Diabetes: Does type matter?

With diabetes being a focus of the NHS Long Term Plan, diabetes care in the NHS continues to evolve at pace. The team has painstakingly been conscious of the need to ensure the correct type of diabetes is referred to in the appropriate policy area. For example, when it has come to the area of prevention, we clearly reference Type 2 diabetes, whilst when we look at the use of technology such as Continuous Glucose Monitors, the reference has been towards Type 1 diabetes.

It may raise the question as to whether diabetes policy should be one homogenous issue – but that fails to take into account the differing pathology of different types of diabetes, whether it be Type 1, Type 2 or genetic causes such as Maturity Onset Diabetes of the Young (MODY).

With Type 2 diabetes being much more in the public consciousness due to the scale of it – as well as the wider drive to improve healthy lifestyle, tackle obesity and discuss modern sedentary, carbohydrate-rich environments, there has been a tendency for policy at local levels to also shift more towards Type 2 diabetes. Another reason may be the oft held view that Type 1 diabetes is a “disease of the young” even though data sets continue to show its presence and even diagnosis at much older ages than traditionally held views. As a consequence, paediatric departments have benefitted from a separate tariff – yet the same impetus has lacked within adult departments.

If one looks at outcomes, the proportion of the Type 2 diabetes population achieving HbA1c<7.5% stands at nearly 66%. This is testament to the work done by primary care. It is also an outcome which other countries would struggle to achieve – especially when one factors in added issues such as frailty, multi-morbidity – where higher HbA1c would be clinically appropriate.

However, when one looks at Type 1 Diabetes, the achievement is around 30% which reflects not only the different pathophysiology, but also the need to clarify to all concerned the need to improve outcomes in this group whose pathology, treatment and care can all be fundamentally different.

The NHS Right Care document thereby highlights the importance of this with clear messaging to CCGs about the need for different treatment and pathways for Type 1 and Type 2 diabetes. References are also made about getting the initial diagnosis right and the relevance of genetic screening, where appropriate. The aim of all this is to focus the mind on local policymakers and to ensure the same attention is given to Type 2 diabetes as to all other types. There is also the nudge to ensure technology gets as quick access as any relevant oral medication, as well as highlight specific areas to improve care and outcomes.

It is important to note that all diabetes care is, however, encompassed by the same principles of support, access or indeed language used by healthcare professionals.

The NHS Long Term Plan is an excellent example of this with appropriate focus and increased investment in prevention of Type 2 diabetes and self-care of Type 2 diabetes through a new online digital education programme, but also ensuring technology access is increased for Type 1 diabetes via flash and Continuous Glucose Monitors.

The intention is to ensure that all types sit on equal footings – and if we can replicate the outcomes in Type 2 diabetes across the board, we all stand to benefit as a nation.

So, does type matter? Yes – especially to the person whose care could be better if we as policymakers and healthcare professionals remember that diabetes is an overarching term yet it covers many different types, all of whom deserve equal attention and support.

Professor Partha Kar

Professor Partha Kar is National Specialty Advisor, Diabetes with NHS England and co-author of the national Diabetes GIRFT report.

He has been a Consultant in Diabetes and Endocrinology at Portsmouth Hospitals NHS Trust since 2008- and pioneer of the Super Six Diabetes Model which is recognised as one of the good examples of integrated care.

He has helped to expand use of technology in Type 1 Diabetes- namely use of Flash Glucose in Type 1 Diabetes and CGM in Type 1Diabetes pregnancy along with online digital self-management platforms- while recently leading on real world data collection on Closed Loops for subsequent NICE review. He has worked subsequently with NICE on updating relevant guidelines in non-invasive glucose monitoring access in Type 1 and Type 2 Diabetes.

His other work has involved introduction of frailty into QoF treatment targets, Diabulimia pilot projects in the NHS; championing “Language Matters” and helping to create an overview of Diabetes care in Primary Care Networks. Recent work has focussed on transitional care models- as well as tackling inequalities in technology access based on deprivation and ethnicity.

He is one of the leading users of social media in diabetes care – and writes a monthly blog for the British Medical Journal.

He has also been:

  • Co-creator of TAD (Talking About Diabetes) – TED talks from those with T1Diabetes
  • Co- creator of Type 1 Diabetes comic (Volume 1 to 4)
  • Co-creator of DEVICES (Virtual Reality educational modules in diabetes)

Beyond diabetes, he also recently taken a role in tackling issues of racial disparity in the medical workforce as the Medical Workforce Race Equality Standard lead for NHS England. He has also been named as one of the most influential BAME individuals in healthcare in 2020,2021 and 2022.

Follow Partha on Twitter: @parthaskar