The State of Diabetes Care in the UK: Challenges and Innovations

In the UK, it’s estimated that a new person is diagnosed with diabetes every 2 minutes.

Health inequities and disrupted checks have been looming issues for diabetes management. Such healthcare system shortcomings have become amplified as the number of people diagnosed with diabetes mellitus keeps rising.

According to a study published in Clinics in Integrated Care, health conditions associated with diabetes like kidney failure and vision loss still represent a challenge for the routine care system. The study highlights that 169 amputations related to diabetes are performed every week, all of which could be preventable by employing early and intensive intervention techniques.

This calls now more than ever for an urgent rehaul of our diabetes care routine and the integration of new innovative technologies. It also requires reducing extant barriers of receiving quality care for people with diabetes.

Follow along as we shed more light on the state of diabetes care in the UK and explore how an adaptable healthcare system can improve the quality of life of millions of people with the condition.

Chronic conditions like diabetes require lifelong care. The healthcare system should account for “forgotten” people, to both follow up and work on improving patient adherence to treatment.

The model in place for diabetes care in the UK keeps moving the patients back and forth between primary care physicians and specialist diabetes physicians. This creates a fragmented model of care where the providers don’t have full control over the patient’s experience, with delayed and duplicated interventions being an issue.

Understanding the challenges of diabetes care should always be the first step before launching a new diabetes prevention program or upgrading the current model of care. Here are some of the pressing issues that the UK faces when it comes to diabetes management:

According to Diabetes UK, the registration figures for 2021-2022 show that over 4.3 million people in the UK have diabetes. It’s estimated that 85,000 people are also living with the condition and yet to be diagnosed.

On the other hand, there are around 791 endocrinologists and diabetes specialists registered with the NHS, placing them at a ratio of over 5,000:1. The figures demonstrate how the discrepancy in the patient-to-provider ratios can be putting more burden on healthcare professionals and affecting the quality of care.

People with diabetes are expected to fulfil a checklist of tests every year, including blood sugar and blood pressure monitoring. Adherence to such a follow-up routine leads to improved clinical outcomes and better glycemic control with a lower risk of complications.

Diabetes UK shows that around 47% of the people with diabetes didn’t receive the full series of checkups in 2021-2022. This is partly attributed to the less accessible healthcare in rural areas.

21.3% of the UK population lives in rural areas, accounting for 12 million people. There is a significant difference in healthcare availability between urban and rural areas. 94% of those living in urban areas have a general practitioner facility around 20 minutes away on foot. In rural areas, the figures drop to only 19%.

However, community pharmacies are becoming more accessible for remote rural residents as they provide a variety of health services. Still, this can’t fully replace integrated diabetes care, especially that the condition is complicated and requires the care of trained physicians to prevent the progression of the disease.

Glycosylated haemoglobin (HbA1C) became a standard test in diagnosing and monitoring diabetes as it provides a measure of glycemic control in the last 3 months. Some valuable data can be inferred from the test results, however, HbA1C doesn’t clarify the whole picture.

The test is superior in identifying chronically elevated blood sugar levels, or hyperglycemia, when compared to other tests, like fasting blood glucose. It’s also a better predictor of chronic vascular complications of diabetes, like visual disturbances and heart disease.

However, the test comes with its own set of limitations. For instance, the standardisation of HbA1C assays is very poor, so the measurements can show variations between different facilities.

Also, some clinical conditions, like advanced kidney disease, pregnancy, infections, and major blood loss, can alter the results of A1C, making the test unreliable. Diabetes educators have to carefully communicate such factors, so people with diabetes can better interpret their A1C results and have a better idea of their disease progression.

Insulin is the cornerstone in the management of type 1 diabetes. However, old school insulin syringes can add to the patient’s burden of controlling their condition, especially when it comes to measuring the dose before each injection.

Insulin injection carries a risk of hypoglycemia (low blood glucose). If the dose isn’t adjusted according to food consumption and the level of physical activity, hypoglycemia can become a recurring issue, which in itself is a health hazard. People with type 2 diabetes also might need to take oral diabetes medications for optimal glycemic control.

In fact, this is the more common method of controlling diabetes in the UK. According to a study published in Diabetes, Obesity and Metabolism, only around 37% of people with diabetes in the UK require daily insulin injections. The study attributes the decrease of insulin injections from 97% in 1991 to 37% in 2010 to the increase in type 2 diabetes cases.

Health care costs for diabetes in the UK are estimated to be around 10 billion pounds per year. This represents about 10% of the NHS entire budget.

Tracking where most of those resources go can help us better optimise our healthcare system. For instance, 80% of the diabetes spendings goes towards managing complications and advanced disease. Some hospitals even report that a quarter of their total bed capacity is used by people with diabetes.

Such metrics show why diabetes prevention initiatives, self-management programs, and patient education are critical to reduce complications and reduce the risk of hospitalisation for people with diabetes.

The past few years have seen a leap in medical technologies. Digital tools are becoming an integral part of our healthcare system and they make it more efficient to organise patient data, plan follow up visits, and even ensure people in remote areas can still reach out to their providers in case of an emergency.

Here are some of the recent advancements in diabetes care that paint a bright future and raises the standard of care for people living with the condition:

Insulin pumps are great to ensure adequate glycemic control, especially in the elderly population where the adjustment of the time and dosage of insulin can be challenging.

When insulin pumps were first approved back in 1974, they were bulky devices used only for a select group with type 1 diabetes. However, with the technological advances, insulin pumps have shrunken down to the size of a deck of cards.

Now, your insulin pump can be stealthily attached with an armband, or rest in your pocket without feeling large or heavy.

The indications for insulin pumps also expanded to include type 2 diabetes patients whose blood glucose levels can’t be controlled with oral anti-diabetic medications and need to inject insulin.

Those computerised devices can be programmed to deliver insulin continuously to simulate the effects of the basal insulin secretion by the pancreas. They also deliver larger doses of insulin following meals (bolus doses). All you need to do is push a button or pre-program the device.

You can also use smart insulin pens, or a needle-free jet injector like InsuJet, which provides a needle-free solution for insulin administration. Such reusable devices can last for around 5000 doses. They provide an accurate knob that lets you adjust the dose easily.

For the longest time monitoring blood glucose level has required pricking the skin to obtain a blood drop that is then placed on a test strip. The strip is inserted into a device that analyses and quantifies the amount of glucose in the blood. This test is known as a fingerstick blood test.

Continuous glucose monitors (CGMs) have been game changers for diabetes mellitus management as they don’t rely on painful skin pricks. Those devices have a small sensor that rests under the skin's surface and measures the amount of glucose in the tissue fluid every few minutes.

This data is then transferred wirelessly to an external device or to your smartphone and sends you notifications if it notices unusual trends in your blood glucose levels. Your healthcare provider will have more input to finetune your management plan with such data.

The continuous glucose monitor sensor can either be disposable, which is placed for up to 7 days before it needs to be replaced, or implantable, which can last up to 3 months before needing to be replaced.

The NHS has started to integrate digital channels into its diabetes management programs, since face-to-face care might not be convenient for everyone. Given that diabetes is a chronic condition that people learn to live with, educating patients on the best self-management practices can significantly reduce complications.

There are online resources commissioned by the NHS to act as comprehensive guides for people with diabetes. For instance, MyType1 Diabetes is a digital portal that delivers personalised advice, educational courses, and interactive videos that you can register to access for free.

The NHS also has a dedicated diabetes app for children and young adults with type 1 diabetes. DigiBete can double as your digital treatment diary, where you can store information of your recent insulin doses, find a supportive community, and keep track of your upcoming appointments.

Furthermore, the NHS has been working on its digital infrastructure to ensure patient records are always up to date and maintain a seamless flow of information between the different organizations under the NHS umbrella.

This way, healthcare professionals won’t have to work with incomplete or outdated data, removing a lot of the burden that the providers face. Such a system is a response to the fragmented care that has negatively impacted diabetes management for years.

The NHS is taking a multidisciplinary team approach in managing diabetes. Instead of throwing the burden of care on the primary practitioner alone, now people with diabetes can work with healthcare professionals trained specifically on diabetes management.

The team includes an endocrinologist, a pharmacist to manage your medications dose, and a nutritionist to to help you with weight loss and healthy eating. Your provider can also refer you to mental health experts to help you on your journey living with diabetes and mitigate feelings of distress or burnout.

The UK has been working to make its healthcare system more adaptable. The disparities in healthcare has also been a talking point, especially for people living in remote or rural areas.

New technologies and innovations are already transforming diabetes care in the UK. Integrated digital portals are overhauled to relieve part of the burden that healthcare professionals face when reviewing patient charts.

Diabetes self-care has never been easier thanks to continuous glucose monitors, insulin pumps, and needle-free injectors like InsuJet. The future of diabetes care is looking promising already with more efforts directed for primary prevention and reducing the risk of complications.