Diabetes: policy context

Policy Overview

The Diabetes Care in Scotland – Progress against National Priorities document was published in 2020 and discusses progress against the Diabetes Improvement Plan 2014 and Diabetes improvement moving forward.

The UK National Institute for Health and Clinical Excellence published a clinical guideline (NG28) on the management of type 2 diabetes in 2015, which was last updated in 2022. This clinical guideline updates and replaces a number of previous NICE guidelines on the management of type 2 diabetes.

The 'A Healthier Future: Prevention, Early Detection and Early Intervention of Type 2 Diabetes framework' was published by the Scottish Government in 2018. It sets out the national guidance for the management of type 2 diabetes from national, board and individual perspectives.

The Diabetes Improvement Plan 2021 – 2026 was published in 2021 and focuses on the priority areas in diabetes care; prevention and early detection, person-centred care, equity of access for all diabetes patients, staff development and many other aspects of improving diabetes care.

Monitoring and Screening

Diabetic eye screening for retinopathy is available to everyone over the age of 12 in Scotland with a diagnosis of type 1 or type 2 diabetes. Screening supports early detection and treatment of retinopathy which can lead to sight loss. Retinopathy risk is increased for people with diabetes as elevated blood glucose levels over time can cause small blood vessels in the to leak or become blocked.
The NHS also provides free eye tests at an optician (separate from diabetic eye screening) for everyone diagnosed with diabetes.
Screening for the condition of Diabetes itself is not currently recommended in the UK, including in Scotland, for any type of diabetes.

Access to Technology

The Scottish Diabetes Survey provides data and insights on use of continuous glucose monitoring (CGM) and insulin pump therapy.

Continuous Glucose Monitoring (CGM)

In Scotland, anyone with a diagnosis of type 1 diabetes using multiple daily injections (MDI) or a pump can access CGM on prescription if they are deemed to be actively engaged in managing their condition. In 2023, 82% of people across all Scottish health boards with type 1 diabetes were using CGM (Scottish Diabetes Survey, 2023).
NICE guidelines recommend that adults and children with type 1 diabetes have access to Flash (wearing a small sensor that enables checking of blood glucose levels) or CGM and some adults with type 2 who use insulin therapy and experience frequent hypos should have access to Flash.

Multiple Daily Injections (MDI) and Pump Therapy

Until insulin pumps were introduced, people with type 1 diabetes, and some with type 2 diabetes, managed the condition through multiple daily injections of insulin.
Many people still use insulin injections, but the use of insulin pumps is becoming more widespread. However, in Scotland, access to an insulin pump requires patients to meet eligibility criteria. In 2023, 19% of people with type 1 diabetes of all ages were using insulin pumps across all Scottish health boards (Scottish Diabetes Survey, 2023), with 55% of those under 18 using pumps, and 16% of those over 18.
NICE criteria for funding includes multiple injections being impractical, having repeated severe hypos that impacts quality of life, or having a HbA1c* of 8.5% (69 mmols/mol) or above despite trying to manage blood glucose levels

*The hemoglobin A1c (HbA1c) test measures the amount of blood sugar (glucose) attached to your hemoglobin. Hemoglobin is the part of your red blood cells that carries oxygen from your lungs to the rest of your body. A HbA1c test gives an average of blood sugar over the last 2-3 months. However, as it is an average, it does not reflect fluctuations in blood glucose that may be having a significant impact on quality of life.

Closed Loop Systems

In a closed loop system, an insulin pump and a continuous glucose monitor are connected to each other and adjust insulin dosing to help control blood glucose levels. Access to closed-loop systems is not available to everyone in Scotland at present, however, funding has been allocated by the Scottish Government to increase access to closed loop systems for those with type 1 diabetes. In 2023, 11% of people with type 1 diabetes were using loop compatible systems in Scotland (Scottish Diabetes Survey, 2023), with 43% of these being under the age of 18.

Access to closed loop systems is currently prioritised for children and adults who have suboptimal control under their current management system, experience severe hypoglycaemia or diabetes related distress.