Partha Kar predicts closed loops will become standard care in the next 5 years

[Tdm]

Looking forawrd to closed loop!

 

[Bruce Stephens]

So, I should (or should I.) expect in 5 years time to be offered the chance of using a closed loop system as part of standard care for type 1s.

Yes, that's how I interpret his prediction anyway. And yes, that's a big jump from where things are. (And surely there'll be people who don't want a closed loop just as there are people who've declined a CGM, and that's fine.)

 

[everydayupsanddowns]

Partha has done amazing work for those living with T1. I think it is a shame his interest in the other 90% of those living with diabetes doesn't have a heart beat.

Bearing in mind the complexity of T2, being that bucket zone for diagnosis of anyone in adulthood, and even moreso if they carry a few spare pounds, I am utterly certain there are many T2s (and "T2"s) out there who would benefit enormously from even basic tech, long available to T1s.

To reiterate, I have the utmost respect for those living with T1, and those living with insulin dependent diabetes whose burden of self care is much greater than my own. I don't grudge those the tech, specialist care and so on that they receive. I just wish the 2 tiers of our NHS care (and, yes it is 2-tier) were not so far apart. That is near criminal.

I believe Partha is attending a Parliamentary event tomorrow exploring ways to widen access to tech for people with T2.

Having been involved in the development of NICE guidance myself a few short years before all this progress has been made, and having come up against the funding and approval brick wall with a very engaged committee who undertook novel health economic analysis to try to balance the cost of sensors against intensive BG monitoring (and potential improvements in BG management, improved outcomes, complication risk reduction over lifetime etc etc etc) - despite the best intentions it all came down to number crunching and cost vs benefit.

For wider access there need to be positive high quality trial data, and, ideally, a reduction in the cost of whatever the treatment is.

 

[Satan’s little helper]

He's simply making a statement about what he thinks to anyone who is on Twitter and follows him, can read. I presume but don't know for a fact, that the people who follow him, all have an interest in the treatment of diabetes.

OTOH the great and good people who were jointly delivering diabetes in 1972 (and after) were all assuring me they thought there would be a cure for T1 found within 10 years. I didn't place a bet on it myself and hope nobody else did!

We're just having a bit of a chat about it, is all.

I heard “that,” back in the 70s & 80s rocking & raving in the 90s. Also. “If I was a good diabetic I can have a pump.”
Or do I need to be in horns & a red suit?

Yes, that's how I interpret his prediction anyway. And yes, that's a big jump from where things are. (And surely there'll be people who don't want a closed loop just as there are people who've declined a CGM, and that's fine.)

Thank you, Bruce. I haven’t been here (on this forum.) long. But always respect your balanced & polite POV.
I do feel a certain cynicism towards what PK sometimes tweets. But never any need to express that. Regarding my personal life as a type 1. I’m more than happy & in good health. I also mix real life now and again with other Type ones. Socially. I get recommended when mentioning my issue with the diabetic team, by others to “take it up with Partha Kar?” Like he is the “messiah?”

 

[Bruce Stephens]

I get recommended when mentioning my issue with the diabetic team, by others to “take it up with Partha Kar?” Like he is the “messiah?”

That advice makes sense when someone (with T1) is being denied a CGM. The proportion of people with T1 using a CGM now is somewhere around 90%, so it's standard care, and he's several times said to contact him when that standard of care is denied. (He can't always fix it, but he'll try, and wants to know about it regardless.)

He's also several times tweeted about the (rather old now) pump technology appraisal advisory TA151 and how it's not at all being followed.

 

[AndBreathe]

I believe Partha is attending a Parliamentary event tomorrow exploring ways to widen access to tech for people with T2.

Having been involved in the development of NICE guidance myself a few short years before all this progress has been made, and having come up against the funding and approval brick wall with a very engaged committee who undertook novel health economic analysis to try to balance the cost of sensors against intensive BG monitoring (and potential improvements in BG management, improved outcomes, complication risk reduction over lifetime etc etc etc) - despite the best intentions it all came down to number crunching and cost vs benefit.

For wider access there need to be positive high quality trial data, and, ideally, a reduction in the cost of whatever the treatment is.

The thing is, unless things change in terms of early days input, the quantum leap from where we are now to where we want to be is huge. There is such an about face required from what T2s don't need to do to encourage better practises.

Passivity seems to be the name of the game in primary care. Quiet life achieved, although in fairness to the HCPs delivering diabetes care in primary care, their training is extremely lacking, so they have not clue what they have no clue about.

Whilst tech will be valuable for those living with T2, it is the basic education that is lacking.

I can't tell you how much I would like my assessment of Partha Kar to be very wrong.

 

[Pumper_Sue]

This would be great, I don’t want to sound objectively negative but the NHS is under enough strain, how would they manage this?

They are struggling now big time with the roll out of sensors for all. My DSN comment was words to the effect that Partha was great in ambitions but hasn't worked out how the teams were supposed to sort everything and the NHS fund it.

Looking at the stats for closed loop it seems to be a boast that users can achieve 80% in range! I manage that without closed loop so I can't see any advantage and in all honesty the biggest issue with closed loop is the sensors are not accurate enough to be worth while looping with.

 

[Satan’s little helper]

The thing is, unless things change in terms of early days input, the quantum leap from where we are now to where we want to be is huge. There is such an about face required from what T2s don't need to do to encourage better practises.

Passivity seems to be the name of the game in primary care. Quiet life achieved, although in fairness to the HCPs delivering diabetes care in primary care, their training is extremely lacking, so they have not clue what they have no clue about.

Whilst tech will be valuable for those living with T2, it is the basic education that is lacking.

I can't tell you how much I would like my assessment of Partha Kar to be very wrong.

Hello, I can’t help thinking he is “showboating” to a selective view misleading the rest of the “10%.”
That’s not by any way undermining the 90%.

Give it five years with me. I’m a patient person. Happy to just wait & resurrect this topic in 2028. Some “hat tricks” are easier than others.

In my experience. The tech I already use, (Libre.) throws my endocrinologist. (Let alone the nurse.)
They just don’t live with this.
Tweet Mr Kar? (As I was advised.) I wouldn’t want to risk getting blocked.

That advice makes sense when someone (with T1) is being denied a CGM. The proportion of people with T1 using a CGM now is somewhere around 90%, so it's standard care, and he's several times said to contact him when that standard of care is denied. (He can't always fix it, but he'll try, and wants to know about it regardless.)

He's also several times tweeted about the (rather old now) pump technology appraisal advisory TA151 and how it's not at all being followed.

Ethically, one shouldn’t write cheques that can’t be cashed? I know a “Kenneth Copeland.” when I see “one.”

 

[Inka]

I turned down a loop and my consultant confirmed my comments were apt and relevant. I don’t think it’s a magic answer and it doesn’t get rid of the absolute weak point in the whole set-up - the cannulas.

 

[AndBreathe]

Hello, I can’t help thinking he is “showboating” to a selective view misleading the rest of the “10%.”
That’s not by any way undermining the 90%.

Give it five years with me. I’m a patient person. Happy to just wait & resurrect this topic in 2028. Some “hat tricks” are easier than others.

In my experience. The tech I already use, (Libre.) throws my endocrinologist. (Let alone the nurse.)
They just don’t live with this.
Tweet Mr Kar? (As I was advised.) I wouldn’t want to risk getting blocked.


Ethically, one shouldn’t write cheques that can’t be cashed? I know a “Kenneth Copeland.” when I see “one.”

I think your post said it all in the first 8 words.

 

[AndBreathe]

I turned down a loop and my consultant confirmed my comments were apt and relevant. I don’t think it’s a magic answer and it doesn’t get rid of the absolute weak point in the whole set-up - the cannulas.

Whilst I am in awe of those who make looping work for them and achieve astonishing results, the inference that it's suddenly bring many into range possibly diminishes the efforts some T1s and Insulin Dependent Diabetics of all types make to deal with their complex conditions.

Were it a silver bullet, there would be a clamoring to get on the band wagon.

 

[Lily123]

@Pumper_Sue I agree with you on the biggest issue if there was the necessary funding would be accurate sensors. Dexcom G6 and G7 seem to more reliable for some while Libre 2 for others.

Some people may not want loops either

 

[Tdm]

@Pumper_Sue I agree with you on the biggest issue if there was the necessary funding would be accurate sensors. Dexcom G6 and G7 seem to more reliable for some while Libre 2 for others.

Some people may not want loops either

I find dexcom g6 very accurate and could see myself trusting. No libre 2 though....

 

[rebrascora]

I have learned that I can trust Libre 2 pretty implicitly and bolus and correct off it's readings and these days I maybe only do 2 or 3 finger pricks a fortnight. I would struggle however to trust a closed loop system nor could I justify the expense of one when, with Levemir and Libre (and Fiasp 🙄 ) I easily achieve 80% TIR and usually around 90%, so see no need for a closed loop or even a pump..... plus I hate all the plastic waste generated by them. Libre is quite bad enough!

 

[SB2015]

Looking at the stats for closed loop it seems to be a boast that users can achieve 80% in range! I manage that without closed loop so I can't see any advantage and in all honesty the biggest issue with closed loop is the sensors are not accurate enough to be worth while looping with

I am pleased that you achieve TIR in the 80s without looping and from your point of view it is not worth you looping. Looping is not going to be the right thing for everyone, and the same way as pumps do not suit everyone.

In spite of my best efforts I did not find that I achieved that level of success you have using just the pump and libre. I worked hard at trying to achieve ‘good results’ and it drove me to into burnout, as I set unrealistic targets. With looping my TIR is in the 90s for a large amount of time. However for me the biggest reason for using looping is the impact it has had on me psychologically. I feel that I can get on with life and at times not even think about Diabetes. I feel that I have my life back, and looping has led to me being healthier both physically and emotionally. For me it is worth my self-funding and I am glad that I am able to make that choice.

Regarding reliability of the sensors I am now happy to bolus using my SG, and only do a BG once a week to calibrate my sensor. The Guardian 4 is proving to be very reliable for me. I am also aware of many others who are confident with the level of accuracy of their sensors.

I think that you tried looping with the T-slim but I may have got muddled on that. I think that you also had some difficulties with their cannulas. Was it their sensors that were unreliable?

 

[Lily123]

I find dexcom g6 very accurate and could see myself trusting. No libre 2 though....

Same here. Some do find Libre 2 more accurate

I do find it hard to trust G6 because I couldn’t trust Libre 2 even when G6 is accurate

 

[nonethewiser]

I have learned that I can trust Libre 2 pretty implicitly and bolus and correct off it's readings and these days I maybe only do 2 or 3 finger pricks a fortnight. I would struggle however to trust a closed loop system nor could I justify the expense of one when, with Levemir and Libre (and Fiasp 🙄 ) I easily achieve 80% TIR and usually around 90%, so see no need for a closed loop or even a pump..... plus I hate all the plastic waste generated by them. Libre is quite bad enough!

By your own admission that 80 & 90% TIR takes a lot of effort & uses up a lot of your head space as your basal needs change a lot & you have to bolus more than average due to your low carb diet.

Thing is with pumps & new tech like CGM is it improves quality of life, simple scan of a phone to check bg or having multiple basal rates to meet our bodies needs, that to me is game changing compared to life before & I'm sure closed looping will do likewise.

 

[Pumper_Sue]

I think that you tried looping with the T-slim but I may have got muddled on that. I think that you also had some difficulties with their cannulas. Was it their sensors that were unreliable?

I was offered the Tslim, but unfortunately their cannulas are not suitable for anyone with dexterity problems. I use the Dex G6 and I would never ever trust them to bolus for a meal or a correction.

In spite of my best efforts I did not find that I achieved that level of success you have using just the pump and libre. I worked hard at trying to achieve ‘good results’ and it drove me to into burnout, as I set unrealistic targets. With looping my TIR is in the 90s for a large amount of time. However for me the biggest reason for using looping is the impact it has had on me psychologically. I feel that I can get on with life and at times not even think about Diabetes. I feel that I have my life back, and looping has led to me being healthier both physically and emotionally. For me it is worth my self-funding and I am glad that I am able to make that choice.

Like you I have to work very hard to achieve my results and yes very wearing but as already stated I can not and do not trust the sensors. I'm having a MRI scan tomorrow so will try a G7 to see how reliable it is after the scan.

 

[SB2015]

I was offered the Tslim, but unfortunately their cannulas are not suitable for anyone with dexterity problems. I use the Dex G6 and I would never ever trust them to bolus for a meal or a correction.

Like you I have to work very hard to achieve my results and yes very wearing but as already stated I can not and do not trust the sensors. I'm having a MRI scan tomorrow so will try a G7 to see how reliable it is after the scan.

I hope the scan is helpful and good luck with G7

 

[Pumper_Sue]

I hope the scan is helpful and good luck with G7

Thank you 🙂 the scan is a waste of NHS money as all they are doing is checking the cyst on my pancreas to see if it's turned cancerous. Have been told they wouldn't operate due to the other medical conditions I have! So not to sure why they are bothering.