Over the last twenty years, the number of individuals with diabetes in the UK has more than doubled, with over 3.8 million people currently affected. About 10% of these people have Type 1 diabetes, which occurs due to a reduction in insulin production, whereas the other 90% have Type 2 diabetes, linked to decreased insulin sensitivity. Additionally, seven million people are at high risk of developing Type 2 diabetes, a reflection of an aging, less active, overweight, and obese population. People living with diabetes face an increased likelihood of heart disease, stroke, lower limb amputation, kidney problems, and vision loss, which negatively impacts their social and economic independence and reduces life expectancy by up to 14 years.
In Scotland, over a quarter of a million people have diabetes, just under 5% of the population, which is slightly better compared to the UK’s 6% overall. However, the situation seems to be worsening quickly, with the incidence rate doubling in the last decade alone. It’s important to interpret these figures cautiously, as some of the increase may be due to better diagnostic capabilities, but the problem appears to be escalating nonetheless. Diabetes costs the NHS in Scotland more than a billion pounds annually, with 80% of this sum going towards managing preventable complications related to the disease. Diabetic patients make up about one-fifth of hospital in-patients at any time and tend to remain in the hospital nearly three days longer than non-diabetic patients.
Both Type 1 and Type 2 diabetes cases are rising. Scotland has the third-highest rate of childhood Type 1 diabetes globally after Finland and Sardinia, and Type 2 diabetes is also growing among young individuals. Type 1 diabetes is an autoimmune condition, unrelated to lifestyle choices, and its increasing prevalence isn’t well understood. However, approximately three-quarters of those with Type 2 diabetes are overweight or obese, with most others affected by familial tendencies or ethnic factors, particularly affecting South Asians and Afro-Caribbeans, who are at higher risk. This increase coincides with the trend of rising overweight rates among Scots. Notably, in 2010, 13.8% of very young Scottish children were obese, and only 65% of schoolchildren had a healthy weight.
Overall, one in five people is either diabetic or at high risk. To address this, the Scottish government established the Scottish Diabetes Research Network (SDRN) eight years ago, creating a National Research Register for patients interested in contributing to research aimed at enhancing the quality and quantity of diabetes research in Scotland, a significant initiative not seen elsewhere in the UK. New treatments are being developed or tested in extensive clinical trials, and research is ongoing into islet cell transplantation with the goal of producing a Type 1 diabetes vaccine. In 2010, the government launched a route map towards achieving a healthy weight, aiming to lower Scotland’s energy consumption, promote exercise, and foster healthy habits in young children to increase the proportion of children with a healthy weight.
A 2013 government report assessed progress, showing early signs of a slight reduction in obesity but acknowledged the lengthy journey ahead, though no decline in diabetes cases had yet been observed. Since the early 2000s, the authorities have also conducted the Scottish Diabetes Survey to assess the quality of diabetes care across Scotland. This survey offers essential information to aid NHS boards in identifying improvements needed for diabetes care and outcomes. For instance, one focus is ensuring individuals with Type 1 diabetes ideally control their blood glucose.
Unfortunately, four out of five people, especially those aged 15-25, do not reach target levels, raising their risk of life-threatening ketoacidosis and other severe complications later. Is this an effective approach? It will take years to determine its success. Continual monitoring against the route map will be crucial to assess progress and make adjustments if trends go off track. Additionally, individuals must take responsibility for their health, whether or not they have diabetes. Emphasizing personal failures in making the right choices may lead to discouragement rather than change. Instead, highlighting positive actions individuals can take themselves is more beneficial.
People with diabetes can register to view their clinical information on an interactive diabetes website, aiding them and their carers in managing the disease. Effective self-management includes performing nine essential healthcare checks annually, such as measuring blood glucose, blood pressure, cholesterol levels, retinal screening, foot and leg examinations, kidney function assessments (urine and blood tests), and checking weight and smoking status. Diabetes UK also advises care planning, emotional and psychological support, inpatient diabetes care, guidance during pregnancy, access to insulin pumps, education, and self-management activities.