Diabetes Care in Scotland Brian Kennon, Consultant Diabetologist, Queen Elizabeth University Hospital, Glasgow 5th February 2019
Outline • Scottish Diabetes Survey • Glycaemic control • CV Risk Factor Management • MDMW & Research Register • Improving Diabetes Care • Type 2 Prevention Framework • Innovation & Technology
Type 1 Glycaemic Control 3 centres ‘cross-over’ 12 centres ‘cross-over’
Pathways of Care Improving 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’?
Type 1 pathway Measure Standard 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
Diabetes Dashboard: ongoing development SCI-diabetes Improving Care Diabetes Improvement LeadGillian Kinstrie Sharing Good PracticeDiabetes MCN workshopsNewsletter
Diabetes Innovation Improving the outcomes in Diabetes related foot disease Health Technology Informatics • Near real-time blood glucose monitoring: • Application Programming Interface (API) • Data Analytics, Cloud Hosting • Data Dashboard Diabetes AI: Digital Health Technology Catalyst • AIM: develop clinical decision support with AI including automated messaging to clinicians and patients. Inpatient Care- Transforming Diabetes Care in Generic Hospital Ward Settings
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
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.
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
Diabetes Technologies & Innovation Collaborative Working: ‘real world’ data P < 0.0001 n = 743 Courtesy Fraser Gibb
Future Opportunities Potential for Scotland to be an ‘early adopter’ site How to ensure we utilise these opportunities
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?