Diabetes Discussions: Technology

Jack [00:00:10]: Welcome to Diabetes Discussions, the brand-new podcast from Diabetes UK.  

[00:00:15]: Each episode we’ll be talking to you about the realities of diabetes, sometimes known as the hidden condition. Millions of us live with it. Millions more misunderstand it.  

[00:00:26:]: We know diabetes can affect everyone differently. It can play a small part in your life or completely consume it. We'll be sharing personal experiences from those impacted every single day, but who don't let it hold them back. 

[00:00:40]: I'm Jack Woodfield from Diabetes UK and I'll be guiding us through the conversation and sharing my own stories of living with diabetes. Today we'll be talking about technology. 

Sam [00:00:53]: You feel quite in the dark with a lot of things, and it's only when something's offered to you that you know about it.  

Georgia [00:00:59]: There's aspects to the pumps that I think the healthcare professionals don't always think about because they haven't experienced it personally.  

Dr Tahir [00:01:05]:We are not as skilled in technology, so I think as people with diabetes are going on this journey, I have to be honest, the healthcare community is also going on this journey with you. 

Jack [00:01:18]: Technology in diabetes care has taken huge leaps forward in recent years, from insulin pumps to continuous glucose monitors, and it’s changing the lives of many people and families affected by diabetes. But many people living with diabetes are not able to access technology or choose not to.   

[00:01:35]: Today we’ll explore the world of diabetes technology, including the benefits it can bring, as well as the challenges facing availability and uptake. 

[00:01:44]: Joining me on this episode are Georgia Weston, Sam Dottin, and Dr. Waqas Tahir. Georgia is a medical student currently studying at Keele University. She was diagnosed with type one diabetes two years ago, age 26, and uses a continuous glucose monitor, or CGM as we might refer to it in this episode, and multiple daily injections to manage her diabetes. Hi Georgia.  

Georgia [00:02:06]: Hi Jack. Thanks for having us on.  

Jack [00:02:08]: Sam works at Diabetes UK as a National Diabetes Audit Engagement Lead. She was diagnosed with type two diabetes nine years ago and uses a blood glucose monitor. Hi Sam.  

Sam [00:02:18]: Hello.  

Jack [00:02:18]: And finally, Dr. Tahir is a full-time GP and Diabetes Clinical Lead in Yorkshire. He's also a member of the Council of Healthcare Professionals for Diabetes UK. Hi, Dr. Tahir.  

Dr Tahir [00:02:28]: Hello everyone. Nice to be here.  

Jack [00:02:30]: So firstly, I think it'll be helpful for our listeners, for you to introduce yourselves in a bit more detail and to explain your relationships with diabetes. So, Georgia, if you'd like to go first.  

Georgia [00:02:40]: So, I'm 28. I was diagnosed a little bit later in life when I was 26, just turned 26 during the midst of Covid, which was um...a great time to be diagnosed with diabetes when no one could come into hospital and see you. 

[00:02:52]: And yeah, I was diagnosed two years ago and I've still got a year left of medical school because I'm doing a Master's at the moment in Cell and Tissue Engineering, also at Keele University. I've got a year left until I qualify and I'm kind of still trying to work out how to be a diabetic and go into the working world and be a doctor. So exciting, but a nervous time.  

Jack [00:03:12]: It sounds like a lot going on and we've spoken to people who were diagnosed in lockdown and it just seems just such a bad time to have been diagnosed. Sam, what about you? What's your story? 

Sam [00:03:20]: I found out I was diabetic accidentally. Uh, when I was putting on a health event for men, one of the nurses pulled me over and said, oh, let me check you and that's how I found out. So, uh, I didn't even have the time to be borderline or anything. I was just full-blown type two. 

[00:03:37]: Uh, and then I went into denial about it cause I didn't have any symptoms and I didn't really understand what it was. So I just carried on living life as I was. And then I think during lockdown, I started to take it a bit seriously because I understood there were more risks with Covid and having type two diabetes and being from an ethnic minority background.  

[00:03:58]: So, started to take it seriously, started working at Diabetes UK so you then become even more aware of everything, so I was privileged to a lot of information. But I think the hardest thing for me is trying to get things under control. So even though I am trying to do all the right things, it's still very, very difficult and I think life circumstances don't make it easier.  

[00:04:21]: I've had a bereavement, I've got, you know, personal stuff going on. I'm moving home. That age cause I'm 50, where hormones are changing so that you're just juggling a whole load of stuff and then trying to keep your numbers in check as well is very difficult. 

Jack [00:04:38]: Diabetes is one of those things, isn't it as well? It can be some days not necessarily a big deal, but then other days it can be a huge deal that completely impacts the rest of your day. And Dr. Tahir, could you just introduce us to yourself in a little bit more detail in your relationship with diabetes and diabetes technology? 

Dr Tahir [00:04:55]: Absolutely. So thank you for the kind introduction, Jack.  So by background I'm a GP. I practice locally in Bradford, West Yorkshire, and I have various leadership roles, uh, supporting people with diabetes. So that's whether it's on the front face, uh, clinically in clinics, um, supporting people with either access to technology or different treatments, management options. But also, more importantly in the wider landscape around how we plan and support service delivery and services for people, uh, with diabetes.  

Jack [00:05:25]: Thanks Dr Tahir and thanks everyone for being here, and I think it really shows a variety of experiences, particularly with Sam and Georgia that people with diabetes have in their diagnosis stories.  

[00:05:35:]: So, staying with you, Dr. Tahir, what is the importance of diabetes technology for people with different types of diabetes, and what are some of the examples of diabetes tech that is currently available in the uk? 

Dr Tahir [00:05:45]: I think when it comes to diabetes in particular, we've seen an avalanche of technology and advancements at least over the last decade or two. Uh, and this is really both, um, important and significant for people with all different types of diabetes. So, I think one of the first things I would be thinking about would be specifically tech for people taking insulin. So this is how we either, um, deliver insulin or how people access, uh, insulin delivery. And- and usually when we talk about insulin delivery, we mean technological advancements like insulin pumps as well as smart insulin pens. 

[00:06:18]: An insulin pump is a small electronic device that releases a regular of insulin that your body needs through the day and night, so you don't need to do insulin injections. But even there, we see more recent technology, for instance, uh, taking insulin in, uh, a closed loop system. So sometimes people might have heard the word artificial pancreas where we have a pump that releases insulin based on readings from a- a sensor or, or a continuous glucose monitor. So that's one aspect of technology, uh, for people with diabetes of how they either administer or take insulin.  

[00:06:51]: Secondly, I think, which I think is um, definitely exciting cause it throws its own challenges, is around where we use tech for checking blood glucose, uh, levels or blood sugars for short. And this is where we have seen newer tech, particularly around CGMs or continuous glucose monitoring and flash. Um, uh, so these are, if you think electronic blood sugar monitors that let you check your blood sugar levels, uh, without pricking your fingers so you can see what happens more or less, uh, to your blood sugar levels during the day, during the night with different activities, but also, you know, depending on what different types of food we eat and how we feel through different, um, parts of the day.  

[00:07:29]: The third element, I think is technology, particularly around supporting people so that they can look after their diabetes better. And sometimes, uh, this may include things like carb counting apps, ketone monitors, or other ways to monitor, um, things like ketones or ketones. Um, just very briefly, they are sort of, poisonous or toxic chemicals that can develop if there isn't, uh, enough insulin in the body to allow the glucose to enter the cells. And there are lots of other apps in smart technology that can help, for instance, around managing, um, your weight, exercising, uh, and even looking at things like carb counting. So, the types of food, uh, nutrients and carbohydrates in that. 

Jack [00:08:12]: Thank you for explaining that. And it is incredible to see how far technology has come, particularly since when I was a child, when I was diagnosed with type one age four, and in the middle of the night my parents would have to sneak in to try and finger prick my finger to get some blood for a blood glucose test and to avoid putting a light on to avoid waking me up.  

[00:08:27]: Whereas now with things like, you know, Freestyle Libre and continuous glucose monitoring, it’s so much more advanced and it’s so beneficial for, not just people living with diabetes, but families and parents as well.  

[00:08:36]: So, Georgia you use a continuous glucose monitor and multiple daily injections to manage your diabetes. So, could you explain to us a little bit how these work for you and what do you find are the key benefits or things that you find challenging?   

Georgia [00:08:47]: So, at the moment, I am on the Dexcom CGM. I think the main reason why I appreciate that technology specifically so much is because of my lack of hypo awareness. When I was first diagnosed, I remember immediately, as soon as I found out about CGM, I just wanted one.  

[00:09:00]: I was like, this is the thing that's gonna keep me safe. Why would you not want this? And the nurses were quite reluctant to allow me to have that technology straight away, which I completely understand now but at the time I was like, this is crazy. Please just let me have the thing that's gonna keep me safe.  

[00:09:14]: And it’s sort of allowed me to get a bit more awareness of my blood sugars because I think if you rely entirely on the technology, you don't really listen to your body. But as I've got less awareness than, I think the average person, when I do go low it's just been a-a game changer for me. 

[00:09:29]: It’s just given me the confidence to travel. When I first got diagnosed, I would be terrified going for a walk. I’d think have I still got active insulin in me? Have I eaten enough today? How is this gonna affect my blood sugars? 

[00:09:39]: Since I’ve been diagnosed and been on the CGM, particularly the Dexom, I’ve been surfing, I’ve been on solo holidays, I’ve been abroad. I’ve done all the things I wasn’t sure I’d be able to do when I first got diagnosed. So, I think for me that is one of the best pieces of technology. Everyone’s different. I completely appreciate that, but in my situation it’s-it changed my life completely.  

[00:09:58]: So, in terms of the injections, so I'm on the MDI, just the normal multiple daily injections, I've been doing that since, since the start. I have thought about the options of pumps, but I think for me it's already a lot to have on your body and I- I'm not sure if this affects everyone or whether it's just me, but to be physically identifiable is different. It’s something I really struggled with at the start, particularly being a young woman, you kind of- part of you just wants to fit in and just look normal.  

[00:10:25]: You don't want something on your body constantly that identifies you as being different. So, I did have an issue wearing the CGMs for that reason until I really realized the benefit and then thought, you know what? Doesn't really matter to me. But it's still quite a big deal to be going out in public, particularly this time of year when you know, you might be having short sleeve tops or summer dresses or things that will show the technology that you've got and people will sort of initiate conversations and it's not always nice conversations. 

[00:10:48]: Some people will be like, oh, what's that thing on your arm? Or, what's that? Or they'll even assume that it's something- certain people think it's, you know, the nicotine patches and I’m like, no, it's for this. It's an opportunity to educate people, but I do struggle sometimes when you just get the odd side eye or look or a family at a table staring at you thinking, what's wrong with that girl? Why has she got this on?  

[00:11:06]: So I think to have a separate pump and sometimes with the tube- and I know you can get the pods that don't have the tubes, but it's just- I don't think it's always understood entirely by healthcare professionals. And this isn't a- -generalization, but it's something I've come across in the past where they just think, this is what's best for your diabetes management so why aren't you doing it?  

[00:11:23]: And for me, that's not always what's best for me because you've gotta think about living as a person and how it makes you feel sometimes and it can be exhausting just hearing all the alarms and the alerts from just my blood sugar monitor, never mind have a pump as well cuz I know sometimes they fail and they make certain noises and I know people who have them and they’re constantly going off and the cannula might get a little bit bent so it doesn't function properly. 

[00:11:43]: So yeah, I think for me that's what works best, but I completely appreciate that- w l, the technology is better for other people in- in certain ways. I think it's just each to their own really.   

Jack [00:11:51]: I think it's a really important point about the emotional side of things, particularly those two strands you mentioned about one, about wearing, you know, a very visible pump or sensor on your body, and I can attest to that. When I first started using the Libre, I was quite uneasy about, you know, even discussing it with friends and family and at gatherings.  

[00:12:05]: It took me a little while to develop that confidence to talk about it, but also the point you mentioned about, you know, some tech doesn't always work for some people, and we'll be including some links in our episode notes about the advice that people can follow to hopefully troubleshoot and learn more about why technology might not always work.  

[00:12:21]: And Sam, so the same question to you. So, you currently use a blood glucose meter for your type 2 diabetes. So how beneficial do you find that and what is it that you are looking for in diabetes tech that you feel would most benefit you?  

Sam [00:12:34]: Well, I was a person that didn't engage with my diabetes. I'm now really, really trying to get it under control. I think the hardest thing, and one of the reasons why I didn't engage with it is because I never had any symptoms. I still don't have symptoms, so it's hard to treat something if you can't feel how it's affecting you.  

[00:12:54]: But my awareness is greater now, so I could eat really badly, not do any exercise, test my blood glucose in the morning and, oh, it’s on seven. Seven’s great for me. Yesterday I ate really well, went for a walk, took my reading this morning and it was nearly 14. I don’t understand what’s going on. 

[00:13:15]: I had to beg for finger prick testing meter because they were like, you don't need it, you know, we’re gonna test your HbA1c. But I don't understand how my body's working and in order for me to really control what's going on, I need to understand how food is affecting me, what food is affecting me, what exercise is working for me, and those kinds of things and I can't figure it out.  

[00:13:38]: I'm logging my food. I've got my Fitbit, so it's logging my steps. I'm testing my bloods in the morning. I don't understand what's going on and I've been doing this since January. Every day. So, I have asked for a CGM and they said no because I’m type 2 and they said the NICE guidelines say X, Y, and Z. I was able to say, yeah, but they’re just guidelines, they’re not rules. 

[00:14:03]: And if you want me to be able to be a better person with diabetes, you need to work with me and help me to understand what’s going on. And the only way I can understand what’s going on is if I can start to monitor throughout the whole day and see what happens when I eat, what I eat, when I walk what happens? 

[00:14:22]: So right now, I'm waiting to hear a decision. They've said that they've- my diabetes nurse said she's got to go to the board and I've got to wait. So, I'm waiting for these people that don't know me. They don’t know my medical history. They don’t know what I'm like. 

[00:14:38]: So, you know, I didn’t understand the risks before I worked at Diabetes UK so I'm grateful for the position that I'm in and I'm in a different position from Georgia and I completely understand this. I'm older and I can be a bit of a campaigner and a bit mouthy, so I'm really happy to wear my little thing on my arm and if anyone asks me, cuz I'm at that stage of life, I don't- I don't care.  

[00:14:59]: So, I can wear it and I'm quite happy to be asked questions and deal with that. Um, but I also, in the same respect, I do absolutely understand what Georgia’s saying as well. And I think everybody’s diabetes is so different, everyone’s situation is so different that they have to really look at you as individuals.  

[00:15:19]: So, I’m really keen to see what happens and hope that this podcast make a difference with kind of how people look at what they’re giving to people with diabetes to help support them. 

Jack [00:15:30]: Absolutely. We hope so too. And I think it's really, really admirable that you're looking to actively embrace technology to, you know, improve your diabetes management and feel that you've got a greater understanding of what's going on with you. And as you alluded to there, I think it's a really important point regarding NICE or the National Institute for Health and Care Excellence. 

[00:15:48]: So, this is the public body in England, which among other things, recommends the use of new technology and the eligibility criteria, as Sam just explained for people with diabetes differs depending on your diabetes type, where you live in the UK as well as how old you are. And so, Diabetes UK is currently running a Diabetes Tech Can't Wait campaign to make sure that people across the UK get access to the technology that they need. 

[00:16:10]: And you can read about this in the episode notes where we’ll also signpost to a link from our website, which details the eligibility differences and who qualifies for what tech. So, Dr. Tahir, as Sam alluded to, just how significant is this difference in eligibility across the UK? 

Dr Tahir [00:16:22]: I think first of all, I'm just gonna say thank you to both Georgia and Sam for sharing your incredible experiences and stories with us, because it just highlights that how we have different views and it's your diabetes and we're all individuals and therefore it needs to be tailored to that. 

[00:16:40]: And I think that is, uh, definitely one of the lessons, uh, that I always think we need to share with the healthcare professionals because we often forget this really, really important, significant message. But coming back to your question, I think, um, uh, Sam alluded to some of those problems, which I'm going to describe as barriers to commissioning. 

[00:16:58]: Different areas, different geographies, different regions have different ways of looking at commissioning. So, what they, in essence have to do is weigh up the cost-of-service delivery across not just diabetes, but all forms of other health conditions and that's where we see one of the biggest delays, in terms of guidance or a body recommending specific recommendations.  

[00:17:22]: And then I call it action happening on the ground, Sam. Um, and- and- and I think as a healthcare community, uh, we can only apologize cause this needs to happen yesterday if we call it, um, and it's not happening. But I think in addition to that, there are wider issues and problems that we see.  

[00:17:38]: Georgia alluded to some of them earlier on where she described that her doctors or her healthcare professionals, her diabetes team had a very different view of how they wanted her to use pumps, for instance. So, I think we need to acknowledge that again across regions, we have a very diverse workforce. We are not as skilled in technology. 

[00:17:56]: So, I think as people with diabetes are going on this journey, I have to be honest, the healthcare community is also going on this journey with you. So we are learning with you, we are learning more about how we can support you in the same way. You are learning more about this technology and how the different things that you do impacts the blood sugar levels. 
 
Jack [00:18:14]: So how much of a learning curve is prescribing technology for healthcare professionals?  

Dr Tahir [00:18:19]: I think it's a real learning curve for us. And then if we look at, one of the other challenges that we see is, uh, Sam mentioned that she has a different form of diabetes – type 2 diabetes. So predominantly this form of diabetes is looked after in the community and primary care by your GPs or by your practice nurses.  

[00:18:36]: So again, we need to take them on this journey around educating the workforce, skilling up the workforce. So that if we're better skilled, we're better educated, and we have that knowledge, we can make those better informed choices and those shared decisions with people living with diabetes like Sam and with Georgia. 

[00:18:54]: So, I think there is a lot of work and a lot of challenges for us in that area to do. And I think one of the other, um, challenges that we often hear, and see is access to technology. So, some of those are due to workforce. Some of those are due to the infrastructure and, um different policies that regions have. 

[00:19:11]: But some of those are also down to the fact that there are either a lack of access points for people. So, whether that's to do with health literacy, whether that's to do with health inequalities, or whether that's to do with a lack of libraries or lack of support mechanisms on the ground to support people to access how they get healthcare provision. 

[00:19:30]: For instance, I look at West Yorkshire, we have almost 150,000 people with diabetes. So, if you think of all of these people, at some point will embrace and will be on different forms of technology, as a health system, what tools do we have that helps us identify people who would require our support more than others. So that may well be looking at people who have diverse multiethnic backgrounds, health literacy, health inequalities, different types of treatments. 

[00:20:01]: So, you may be on one, two, or three different insulins or insulin pens, or you might have other health needs that are not addressed through the other forms of technology. So, risk stratification platforms allow us to identify risks in people, whether that might be someone who perhaps is having more episodes of hypoglycaemia or, or hypos for short. 

[00:20:24]: So, it again helps us figure out who we need to see more urgently and in a timely fashion as well. Lots of challenges, but equally, um, there are lots of opportunities for, uh, us to work together on this front. 

Jack [00:20:35]: It sounds like there are so many factors that are involved with accessing tech, and so I'd like to stick with eligibility just for a second because look, my experiences with technology are a little bit mixed. 

[00:20:44]: So a few years ago I was offered a chance by my healthcare team to adopt the Freestyle Libre, which was very exciting. But also, since then, my healthcare team haven't actively approached me about any new technology. And so a few months ago, my insulin pen broke and I wanted to get a replacement, and it was only then that I really found out about smart insulin pen. 

[00:21:01]: So Georgia, I'm interested to know, do you know what technology you're currently eligible for, and also do you feel that you're supported by your healthcare team if you want to learn more about this?  

Georgia [00:21:10]: To be honest, just to pick up on what I was saying before, my views have changed a lot since I've been diagnosed. So when I was first diagnosed, it was a massive deal and I didn't want anyone to know because I was still getting my head around it. Whereas now I wear- I mean, I've got the Dexcom out today, like it's not a really a big thing for me. So, I'm actually pushing at the moment for a pump. I've completely switched my views. 

[00:21:30]: So, because my HbA1c is what a lot of nurses and doctors would consider, and the textbook says, is good control for a type one diabetic, they're all like, oh, you're doing great. You don't need anything. And I'm like, no, this is an okay HbA1c. I would like it better.  

[00:21:45]: I'd really like a pump and I actually spoke to my nurse, I think it was last week, just to catch up really. It's just sort of like every few months. I haven't seen my consultant in over a year. I think once you reach a certain threshold and you're just not flagging up as you haven't been in DKA, you haven't had severe lows, you're not contacting them very often, you kind of just sort of slip under the radar.  

[00:22:04]: So, when you want help, the support is very limited. It's not really entirely for you at this point because the NHS is so overstretched, which I understand, and I'm not saying it's not, there's no support at all. It's just when it comes to specific things like tech, the pot of funding is very limited, so they give it to people, understandably, that are really struggling to get the blood sugars down due the means that they've already got, whereas, with MDI I manage most of the time to be okay-ish in range. 

[00:22:29]: And then they're like, okay, that's fine. So, I've really struggled, especially as a student, I mean, I'm-I'm due to graduate and study- I've studied medicine for the past four years. I haven't got a great amount of money, but I'm due to graduate in a year. And then at that point I might be able to fund it myself, but as a student it's impossible. 

[00:22:44]: There's no way I can live and function and pay for pumps and everything on top and then nurses openly said to me that if I had a poorer HBA1c, I would be able to get it for free on the NHS. So, you think, do I just allow my blood sugars to run high to be like, okay, this would happen. I can make this happen. 

[00:23:01]: I'm just choosing to stop it because at the moment I'm injecting up to 10 times a day sometimes. I'm not saying that's enjoyable by any means. I mean, my belly is covered in holes and my legs are covered in holes, and I do what I can to control it because that's more important to me than the fact that I have to inject, which obviously isn't pleasant, but it gets the job done. 

[00:23:17]: But it'd be so much nicer to just have a small pump somewhere that I could control from my phone and even the- the things that people don't always think about. So I'm quite active. I like going to the gym and being outdoors and kayaking and surfing and all those things are so much easier to control if you can prevent the basal rate. 

[00:23:33]: So, obviously with the injections that I do at the moment, I inject a basal once a day. I know it's, - I'm saying obvious, it's not obvious. Everyone's different. But for me personally, I inject once a day is a basal rate, and then that's slowly degrading in my system over a 24-hour period. So if I decided to be more active that day, really I didn't need as much basal, but it's a one injection, so I-I don't have the option to really change that. 

[00:23:56]: So, with the pumps, you could stop that and there's like activity modes and things where you can drop the basal rate or stop it entirely. So then you don't have to eat because the amount of times I go to the gym and I eat more calories, it's not that I go just for the calories, but it's not nice to be like, okay, I've just ran five miles, cycled three or four, and now I've eaten probably 6/700 calories and I sort of feel a bit stodgy and gross when I went there to feel healthy.  

[00:24:19]: And there's aspects to the pumps that I think the healthcare professionals don't always think about because they haven't experienced it personally. So yeah, I think for me, that'd be my experience but there's pros and cons and I would love a pump, but I'm not eligible until my HbA1c is a little bit poorer, which I understand, but it's not ideal, I would say is probably the best way to sum it up. 

Jack [00:24:37]: I think you've raised some really interesting points there, and it's not the first time that we've heard from people that have that same query with the HbA1c eligibility and considering running higher and obviously as a charity, that is not something we would advocate at all, but we understand there is something with the eligibility there that probably needs to change.  

[00:24:53]: And Sam, just going back to your relationship with your healthcare team. So, you’re are looking to get access to a CGM and the eligibility criteria is currently preventing you from doing this. So, have your healthcare team been able to offer you alternative support, something that in the meantime while you are looking to actively manage your diabetes more, something that they can help you with that makes you feel a bit more comfortable? 

Sam [00:25:15]: No, and I don't know of anything, and I think this is one of the things about specifically having type 2 diabetes, you feel quite in the dark with a lot of things, and it's only when something's offered to you that you know about it. 

[00:25:28]: So unless someone talks about it, you just think whatever's been offered to you, Metformin, whatever it is, that's it, that's the only option that you've got. I know about CGM through my work. If I hadn't worked at Diabetes UK, I wouldn't know about it and I'd just have to suck it up really. So, this is why I'm pushing, and I think there are so many people that don't engage in their healthcare. 

[00:25:53]: So when you have someone that engages with their healthcare, especially when you know that your mood can be impacted by having diabetes, support that person to make them feel in control of what's happening with them. And I think that will kind of lift your mood as well, because you have all these other external factors happening. 

[00:26:11]: You know, family stuff, housing stuff, whatever it is, job, that can bring your mood down anyway when you feel like you can't even control your own body, that is really not a good place to be. So, when you've got someone that's engaged, you really wanna kind of support them with that and cheer them on. 

[00:26:29]: I've not been offered anything. My medication is, uh, metformin and I'm using, uh, daily injections of Victoza, which is aimed to help me get my blood glucose under control, but it's also supporting me with losing weight. So that's good and I really am grateful for that cuz I started that in January and I can see a difference, definite difference, but there's still a lot I don't understand. 

Jack [00:26:54]: It's not ideal for you now at all, and I think hopefully in the next few years we might see some changes on that front and, on that point on availability, so we were really pleased to see earlier this year that NICE did make two big announcements regarding availability this year. So firstly, they recommended the use of hybrid closed loop systems for some people with type one diabetes in England and Wales, and we'll have a link to that information in the episode notes. 

[00:27:18]: And secondly, they recommended continuous glucose monitoring technology for children and young people living with type two diabetes in England, Northern Ireland, and Wales. So, Dr. Tahir, could you explain to us a bit more about why these decisions were made and how significant could they be? 

Dr Tahir [00:27:33]: So, I think the reason that the decisions were made are to do with the evidence. So like Sam says, and Georgia, we've been on a journey, you've been on a life journey. Diabetes itself has been on a journey where we've seen so many different advancements from medications to different therapies, to different types of insulin, to the way we get insulin and then to tech on board.  

[00:27:54]: And this is just the sort of next stage of that where now across different, um, trials, uh, from different parts of the world, we see that these technologies are having significant benefits to both the quality of life and all those things that matter to someone with diabetes, not just for the type 1 community, but even now for people with type 2 diabetes.  

[00:28:16]: And also, we're seeing it across, um, a breadth of different age groups. So, we- we looked at adults, we now see it across pregnancy. Clearly very important, um, part of one's life. And then we're also seeing it where we can now use the same technology and the guidance is there for people with young onset diabetes as well. And also, the age threshold has gone lower as well.  

[00:28:35]: In essence, this is always welcome news because now what we can see is across the different types of diabetes that you may have, across the different age groups and across the different life experiences, you will more or less be eligible to a vast array of technologies to support you with diabetes.  

[00:28:51]: It's all driven by evidence. As the evidence changes, the goalpost changes and that just allows us to come with newer recommendations. So perhaps in 10 years from now, you know, closed loops like we think are very innovative now, it might be the norm over the next 10 to 20 years, but then there might be something else coming, um, in front of that as well.  

[00:29:10]: So, we’re always evolving and innovating as a human race and this is always exciting, particularly in diabetes where things are rapidly changing. I think we just need to ensure that the right technology reaches the right person so that they can get the right support at the right time, you know, that would one of the key messages for me in terms of knowing what you can access and where to access it as well. 

Jack [00:29:29]: Absolutely. And like you said, hopefully in a few years the situation will be completely different. So, we've spoken about eligibility, but I think it's also important to talk about uptake because I mean, Sam and Georgia, you are actively looking to embrace new technology. 

[00:29:41]: But we do know people who perhaps might not want to embrace new technology for a variety of reasons. As we've already discussed, you know, the visibility of having pumps and sensors on our bodies, but also perhaps the concern over being stigmatized for having this technology. And also, there's a lot of information that comes from technology and it can be quite overwhelming, and I think it can lead, in some cases, to burnout from checking and seeing numbers all the time. 

[00:30:06]: Dr. Tahir, you've already spoken about some of the other barriers with regards to tech and accessing for people with diabetes, but how do you find, from people that you've seen, uptake is an issue and that reluctance perhaps to embrace new technology?  

Dr Tahir [00:30:18]: Yeah, I think it's an issue both ways. So, I think I see, um, access issues. So locally I practice a lot of my diabetes across West Yorkshire , in particular in Bradford where we have lots of health inequalities, a diverse community as well. So, I have firsthand knowledge of this, uh, purely where when we look at access to technology, just as an example from our place, our numbers as a system look absolutely fine. They're at par with the national average.  

[00:30:43]: But we see a stark difference when we start looking at health inequalities within that community, but also in terms of who is accessing that technology. So, we get two very, very clear cohorts that we see. So we see the outskirts of Bradford so think of Bradford a bit like a donut where the centre of the donut, the hollow bit, has higher levels of diabetes, higher levels of, uh, socioeconomic deprivation, but also, um, higher levels of, uh, multiethnic populations.  

[00:30:10]: And the periphery is, uh, predominantly white, Caucasian, affluent. So, you can see we've got two very distinct and, and stark contrasting, uh, populations and where we see technology is predominantly used across that outer circle. So if you look at our total numbers, the donut looks fine, but actually if you look, pay closer attention, you then find actually, and even in terms of having one policy, having one hospital, one way of doing everything, one access point, we still see those ongoing differences across, um, our communities. 

[00:30:41]: So for me, that always is a big challenge and one which we try to address through innovative ways like this podcast today, but also through other things in webinars and reaching out, you know, um, through Diabetes UK uh, who are thankfully doing amazing work, particularly the north region, who have worked with, uh, the Bradford team in, um, accelerating that change of pace that we want to see across our community. 

[00:32:03]: The other thing which we see is patients. So, we often have some patients who come to me who are completely unaware that they are allowed specific technology. So, we look at the results and often every clinician is under the impression that the patient knows or the patient can ask for what they want or perhaps a previous clinician has mentioned technology.  

[00:32:23]: And I think that's the other thing which I've found, uh, across the healthcare system is I'll ask the question, do you know that you know, this is what we need to do for your diabetes and this is how we can help you and actually you could access A, B, C, all these different types of technologies from Dexcom to Libre.  

[00:32:39]: And for me it's very both disappointing and sad to see that sometimes tends to be the first conversation, the first time they've- they've heard those words. So, I think for me there is still a lot of work for me, uh, and for all of us to do in terms of how we can amplify this message. 

[00:32:54]: Um, so it reaches the vulnerable community so that they are aware they can access all these technologies through contacting their diabetes team, their GP, or even just someone else living with diabetes. Or not the least, just have a look at the DUK website.  

Jack [00:33:08]: Thank you very much for the kind words, by the way. And he said that of his own volition to anybody listening [laughs]. Um, so the final question that I'd like to ask you all is, is quite general, it's what advice would you have for anybody listening to this who is interested in learning more about diabetes technology or perhaps reluctant to learn more about diabetes technology and the best places to start. So Sam, what would your advice be?   

Sam [00:33:32]: I think having conversations about what's out there so ask your healthcare provider what's out there cuz they might not bring it up to you, so you ask the questions. The Diabetes UK website is great for information. 

[00:33:48]: A lot of that information is used by healthcare professionals to talk to their patients so there's lots of information. There's the helpline there as well. And I think if you can talk to other people that have accessed technology and ask them how they feel about it, what made them use it, what are the benefits? 

[00:34:06]: I learned about CGM from my neighbour who's 80. That's the first time I ever heard about it a few years ago, and it just sounded amazing. And I was like, why hasn't everybody got this? So, conversations with real people are great. It's just trying to find out who they are and how to have those conversations but yeah they're the things that I think would really, really help.  

Jack [00:34:25]: Thanks Sam, and Georgia, what about you?  

Georgia [00:34:27]: Yeah, everything that Sam says I completely agree with. It's so much, whether you're first diagnosed or whether you've been in the game, if you will, for years. I know people who've had diabetes for 20 years and just don't wanna entertain the conversation and you just kind of have to know that whatever is right for you is okay. 

[00:34:40]: You don't have to have technology. Like, it's great for some people it might be horrific for some others. If it's something that you manage well enough and you're happy with how your control is and how your lifestyle is, and then don't feel that you need to do anything else. But yeah, there are tons of places that you can go for information. 

[00:34:56]: And then for me personally, a little bit cheesy, but I do like a YouTube video and I like to sort of find a few YouTubers where they evaluate tech and they'll sit there for sort of 20 minutes talking about the latest features of the new one and why it's different from the last. There's a guy called Nerdabetic that I'll watch all the time and he's great.  

[00:35:11]: Yeah, something to chill and watch in the bath at the end of a long day. So whatever works for you I think, whatever you wanna do, do. Surround yourself with people who have it, educate yourself, but if you don't want it, that's absolutely fine as well. 

Jack [00:35:23]: This seems like an appropriate time to point out that Diabetes UK does also have a YouTube channel [laughs].  

Georgia [00:35:27]: Sorry about that!   

Jack [00:35:29]: Dr. Tahir, is there anything further you'd like to add to that? 

Dr Tahir [00:35:32]: I think in addition to that, um, just be curious. Be curious. Want more, want more for yourself and just contact your local diabetes team, your GP practice, like, uh, Sam and Georgia mentioned someone else living with diabetes, someone else using this technology. 

[00:35:45]: Just be curious. Just ask what is this? How is this helping you? Just widen your horizons. And I think on that final note, I think, um, I always like to share, one of the quotes from Martin Luther King, which is around health access, health inequality, and one of the quotes, he mentions that of all the forms of inequality, injustice and health is the most shocking and inhumane. And I think that's what we're here to address and that's what we want to do for people with diabetes as well as technology.  

Jack [00:36:10]: That seems like a really perfect point to call it on. Georgia. Sam, Dr. Tahir, it's been absolutely brilliant talking to you all today. Thank you for joining us on the podcast and for sharing your stories and experiences of diabetes technology. Thank you so much.  

Sam [00:36:23]: Thank you.  

Georgia [00:36:23]: Thank you for the opportunity. Thank you.  

Dr Tahir [00:36:24]: Thank you. 

Jack [00:36:30]: That's all for this episode of Diabetes Discussions. We hope the conversation has helped you with your own experiences of living with or supporting someone with diabetes.  

[00:36:40]: For more advice and support, search Diabetes UK online or check out the information and links in the episode notes. Don't forget to hit subscribe so you never miss an episode. 

[00:36:50]: And if you like what you've heard, please rate and review to help others discover the podcast. Thanks for listening. See you next time. 

[00:36:59]: Since the recording of this episode, Sam has been offered a three- month trial of a Dexcom CGM.