The Big Interview – INPUT’s Lesley Jordan
Lesley Jordan is the chief executive of INPUT, which is a charity that helps people with diabetes gain access to technology and support from the NHS.
Lesley, an insulin pump user herself, tells The Diabetes Times what her greatest ambition is and what she wants to see change in the diabetes community.
What are your priorities at INPUT?
Our mission is to help people access diabetes technology and support from the NHS, including insulin pumps, smart glucose meters and continuous glucose monitoring.
We are a small charity with a clear focus, and working with a tax-funded NHS, so bringing services in line with NICE recommendations is a good starting point.
What’s your biggest achievement so far at INPUT?
Our biggest achievement is – sorry I can’t choose between the one-to-one help we provide to over 400 people a year and our fabulous website which was visited by over 40,000 people in the last 12 months!
What is the biggest challenge faced by the diabetes community today?
Keeping going, day after day, without a break. A close second is variation in care – if you attend a well-resourced clinic your diabetes story will be totally different from someone who attends a poorly-resourced clinic.
For example, so few have completed structured education. In this day and age that should be an embarrassment to the NHS.
What would your one message to healthcare professionals be?
Technology cannot replace education and a supportive diabetes team, but technology isn’t a passing phase. Stay plugged in to technology discussions with your colleagues through the ABCD Insulin Pump Network.
How can access to diabetes technology be improved?
More DSNs and protected training time for type 1 service professionals. Again, the achievements of the trusts collaborating within the London Diabetes Clinical Network is a great example of best practice and shows that trusts with very different working procedures can collaborate for the benefit of their patients.
Are there are any downsides to using technology?
Of course, but every good thing has a downside! You are connected to it 24/7, technology can fail, you might not be given a choice, you have to find a way to carry it/wear it, people might ask questions, you need to commit to checking your glucose at least 4 times a day (taking no long acting insulin means risk of DKA if the technology fails).
Why do some patients initially resist insulin pumps?
According to our web page on the subject some people dislike the idea of being connected, or trusting a device.
Some people feel guilty about the cost.
How accurate is current diabetes technology and are there are any risks for those who rely on it to control their diabetes?
I was diagnosed with type 1 aged two, and before blood glucose testing, so the most accurate glucose measurement was blue, green and orange!
I think because blood glucose meters show results with a decimal point, we assume they are accurate, but even the most accurate meters can still be more than a mmol/L out even within 4-8 mmols/L range.
All pumps deliver precision (down to say 0.05u/hr basal) but some are likely more accurate than others. CGM is now approved as ‘accurate’ enough to make dosing decisions (Dexcom G5).
We all rely on some technology – even if you rarely blood test, you’ll still rely on the accuracy of your insulin pen. I rely on autopilot when I fly abroad and rely on the pilot to make any necessary tweaks.
Likewise, I rely on my diabetes tech to help me fly fairly evenly and am ready to make any tweaks necessary, whether they are caused by inaccuracy or by the fact that my body never works the same way two days running.
What would you do if your budget doubled?
Ooh, what an exciting idea! With another £21,000 we would run more events around the country, have a greater presence in the diabetes online community, and work on making information for healthcare professionals, commissioners and MPs more accessible.
What is the future of diabetes in the UK?
For type 1 diabetes, the near future includes evolving technology towards fully automated insulin delivery, with ongoing battles to get funding and equitable access.
I believe the distant future includes smart insulin and vaccines. All within a specialised service.
For people with type 2, I think simple basal-only patch insulin pumps will enable primary care services to start people on insulin sooner and reduce the incidence of complications, and I would like to see studies on short-term use of flash glucose monitoring for behaviour-modification in people with pre-diabetes.