JDRF Input Fusion, Professor Partha Kar, diabetes technology


continued over

Prof. Partha Kar

National Specialty Advisor in Diabetes, Kar

spoke about his mission to improve access

for diabetes technology for all who need it.

This year's Input Fusion event began

with a keynote speech from Professor

Partha Kar. His talk, Access to Technology:

Art of the possible gave many in the room

much heart when it came to hopes of one

day being on diabetes technology.

He stated that, thanks to pretty good

gathering of data about diabetes care in

the UK certain statics are known, such as

only (approximately) 30% of people during

2017 to 2018 achieved an HbA1c of less

than <7.5%. He also noted that there is

about £3,000 allocated per child (ages

0-18), per year, for diabetes care, but

that this excludes the cost of technology.

The cost increases with the addition of

technology. Making an obvious point, he

said to those gathered in the room, "The

truth is that to get improvements in Type

I diabetes control is hard. It seems clear

that white, affluent middle-class people

are the most likely to get access to such

technology and see improvements.

This means that there are areas and

communities that are not receiving the

same access to technology."

Kar's clinical role is based at is Hospital

in Portsmouth in Hampshire. One of the

nearby electoral wards is Fareham and

Gosport, with Gosport being the third

poorest ward in the country (outside

of London). He says, "For some of my

patients I am usually fairly happy to find

that they're even taking their basal insulin."

But Kar also has a national role, as

National Specialty Advisor in Diabetes.

At a national level, he can see that, "All

the way through our clinical care path,

in order to attain data, hospitals have to

input information in order to justify the

funding that they receive for each patient.

Yet, we're all busy, so what if you don't

have the time to input this data? Well,

then they don't get the funds, so nor does

the patient. Data submission needs to be

part of clinical care, not optional

"The fact is that the NHS is national

- as the name says, and data input - as

well as diabetes care outcomes - vary

from district to district. It's apparent that

people interpreting policy as they see fit

and according to their budgets and do

not necessarily follow NICE guidance."

The good guys

In dense urban areas with big, old

hospitals then the uptake of tech is

particularly high. At Guy's Hospital in

London around 40%% of their patients

are on insulin pumps. The way it works

at present is that patients who are keen

to use technology are likely to be sent

to the bigger hospitals, those seen as

centres of diabetes excellence, in order

to get onto insulin pumps or CGM. Says

Kar, "I sometimes hear people that work

in diabetes care saying, 'We don't think

pumps are that good.' Or they say, 'No

one at the centre is trained to put patients

on pumps.' The obvious answer to that

is, train up!"

Not only does Kar feel that training is

core, that centres need to be trained up

to put patients onto diabetes technology,

but that that consultants also need to be

trained in consultation skills as well. "How

to talk to a patient with diabetes is not part

of formal training as it stands, nor even is

looking for glucose patterns. My feeling

is, do it properly or don't do it at all. In my

view, CCGs must handle Type I diabetes

differently. The pathway must adapt to the

needs of its patients. As a condition Type

I diabetes is different. The purpose of

the pathway is to stop people within the

NHS making their own decisions, making

separate, local interpretations. It is to drive

one way of approaching Type 1 diabetes


And so to Libre

The progress of Abbott's Freestyle Libre

Flash Glucose Monitoring System has

been a paradigm- changer in Type

I diabetes care. It makes living with

diabetes much more bearable, and it is

not just about achieving a better HbA1c.

Says, Kar, "That will come too, but it drives

an improved quality-of-life for those living

with this difficult condition, and this should

not be ignored, it is extremely valid. There

is something referred to as the innovation

curve when it comes to the launch of a


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