Diabetes care - progress against national priorities: commitments - 2021 to 2026

Clinical Foreword

The last year has resulted in unprecedented disruption to healthcare services and life in general. All areas of our society have been affected and yet as individuals, teams and communities we have adapted to meet those challenges. The Scottish diabetes community is no different and although many services underwent significant reconfiguration at the start of the COVID-19 pandemic many are now considering within the recovery phase how to ensure the impact on individuals with diabetes is minimised as best we can. As the evidence base grows, highlighting the increased risk of severe COVID for those with comorbidities such as diabetes and obesity, now more than ever it is vital we consider how best to support individuals to optimise their health and wellbeing.

The refresh of the Diabetes Improvement Plan is therefore timely as it allows us to review the progress we've made since the original plan of 2014 and also consider the opportunities that exist to drive ongoing improvements in diabetes care.

A detailed breakdown of the progress against each priority is outlined in this document. Examples of this progress includes a significant increase in the number of children and adults with type 1 diabetes accessing technologies such as insulin pumps and glucose monitoring devices. Other national initiatives focusing on improving type 1 diabetes care include a DKA prevention campaign, supporting children and young adults at school and early glycaemic intensification at diagnosis.

The significant investment in the Type 2 Diabetes Prevention Framework has allowed us to develop an infrastructure across Scotland to help realise its aims of preventing and improving the identification of type 2 diabetes, with the realistic goal of achieving remission with early intervention. The forthcoming national type 2 diabetes structured education package is also a welcome addition to help standardise care across Scotland and wider roll out is imminent.

We have made progress in improving the care of individuals with diabetes admitted to hospital with the roll out of the Diabetes Think, Check, Act programme. This has helped improve the timely management of acute issues such as hypoglycaemia and also upskilled healthcare professionals to identify and manage diabetes in an in-patient setting.

We've also seen Scotland leading the way internationally, using data from SCI-diabetes, to produce world class epidemiological research that helps inform policy and care models. The development of the diabetes dashboard has also been a significant advance allowing ready access to 'real time' data at national, regional, local and individual level to help drive improvements to care and outcomes. The diabetes community is also actively involved within the innovation landscape and outputs from this will help ensure that ongoing care models evolve to meet the challenges of delivering diabetes care in a rapidly changing environment.

The eight priority areas with the refreshed Diabetes Improvement Plan remain the same with an ongoing focus on optimising glycaemic control, preventing and early detection of type 2 diabetes and minimising the risk of complications. Supporting self-management, optimising mental wellbeing and upskilling healthcare professionals all remain key to optimising outcomes. The ongoing focus on in-patient care is also important given the adverse outcomes seen in those with diabetes admitted to hospital.

Driving improvement is a challenge. Timely access to data is vital and within diabetes and we are fortunate that ongoing development of SCI-diabetes means we remain well placed to capitalise on this to evolve and evaluate care processes and outcomes. Embracing innovation to ensure we maximise the benefits of the rapidly expanding number of interventions that we can offer individuals with diabetes remains a priority area. This is particularly important in relation to technologies such as Artificial Pancreas Systems which have the potential to fundamentally change how we deliver type 1 diabetes care.

The way we develop and evolve care models to address these priorities and meet the challenges faced by individuals, systems and society is key to improving outcomes and mitigating risk. For many years we have looked to implement virtual diabetes care models and improve areas such as connectivity with technologies and yet overnight these have become the 'new norm'. We need to ensure that future models of care are fit for purpose not only within the COVID era but also address many of the issues which drive existing health inequalities such as deprivation and ethnicity.

As such, we need to be mindful of the unintended consequences of service redesign and ensure that individuals and groups, who are often the most vulnerable, are not left behind and inequalities widen. Involving people with diabetes, understanding and mitigating against the risk of exclusion and offering services that adapt to individual need is key to improving the care and outcomes for all.

I'd finally like to thank all of you within the Scottish diabetes community and beyond who have been instrumental in implementing the Diabetes Improvement Plan and driving forward improvements in care. We should take time to reflect on the progress we have made and to celebrate our successes. However, there is still much to be done and the refreshed plan allows us to refocus our efforts, consider collaboratively how we progress the priorities and commitments within the plan, aimed at improving the care and outcomes of individuals living with diabetes in Scotland.

Professor Brian Kennon
Chair of the Scottish Diabetes Group