Let’s get personal(ised) – by Robin Swindell
There has been a swell of interest and discussion about Person Centric Care (PCC) of late, and after years of talk its time seems to have come. What does it mean for people with diabetes and what does it look like in practice for those with Type 2 diabetes?
There was a lot of very encouraging talk at the Diabetes UK Professional Conference 2016 (DPC16) about a movement towards this kind of care, which is an approach to healthcare that focuses on the elements of care, support and treatment that matter most to the patient, their family and carers.
It’s a topic that has been getting significantly more attention over time, as can be shown by Google Trends (an online search tool that allows the user to see how often specific keywords have been queried over time);
You may have seen some excellent writing on PCC about this already from my fellow DPC16 bloggers, Andy Broomhead, Ellie Huckle, Helen Wills & Charlotte Austin, but at the risk of some repetition I want to take a look at this from a Type 2 Diabetes point of view, dig into the science of this a little and share some more recent news.
EASD / ADA guidance
In one of the last sessions of DPC16, Professor David Matthews presented “Management of hyperglycaemia in Type 2 diabetes, 2015: a patient-centred approach”, a joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. As part of this he highlighted some of the problems in conducting suitable research into the effectiveness of T2D combination treatments. This is because the number of possible treatment options is so high; a combination of diet, exercise and up to 6 different drugs could lead to as many as 120 permutations to be considered. A further complication is in finding suitable and willing trial participants; excluding those that are not eligible for the trial, those that do not give their consent and those that drop out of the trial can leave a very small pool of potential participants. These restrictions also raise questions as to whether those who take part in the trial are typical of the wider patient community in general.
Professor David Matthews summarised by explaining that the lack of clinical evidence of what works best for patient means that in respect of Type 2 diabetes, treatment can nearly always be summed up as:
- After diet, use a tablet
- The tablet should probably be metformin
- Then add something else
Hardly personalised treatment is it?
Recognising that people can have very different responses to the same treatments for Type 2 diabetes, that the many treatments vary greatly in the way they work and that that the condition itself can have many different mechanisms, the study sought simple stratification for Type 2 diabetes treatment.
The study analysed a large amount of publicly-available data about patients with T2D, anonymised data from GP practices and data from drug trials run by pharmaceutical companies. Using this data they picked out patients who respond well to the different drugs and also to identify which patients have side effects, after investigating whether those who appeared not to respond, or not to respond well, actually collected the prescriptions they were given. The results can be used to identify which therapy is likely to benefit an individual, without expensive tests.
A number of key factors were discovered, showing significantly different responses and side effects depending upon:
- Age when diagnosed
- The person’s weight
- The person’s gender
This has great practical implications for us people with diabetes; it should allow our Health Care Providers to have a much more informed discussion with us about not only the potential benefits of the treatment, but what the likely side-effects are.
Putting this into practice
Research is one thing, but the intent to make significant changes to clinical practice is quite another, and this brings us to the more recent news; on the 12 March 2016, the Professor David Haslam, Chairperson of NICE (The National Institute for Health and Care Excellence), the UK public body charged with providing national guidance and advice to improve health and social care, published a blog launching new guidance on PCC. This guidance marks a significant strengthening of previous advice, and is explicit that the views of the person being cared for and a doctor’s or other professional’s experience can and should affect decisions about care.
In the blog, Professor Haslam makes an unequivocal statement about the intent behind these new guidelines;
“Decisions can be guided by bodies like NICE where evidence and expertise have dictated our work; but increasingly the old ways of prescriptive, top-down medicine are dead, as our new guidelines recognise. Now we have to bury them.”
This is significant and good
The combination of these two items; a jump forward in understanding of what treatments work well for individuals with T2D, and a strong commitment from NICE that PCC should be at the heart of future medicine in the UK are great news for the future of our treatment.
Robin Swindell was diagnosed with Type 2 diabetes in May 2013, and manages the condition with diet, exercise and oral medication. He is a keen runner, occasional cyclist and can usually be found at Oak Hill parkrun at 9 o’clock on Saturday morning. You can follow Robin on Twitter @fractis.