Nice - Closed loop consultation

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Interesting! I wonder if this means opening up access to more people?
 
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Eternal422 said:
Interesting! I wonder if this means opening up access to more people?
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I'm hoping it is. Trying to interpret the general attitude of his tweets it seems - to me at least - that he's got a very positive outlook on the current situation. Time to cross those fingers.
 
Say access on the NHS became available on the NHS, would it take time to all roll out? I am getting the 780G in March. It would be great if their sensors were provided on the NHS. For me, self-funding is becoming less of an option.
 
If NICE recommendations change, how will the additional pumps and CGMs be funded?
The NHS is not exactly flush with money. I fear they will come at a cost to some other service.
 
helli said:
If NICE recommendations change, how will the additional pumps and CGMs be funded?
The NHS is not exactly flush with money. I fear they will come at a cost to some other service.
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I think the non political answer would be that funding closed loop would reduce costs for fixing problems, thus being an overall saving (i.e. build on why Libre has been a success).

Political answer would be we stop giving out billions of quid to fossil fuel companies, bankers and Michelle Mone and spend where it's actually needed.
 
Rob Oldfield said:
I think the non political answer would be that funding closed loop would reduce costs for fixing problems, thus being an overall saving (i.e. build on why Libre has been a success).

Political answer would be we stop giving out billions of quid to fossil fuel companies, bankers and Michelle Mone and spend where it's actually needed.
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Alas local politics in an ICS don't have that bigger perspective. Their medications bill won't necessarily be increased by the NHS or National Government and they will delay any implementation for as long as they can - as they are currently doing for no-cost options such as Dexcom One instead of Libre 2.
 
helli said:
If NICE recommendations change, how will the additional pumps and CGMs be funded?
The NHS is not exactly flush with money. I fear they will come at a cost to some other service.
Click to expand...
I had relatives who worked in the NHS. I have friends who work in it now. It is a marvellous organisation.

However, many millions (billions) of pounds is wasted each year by the NHS. There are many efficiencies that could (and should) be made.

I bet cancer sufferers (and alas my family has, unfortunately, had run-ins with the "Big C") never say "oh, I wonder where the NHS is going to find the money for this or that new cancer therapy."

The NHS still adopts a "pennywise, pound foolish" approach to diabetes. If (god forbid!) any of us have to have a limb amputated, or lose our eyesight, or our kidneys fail, or any one of a number of other quite horrible consequences of having this awful chronic disease befall us, in money-terms it will cost the NHS significantly more to treat those ongoing complications than handing out pumps and cgms to those that would benefit from it clinically.

Does anyone know how much it costs the NHS every time a diabetic is hospitalised with diabetic ketoacidosis? In 2017 the median cost for a hospital stay was put at £2064.

Yes the medical device companies are probably making a healthy profit margin (and I apologise for the part I have played in that over the years). But the NHS ought to have the negotiating nous to persuade these companies to offer it significant discounts IF the NHS can promise sufficient patient take up and use.

It is an unfortunate truth of life that if one let's others treat one terribly, or ignore one, human nature dictates that they will do so.

Adult diabetics pay tax. We deserve our money's worth! Don't we?!
 
I DO get my tax money's worth without closed loop.
With all drugs and medical treatment, the NHS need to do a return on investment calculation. There is no value in giving someone a pump if they don't carb count or won't change their pump every 3 days. It is very risky giving someone closer loop who can't cope with it failing.
These decisions are made by humans which make it very important to show our best side to our DSN.
 
helli said:
I DO get my tax money's worth without closed loop.
With all drugs and medical treatment, the NHS need to do a return on investment calculation. There is no value in giving someone a pump if they don't carb count or won't change their pump every 3 days. It is very risky giving someone closer loop who can't cope with it failing.
These decisions are made by humans which make it very important to show our best side to our DSN.
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A return on investment? I agree but with the proviso that we are talking about human beings and the return on investment is in quality of health and quality of life and not about building infrastructure such as a road or a railway line or a bridge or a school.

That is why Professor Kar and his colleagues have been gathering the data to build a case for NICE to change the current guidance.

I get the sense that you assume - erroneously in my view - that a vanishingly small number of diabetics will respond to proper education and training about diabetes in the use of pumps and cgms and attendant peer support.

I'd like to think Professor Kar agrees with me.

I have no doubt that a significant amount of money could be saved on treating DKA and avoiding complications if the NHS spent our diabetes bucks smarter.
 
BadaBing said:
I get the sense that you assume - erroneously in my view - that a vanishingly small number of diabetics will respond to proper education and training about diabetes in the use of pumps and cgms and attendant peer support.
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You get the wrong sense.
My pont, which you missed, was to maintain good relationships with those who make the decision.
 
helli said:
You get the wrong sense.
My pont, which you missed, was to maintain good relationships with those who make the decision.
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OK, then you have my apologies.

I am keen for the NHS to save as much money as possible off the back of spending less on treating DKA and complications. That starts with education, training (and peer support) from first diagnosis onwards, and access (by those who want and will benefit from it, which educated and experienced diabetologists ought to be able to determine) to technology.

Maintaining good relationships is always good. However, in the final analysis the NHS is there to provide a service to the public and do so in accordance with the law of the land.

The upcoming NICE closed loops recommendation is a technology recommendation. I understand (please correct me if I am wrong) that once it is finalised, the NHS (including integrated care systems/integrated care boards) are required to implement the new guidance within three months.
 
BadaBing said:
The upcoming NICE closed loops recommendation is a technology recommendation. I understand (please correct me if I am wrong) that once it is finalised, the NHS (including integrated care systems/integrated care boards) are required to implement the new guidance within three months.
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Presuming it takes that form (and I've no reason to think it won't) that's my understanding too:

Types of technology appraisal recommendation

The technology appraisal committee can make 5 types of recommendation: Recommended, Optimised, Recommended for use in the Cancer Drugs Fund, Only in research, and Not recommended.
www.nice.org.uk www.nice.org.uk

(As I've suggested before, I think it's quite likely that closed loops will be recommended to pretty much the same group as are recommended pumps now. I can imagine slight tweaks, in particular perhaps adding diabetic distress as one of the criteria (as people have said is the case in Scotland).)
 
Hello Bruce Stephens.
Could you add some flesh to this extract from your post above.
Bruce Stephens said:
I can imagine slight tweaks, in particular perhaps adding diabetic distress as one of the criteria (as people have said is the case in Scotland)
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Thanking you in advance.
 
mark king said:
Hello Bruce Stephens.
Could you add some flesh to this extract from your post above.


Thanking you in advance.
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I'm just referring to one person who wrote that signs (or measures) of diabetic distress is one of the criteria that's used when deciding on whether to offer someone a pump in Scotland, while that's not the case in the current NICE technical recommendation.

Oh, I'm wrong. It's one of the criteria for a closed loop:

 
Thanks Bruce that was my understanding from talking with my Diabetic team here in Wyre Forest Worcestershire, but that may be something further down the line for me as I have reasonable control with L2.

However they are moving me off L2 and onto Dexcom G7 sensor as they state it is more accurate and they seem to want to standardise on Dexcom products going forward.
 
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