurer will fund the treatment of long term health problems. If I’m wrong, someone will hopefully correct me.
For all its faults, I reckon the NHS does a pretty good job, but there are always going to be errors and inequalities, it is, after all, run by people. The problem is, it’s difficult to get these people, who are mostly bookkeepers, to take a long view when their immediate aim is balancing the annual budget. Thank goodness the majority of the time they don’t do too badly, but I’m pretty sure there wouldn’t be a conflict between your pump and a child’s cancer treatment, they’re probably funded from different budgets, and anyway, there’s special provision for cancer treatments.
I meant combined so as to be close to a pancreas… Combined at all would be more helpful, more helpful enough that it might over come the other short comings for me, but I’ll probably not want a pump for a few years yet – not until my life becomes more sedentary! Though the way my knee is going that might be sooner than I’d like to think
Those people who would like the pump and are able to manage such a machine should be given the chance to try it and hopefully have less later life problems. As I understand (please correct me if I’m wrong) although the Veo pump has the cgm it still requires you to use a meter to achieve an average reading. Surely what we need is a pump which talks to a device which continually monitors your blood but without needing our interpretation to feed info to the pump. I was told the French are looking into this. Whilst the British are still seeking an artificial pancreas. Not sure if I’d want to be normal and undergo an op!
@mustard – as I understand it CGMs measure interstitial blood glucose, which is apparently different from finger-tippy blood glucose. The former reacts slower to BG changes than the latter (I think). So with any CGM you need to keep finger pricking to make sure everything’s tickety-boo.
@Tim I hate finger pricking I have no sensitivity left in them. We need some one to create this better link to the pump so you never have to finger prick again. Money spent on ‘Why I’ve become diabetic’ is a waste its happened get on with it. Yes its very unreasonable but it is manageable. Sorry if I offend anyone.
@cbbc11 – how to get a pump? A cynic would suggest that you should learn the NICE guidelines, then fit your symptoms to match the criteria for getting a pump set down in them.
The long and short of it is that pumps are rationed because they are expensive. Therefore to get yourself on a list you have to demonstrate you meet the criteria and (probably) that you can convince your DSN you would make the best use of one. But what do I know?
@cbbc11 sounds like it’s time for a new diabetes team – flat no is not acceptable. Mine seem to be very pro pumping which is much more helpful.
If they won’t support you going for one, ask to be transferred to another hospital / trust.
@tim going to sound like I’m showing off but …….. my dietician pretty much told me that for those who want it and are showing willing / commitment to it, they can usually find a way regardless of NICE …..