Select Committee on Health Written Evidence

Memorandum submitted by Diabetes UK (CP 5)

  Diabetes UK is one of Europe's largest patient organisations. Our mission is to improve the lives of people with diabetes and to work towards a future without diabetes through care, research and campaigning. With a membership of over 170,000, including over 6,000 health care professionals, Diabetes UK is an active and representative voice of people living with diabetes in the UK.


    —  There are two million people with diabetes in the UK, equivalent to 3% of the population.

    —  Diabetes is set to increase. It is predicted that diabetes prevalence will double world-wide, rising to at least 5% by 2010, accounting for 3.07 million people in the UK. [7]

    —  Diabetes affects the young and old, and has particularly poor outcomes in those of lower socio-economic status and in those from black and minority ethnic groups.[8],[9]

    —  Evidence is available supporting the need for improved education of people with diabetes and their carers if better control and improved outcomes are to be achieved.[10],[11] ,[12]

    —  Diabetes, if undetected or not well managed, can lead to many complications and have a devastating impact on quality of life.


  The NHS makes charges for certain treatments, for example prescriptions, dentistry and optical services and for certain amenities for example TV and telephone use and for care parking at some hospitals. These charges (sometimes known as co-payments) have not been systematically or thoroughly examined for many years. Their rationale is unclear. Patients are often unaware of the rules surrounding charges and of exemptions. Accordingly the Health Committee has decided to undertake an inquiry into the subject with the following terms of reference:

    —  Whether charges for:

    Treatments, including prescriptions, dentistry and optical services; and

    Hospital services (such as telephone and TV use and car parking)

    are equitable and appropriate?

    —  What is the optimal level of charges?

    —  Whether the system of charges is sufficiently transparent?

    —  What criteria should determine who should pay and who should be exempt?

    —  How should relevant patients be made more aware of their eligibility for exemption from charges?

    —  Whether charges should be abolished?

Whether charges for:

Treatments, including prescriptions, dentistry and optical services; and hospital services (such as telephone and TV use and car parking) are equitable and appropriate?

    —  Many people with diabetes have informed us that they have had problems getting access to blood glucose testing strips on prescription. Some PCTs and GPs have tried to limit the number of blood glucose testing strips that are given on prescription in order to save money. The National Institute for Clinical Excellence (NICE) has issued guidelines for Type 2 diabetes and the management of blood glucose[13]. The recommendations state that: "Self-monitoring can be used in conjunction with appropriate therapy as part of integrated self-care". The guidelines focus on the use of HbA1c for giving healthcare professionals and people with diabetes a good picture of overall control and for that control to be stable. It is difficult, however, to make recommendations and take action on treatment adjustment, without at least some home monitoring. To use the guideline as a basis to restrict access to home monitoring is a misinterpretation of the guideline and was not the intention of the Guideline Development Group and it is both inequitable and inappropriate.

    —  Diabetes UK believes that people with diabetes should have access to home blood glucose monitoring based on individual clinical need, informed consent and not on ability to pay. Home monitoring is essential in the context of diabetes education for self-management in order to enable the person to make appropriate treatment or lifestyle choices. Blood glucose testing enables self-care in order to maintain optimum control. Key to this is being able to maintain blood glucose levels at as near normal levels as possible. The only way this can be accurately assessed and actions taken, is by monitoring blood glucose levels regularly. HbA1c is a valuable method of assessing overall control and is a good indicator of the risk of developing long term complications, however, a person with diabetes can have good HbA1c results and have poor day to day control with extremes in blood glucose levels. Stability of glucose levels is only measurable and achievable through home monitoring.

    —  Individual need, choice and circumstances will dictate, the most appropriate form and frequency of testing. There are times when it will be appropriate for people to test more frequently than is usual for them. It is unacceptable that people with diabetes should be restricted or deprived of home blood glucose testing equipment and supplies because of postcode prescribing, blanket bans or restrictions imposed by Primary Care Trusts (PCTs) or through clinicians' inadequate knowledge of diabetes or the individual patient's needs.

    —  People with diabetes value being able to monitor their blood glucose levels for themselves as it enables them to better manage their diabetes, help prevent devastating and potentially costly complications, and take control of their own diabetes. Restrictions on the type and numbers of testing strips is unacceptable as this does not meet individual needs and circumstances. Such a policy is against Standard 3 of the National Service Framework (NSF) for diabetes relating to patient empowerment4.

    —  There are considerable cost savings to be made from supporting self management, by reducing the frequency of support needed from the NHS and preventing people with diabetes from needing hospital treatment either with diabetes emergencies or long term complications.

What is the optimal level of charges?

    —  All people with diagnosed with diabetes (on insulin, tablet and diet treatment) should have access to blood glucose testing strips free on prescription. However, the costs of blood glucose monitoring are considerable. In order not to waste resources therefore it is important that people with diabetes are able to utilise home monitoring effectively through diabetes education. Without this education to know when and how to test, and what to do with the results, there is little point in home monitoring. The purpose of improving and facilitating people's ability to self-manage their diabetes is to improve their blood glucose control, with a view to preventing complications both long and short term. There are potentially, considerable cost savings to be made from reducing the number of people with diabetes needing to be admitted to hospital either with diabetic emergencies or with the consequences of long term complications eg for treatment of foot ulcers. There are also cost savings to be made on reducing the number of visits to GPs and other primary care professionals, if people are able to manage the condition more independently.

    —  It has been cited that more is spent on testing strips than on oral glycaemic agents. The implication being therefore that this is not a good use of resources. What this does not consider is that for some people with diabetes, being able to monitor blood glucose levels may be as beneficial to them as taking the tablets. In any case to restrict blood glucose testing strips when they are used effectively for self-management is, in our view, contrary to Standard 3 of the National Service Framework for diabetes on patient empowerment[14].

What criteria should determine who should pay and who should be exempt?

    —  All people diagnosed with diabetes (on insulin, tablets and diet treatments) should be able to receive free blood glucose testing strips on prescription.

How should relevant patients be made more aware of their eligibility for exemption from charges?

    —  When people are diagnosed, they should receive more information about their eligibility for exemption from charges.

Whether charges should be abolished?

    —  Prescription charges for blood glucose testing strips should be abolished for all people with diabetes (on insulin, tablet and diet treatment).

Diabetes UK

2 December 2005

Guideline for Type 2 diabetes—management of blood glucose, September 2002, National Institute for Clincal Excellence. Available at URL:

7   Amos AF, McCarty DJ, Zimmet P. The Rising Global Burden of Diabetes and its Complications: Estimates and Projections to the Year 2010. Diabetic Medicine. 5: Volume 14. 1997. Back

8   Chaturverdi N, Jarret J, Shipley MJ, Fuller JH. Socio-economic gradient in morbidity and mortality in people with diabetes: Cohort study findings from the Whitehall Study and the WHO multinational study of vascular disease in diabetes. BMJ 1998; 316: 100-106. Back

9   Mather HM, Chaturverdi N, Fuller JH. Mortality and morbidity from diabetes in South Asians and Europeans: 11 year follow-up of the Southall Diabetes Survey, London, UK. Diabetic Medicine 15: 53-59. Back

10   UK Prospective Study Group (UKPDS). Effect of intensive blood glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) The Lancet. Vol 352, 12 September 1998. Back

11   Diabetes Control and Complications Trial (DCCT) Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine. Vol 329: 14. 30 September 1993. Back

12   UK Prospective Diabetes Study Group (UKPDS). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38). BMJ Volume 317, 12 September 1998. Back

13   McIntosh A, Hutchinson A, Home PD, Brown F, Bruce A, Damerell A, Davis R, Field R, Frost G, Marshall S, Roddick J, Tesfaye S, Withers H, Suckling R, Smith S, Griffin S, Kaltenthaler E, Peters J, Feder G (2001) Clinical guidelines and evidence review for Type 2 diabetes: management of blood glucose. Sheffield: ScHARR, University of Sheffield. Back

14   National Service Framework for Diabetes: Standards, Department of Health, London. December 2001, available at: URL:http// Back

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