Diabetes Ireland has launched its 2022 Pre-budget submission and is proposing 8 immediate actions for implementation which will improve the quality of life for over 225,000 people living with diabetes and reduce the long term costs of preventable diabetes complications. The submission is focused on a range of deliverable actions that are person-centred, cost effective and builds on existing HSE commitments to tackle chronic conditions including diabetes.
One of these Actions is Access to Education and Insulin Pumps for Adults
Structured Education and Insulin Pumps for Adults
Structured Education and Insulin Pumps for Adults with Type 1 Diabetes
Over half of adults living with type 1 diabetes do not have access to DAFNE diabetes structured education, a vital training in enabling self-management of insulin dependent diabetes and one third of adults with type 1 diabetes do not have access to insulin pumps as a treatment option (NCG No17, 2018). Diabetes Ireland is calling on government to ensure that funding to complete the current rollout of DAFNE Structured education centres continues in 2022. In additional to this, we are also recommending that one diabetes insulin pump nurse specialist be recruited for each of the DAFNE centres, where this position does not currently exist, to initiate insulin pump therapy for adults with type 1 diabetes.
DAFNE Diabetes structured education is the cornerstone of diabetes management for adults with type 1 diabetes. The National Clinical Guidelines for Adults with Type 1 diabetes (2018) states that the clinical evidence DAFNE training provides results in a reduction in hospital admissions, “fewer long-term complications as a result of improved glycaemic control, reduced number of episodes of diabetic ketoacidosis (DKA) resulting in hospital admission, improved psychological adjustment to living with diabetes, improved undertaking of diabetes self-management behaviours, improved clinical outcomes”.
The National Clinical Guidelines for Adults with Type 1 diabetes also highlights that over half (55%) of the adult type 1 diabetes population do not have access to diabetes services providing access to these specialised type 1 diabetes clinics. In 2018, there were 7 accredited DAFNE centres in Ireland with a plan for 11 additional centres in line with implementing the National Clinical Guidelines (NCG) for Adults with type 1 diabetes. So far in 2021, 5 of those additional centres have been established bringing the total to 12. We want to ensure that the remaining 6 centres become DAFNE licensed in 2022. This is 6 WTE at a cost of €0.3M.
In addition to establishing DAFNE licensed centres, Diabetes Ireland is asking for one diabetes insulin pump nurse specialist for each of the 18 centres where this position is currently not in place to initiate insulin pump therapy for adults with type 1 diabetes.
An insulin pump offers greater flexibility to people with diabetes because the user can administer insulin more precisely than if on injection pens. Uptake of insulin pump therapy is less than 7% in adults with type 1 diabetes comparted to the internationally average which ranges from 15–20% in 2010. The NCG for Adults with Type 1 diabetes states that the percentage of diabetes services providing insulin pumps to adults with type 1 diabetes is 39%, meaning that over two thirds the population does not have access to this treatment option. One of the barriers identified to access was the lack of pump specialist nursing staff (Gajewska, 2020a). Diabetes Ireland is asking for funding to secure a minimum of one WTE diabetes specialist pump nurse in all the 18 DAFNE certified diabetes centres where currently there are none to ensure equal access nationally. This is 18 WTE at a cost of €0.9M.
Insulin pump therapy should be considered as a treatment option when health outcome targets are not being reached on injections or when the individual is extremely sensitive to insulin and requires very small doses and based on additional clinical need.
The clinical evidence on the benefits of insulin pump therapy is vast and have demonstrated improved glucose control, reduces glucose variability, reduction in hypoglycemia events and significant improvement in quality of life (ABCD DTN-UK 2018 and Berget et al. 2019).
With the advances in the development of sensor augmented closed loop “smart” insulin pumps these barriers to pump access present in significant problem for the health service in catching up to current international best practice in diabetes management.
Diabetes Ireland is calling on the government to ensure that funding to complete the implementation of DAFNE Structured education centres in 2022 is in place and also recommending that one diabetes insulin pump nurse specialist be recruited for each of the DAFNE centres, where this position does not exist, to enable the provision of insulin pump therapy as a treatment option for adults with type 1 diabetes.
With the HSE Cyber breach still preventing answers to Parliamentary Questions from public representatives and the Dail going into summer recess, we have postponed our “call to action” where we will be asking members of the diabetes community to contact their local representatives on the issue(s) most relevant to them until late August/early September as the Dail resumes.
However, Diabetes Ireland contacted all TDs and Senators on Wednesday 14 July on behalf of our community asking them to make representations on all these issues on our behalf. Some of our active volunteers groups also followed up locally with their own local representatives. In late August/early September, we will need your help to highlight these issues once again in advance of the upcoming budget.
Please note there are many other important issues we plan to highlight and advocate for implementation and we will be working with all stakeholders to do this in a strategic way going forward.