“Unique challenges” of diabetes care discussed at healthcare professionals conference
Importance of diabetes prevention programmes highlighted as rising cases of diabetes diagnosis reported.
Programmes to help reduce new cases of type 2 diabetes were among the key talking points at a recent diabetes conference for healthcare professionals.
Claire Levy, PR and communications at DRWF, reporting from the opening day of the Diabetes UK Professional Conference held recently at the SEC in Glasgow.
This comprehensive professional conference opened with an address by Jenni Minto, Minister for Public Health and Women’s Health, Scottish Government.
Jenni said there are “unique challenges when it comes to diabetes care, not least our diverse geography that our health boards span, but also our population.”
Jenni said that in Scotland latest figures for people living with type 1 diabetes are estimated at around 36,000 and that type 2 diabetes accounts for almost 90% of diabetes cases nationally. It is an area of focus for early intervention. In addition, 1 in 5 people have prediabetes or diabetes, equalling around 936,000 people in Scotland.
Jenni discussed how the launch of the Type 2 Diabetes prevention framework by the Scottish Government in 2018 was an investment in weight management services to deliver on policy commitments. She added that this funding has enabled health boards to build, implement and enhance evidence-based programmes.
An intensive weight management programme of total diet replacement with shakes and soups has been delivered successfully in Scottish health boards for the past five years, co-led by Scottish academic professor Mike Lean of Glasgow University in partnership with Professor Roy Taylor of Newcastle University.
The digital programme, delivered through the Accelerated National Innovation Adoption Pathway, known as ANIA will help turn the tide on type 2 diabetes related ill health. ANIA has been established to support and prioritise innovations for investment, which can maximise impact on the prevention of ill health and the productivity of the health service. The Digital Diabetes Remission Programme will benefit 3,000 people newly diagnosed with type 2 diabetes, providing access to a digital intensive weight management programme across Scotland over the next three years.
Achieving remission from type 2 diabetes has a significant positive impact on quality of life for participants, reducing the number of medicines needed daily and enabling people to meet their health goals. The amount of weight that is lost on average through this programme is between 10 and 15%, which is significantly more than is achieved through standard care, leading to greater health benefits in terms of physical function, reduced blood pressure and blood glucose, and improved dietary quality.
It was reported that this programme will be both health improving and cost effective, reducing the risk of future cardiovascular and diabetes related medical complications. For participants delivering a preventative model of type 2 diabetes care in NHS Scotland, as well as remission of established type 2 diabetes.
For people living with type 1 diabetes – the Scottish Government has established a national programme, which is on track to deliver closed loop systems to more than 2,000 people this year.
This service has been designed for with people living with type 1 diabetes, it provides virtual education and support over a few weeks. The national policy has been to provide this life changing technology to any child or young person that wishes to use it, and national usage is now over 65% and looking to deliver universal access with closed loop systems.
Interim GIRFT report for children and young people's services: Technology challenges and wins
Doctor Dita Aswani
Consultant paediatrician working in paediatric diabetes and complications of excess weight in Sheffield. The regional lead for paediatric children and young adult diabetes in the North East. Clinical advisor for the Getting It Right First Time (GIRFT) in children and young adults diabetes programme
Dr Aswani shared insights in how the programme is enabling the roll out of diabetes treatment technology across England, with a real focus on equity of access.
Despite the improvements nationally there is still significant variation in and between systems. Keen to understand the granular detail behind this, and extended analysis shows persistent health inequalities in HbA1c in outcomes by deprivation and ethnicity.
The worse outcomes by deprivation and in certain ethnicities are influenced, at least in part, and if not mostly, by the lower use of pumps and hybrid closed loop systems. And this lower uptake is unlikely to be due to not having fully informed patient choice. The opportunity offered by GIRFT is very aptly named in paediatrics. If they “get it right” from the beginning, these children start off with the best start that they can possibly give them.
This is relatively new to paediatric medicine, and the general principles of each programme involve clinically led, data driven reviews of services to identify and understand the reasons behind unwarranted variation and the variation in care and outcomes, and then to provide targeted recommendations for improvement leading to standardised patient pathways and best practice guidance for children and young adults.
Diabetes is a new workstream for GIRFT, with the aims of the programme to support the four key areas of focus of the National Diabetes Programme:
- Address diabetes health inequalities in children and young adults
Children and young people living in the most deprived areas have higher HbA1c levels than those living in less deprived areas. Black and minority ethnic groups also have higher HbA1c levels compared to White children and young people. They are also more likely to experience diabetic ketoacidosis (DKA) and repeat DKA admissions to hospital. Despite this, the same groups are less likely to use continuous glucose monitoring technology.
- Reduce variation in treatment, care, and outcomes across health systems
Completion of health checks and achievement of treatment targets is associated with reduced complications. However, rates of health check delivery and treatment target achievement vary across units and within integrated care systems between different areas of the country.
- Improve treatment and care for people transitioning from paediatric to adult services
Outcomes at transition age are shown to decline, with spikes in DKA and repeat DKA admissions. In addition, there are also drops in key health check completion and treatment target achievement within this age group.
- Improve treatment and care for children and young adults with type 2 diabetes
Addressing health inequalities, particularly in access to technology and reducing unwarranted variation and improving care and outcomes for those transitioning at a very vulnerable stage from paediatric to adult care and care and outcomes.
There are significant challenges with the provision and sustainability of young adult services for 19 to 25 year olds in particular, and many places are describing long delays, with children and young people unable to transfer in a timely or a planned way from paediatrics in a number of places where there is no young adult service dedicated to 19 to 25 year olds, and young people go straight from paediatrics to an adult service without a transition or transfer process. The drop off in engagement, fragmented care, care outcomes, process completion and an increase in DKA admissions are very evident from the data, and we know this age group is vulnerable for many different reasons, not least because of the increased mental health challenges.
Pumps and hybrid closed loop in type 2 diabetes – The research
Charlotte Boughton (MD, PhD)
Clinical Lecturer in Diabetes and Endocrinology at the University of Cambridge
At present, around 15% of people with type 2 diabetes use insulin, but the clinical need is likely much higher than that. There are fantastic new treatments, GLP1 receptor agonists and associated medications and SGLT2 inhibitors. These are likely to reduce, but not eliminate the need for insulin in the management of type 2 diabetes.
Intensive glycaemic management to meet target HbA1c is supported by really good quality evidence established over many years. But despite this, over 50% of people with type 2 diabetes cannot meet the recommended glycaemic targets. This is in part due to therapeutic inertia and healthcare professional workload burden, but also an increased risk of hypoglycaemia with standard insulin therapy.
The variability of day to day insulin requirements in people with type 2 diabetes who need insulin is very high, and it is actually even higher than in people with type 1 diabetes.
France has a unique reimbursement model where adults with type 2 diabetes who are not able to meet target HbA1c with multiple daily insulin injections are able to use a reimbursed insulin pump. This study compared the Diabeloop system with a pump and sensor for a period of 12 weeks in just 17 adults who had a baseline HbA1c of 7.9%. What they showed was not only the hybrid closed loop system was safe, but it improved the time and target glucose range 76% during hybrid closed loop use versus 61% during the control period. This improvement was down to a reduction in hypoglycaemia and importantly, did not increase the risk of hypoglycaemia.
There is some anxiety around how to implement this for people with type 2 diabetes. One option to help mitigate this is having a fully closed loop system. Unlike type 1 diabetes, this has been designed to be fully automated with no requirement for mealtime bolusing. It mitigates the need for any healthcare professional optimisation or dose adjustments, making it more amenable to potentially being started in a primary care setting.
Closed loop systems can improve glucose outcomes without increasing hyperglycaemia in adults with type 2 requiring insulin. They are safe and associated with very low time in hyperglycaemia. Importantly, closed loop devices are manageable by users with type 2 diabetes new to diabetes technology and have high acceptability in this population. But fully closed loop systems really allows us to remove the need for healthcare professional input for dose adjustments after the initial training, which will help mitigate therapeutic inertia and workload burden.
Healthcare professionals will need to address any potential unconscious bias when considering closed loop systems for people with type 2 diabetes in the future.
From disparities to access: Diabetes technology to boldly go
Professor Partha Kar
National Specialty Advisor, Diabetes with NHS England and co-author of the national Diabetes GIRFT report.
Professor Kar spoke about the changes seen from 2017 in England there was no flash glucose monitoring systems in this country. The CGM uptake in paediatrics was 4 to 10%, adult pumps 8%. At that time there was NICE (National Institute for Health and Care Excellence) guidance on CGM (continuous glucose monitoring) and there was no adult type 1 diabetes audit.
Now England is one of the top countries in the globe, and from the presentations earlier today, it was wonderful to hear about Scotland. Professor Kar praised the members of the audience and thanked them for what this country has done to be standing out in 2025.
Deprivation gaps in the world of CGM and flash monitoring systems can be addressed with a very simple strategy.
Professor Kar said: “Give it to everybody. Your gaps close. Just give it to everybody. It's quite straightforward. This is in pregnancy. You can see again all teams have worked incredibly hard to do this. One NHS, one rule.”
The challenges he highlighted were pump users, including closed loop. There are gaps, but it is tighter compared to where it used to be.
In 2025, CGM is now the standard care for type 1 diabetes. Insulin pumps are now standard care for type 1 diabetes, with around 67% uptake at end 2024. Hybrid closed loop had a reported 56% uptake at end 2024. Technology is an enabler just to make self-management better. Clinicians do not have time. So that is what technology has done across the population.
Professor Kar praised people living with type 1 diabetes who have supported his work to help to make these achievements happen.
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