Diabetes: key points

• Diabetes results from reduced or absolute deficiency in the production of the hormone insulin, resistance of body tissues to the effect of insulin, or both. The result is abnormally high levels of glucose (sugar) in the blood and widespread disturbances to its metabolism without treatment.

• There are two types of diabetes, type 1 and type 2, which have very different aetiologies (causes).

• Type 2 diabetes is the most prevalent form (around 90% of cases) and is more common in those with overweight or obesity. The number of cases of type 2 diabetes is increasing rapidly in the UK and worldwide, associated with increasing levels of obesity and ageing populations.

• Type 1 diabetes can develop at any age and requires treatment with insulin. At present, it is not preventable.

• Gestational diabetes develops when the maternal body cannot meet the extra insulin needs of pregnancy, resulting in high blood glucose levels. The condition usually resolves after giving birth.

• Crude prevalence in Scotland by type of diabetes is 0.7% for type 1 diabetes, 5.7% for type 2 diabetes and 0.1% for other forms of diabetes. It is of note that there is approximately 10 x more type 2 diabetes than type 1.

• Hospital admissions for type 1 and type 2 diabetes are on the increase. Where type 1 was the principal diagnosis, admissions rates rose from 62.2 per 100,000 in 2011/12 to 65.8 in 2023/24. Where type 2 was the principal diagnosis (35.2 in 2011/12 to 45.5 per 100,000 in 2023/24), increases were driven by higher hospital admission rates for males with type 1 and type 2.

• Diabetic ketoacidosis is a metabolic emergency that occurs in both type 1 and type 2 diabetes. It occurs when ketones build up in the blood due to a lack of insulin. In type 1, rates have increased in most age groups in recent years and remain highest in younger people. In type 2, rates have also increased but are highest in those aged 65+. Males aged 65+ have the highest rate of any group at 166.4 per 100,000 in 2023/24.

• Where diabetes was the underlying factor recorded on death certificates, the rate increased from 2.1 per 100,000 in 2021 to 2.8 in 2023 for type 1 diabetes. Rates for males were consistently higher, and in type 1 almost double the rate for females.

• In type 2 diabetes, mortality rates almost doubled in the same period, going from 8.6 per 100,000 in 2011/12 to 16.9 per 100,000 in 2023/24. As with other trends, rates were higher for males, but rates for females also increased.  

• The Scottish Diabetes Survey is a key source of information on diabetes in Scotland covering prevalence, characteristics, diabetes care and outcomes relevant to the Diabetes Improvement Plan, the Scottish Government’s plan to improve outcomes for people with diabetes.

   

  This section has been written by the ScotPHO team with input and review from Dr. Paul Nelson, Public Health Consultant.