1. Diabetes Care in Scotland
5th February 2019
Brian Kennon, Consultant Diabetologist,
Queen Elizabeth University Hospital, Glasgow

2. Outline Scottish Diabetes Survey Improving Diabetes Care
Glycaemic control
CV Risk Factor Management
MDMW & Research Register
Improving Diabetes Care
Type 2 Prevention Framework
Innovation & Technology

3. Diabetes Prevalence

4. Type 1 Glycaemic Control

5. Type 1 Glycaemic Control
3 centres ‘cross-over’
12 centres ‘cross-over’

6. Type 1 Pump Usage
Baseline 2011 Paeds 8.4% and Adults 2.5%

7. Type 2 Glycaemic Control

8. CV Risk Factor Management

9. CV Risk Factor Management

10. MyDiabetesMyWay

11. Diabetes Research Register

12. Improving Care Pathways of Care Processes of Care Improving Care?
Peer Review
Measures of Care
Standards
How do we use what we measure to drive improvements in care
or are we diabetes ‘historians’?

13. Type 1 pathway Measure Standard % new T1s in DKA at Dx
Prevention of DKA
at diagnosis
% new T1s in DKA at Dx
<10% DKA at Dx
Early insulin/CHO
intensification strategy
% HbA1c <58 at 12 months
>60% HbA1c <58 at 12 months
Structured education
programme
% completed structured education
>50% completed structured education
Continuous subcutaneous
Insulin infusion therapy
<10% waiting >6/12 for CSII therapy
? % on CSII therapy
? % on CSII therapy waiting >6/12
Sensor augmented
pump therapy
% on GCM
Islet cell / pancreatic
transplantation

14. Diabetes Dashboard: ongoing development SCI-diabetes
Improving Care
Diabetes Improvement Lead Gillian Kinstrie
Sharing Good Practice Diabetes MCN workshops Newsletter
Diabetes Dashboard: ongoing development SCI-diabetes

15. Type 2 Prevention

16. Type 2 Prevention

17. Diabetes Innovation Health Technology Informatics
Improving the outcomes in
Diabetes related foot disease
Inpatient Care- Transforming Diabetes Care in Generic Hospital Ward Settings
Near real-time blood glucose monitoring:
Application Programming Interface (API)
Data Analytics, Cloud Hosting
Data Dashboard
Health Technology Informatics
Diabetes AI: Digital Health Technology Catalyst
AIM: develop clinical decision support with AI including automated messaging to clinicians and patients.

18. Diabetes Technologies & Innovation
Existing Assets
Scottish Diabetes Group
Diabetes Improvement Plan
Policy
Additional Assets
Third sector
Procurement
SHTG
Industry
Clinical
Research
MCN network
Type 1 leads network
SCI-diabetes
SDRN
Epidemiology Group
SSGCYAD

19. Vision
Develop the use of data, technologies and Artificial Intelligence (AI) to improve diabetes care and outcomes in Scotland.
Develop a ‘whole system’ infrastructure to support innovation and adoption
Scotland to become an internationally renowned ‘test bed/research’ arena for the development and assessment of technologies used in diabetes care.

20. Diabetes Technologies & Innovation
Collaborative Working: Libre Story
Freestyle Libre: first Flash Glucose Monitoring system
Transformative for individuals with diabetes
Reduced the need for fingerprick tests
Better understanding of their diabetes
Initially self funded
Added to tariff
Limited evidence base
Variable approach by Health Boards across Scotland ‘Postcode Lottery’
National guidance – variable impact 20

21. Diabetes Technologies & Innovation21

22. Diabetes Technologies & Innovation
Collaborative Working: ‘real world’ data
P <
n = 743
(Median change -4 mmol/mol but -7 in those with HbA1c > 57)
Courtesy Fraser Gibb 22

23. Future Opportunities
Potential for Scotland to be an ‘early adopter’ site
How to ensure we utilise these opportunities

24. SUMMARY Ongoing increase in prevalence of diabetes
Improving glycaemic control particularly in T1DM
Challenge of ensuring monitoring and treatment of CV risk factors – are current models of care appropriate?
Diabetes is data rich – how do we use that to drive improvements in care?
Political and clinical will to tackle T2DM prevention – how best to seize that opportunity?
Massive increase in technologies to manage diabetes - are services fit for purpose? 24 24