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New toolkit in Scotland to help improve blood glucose control in type 1 diabetes

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A new decision-support toolkit will help healthcare professionals to support people with type 1 diabetes to improve blood glucose control.

The Scottish Intercollegiate Guidelines Network (SIGN) has updated the SIGN clinical guideline ‘Optimising glycaemic control in people with type 1 diabetes’ and developed a decision-support toolkit.

Healthcare professionals will be able to use this toolkit to support people with type 1 diabetes and improve their blood glucose control.

Optimal glycaemic control (HbA1c <58 mmol/mol or >70% time in range) improves the short-, medium- and long-term outcomes of people with type 1 diabetes by reducing the risk of chronic complications.

In Scotland, only 25% of patients with type 1 diabetes achieve optimal glycaemic control, with significant regional variations across NHS boards.

The toolkit, which can be used on a desktop browser or mobile app, prioritises five factors which influence the ability to manage glucose control:

  • Environmental and social factors 
  • Structured education
  • Psychological and behavioural interventions
  • Glucose-lowering and glucose-monitoring technologies 
  • Glucose metrics 

This toolkit is for healthcare professionals in primary and secondary care involved in the care of individuals with type 1 diabetes, including general practitioners, diabetes physicians, nurses, paediatricians, clinical psychologists and pharmacists.

It will also be of interest to:

  • People living with type 1 diabetes, their family and carers
  • Supportive organisations in the voluntary sector
  • Policy makers.

How this toolkit was developed

This toolkit was developed using a method which involves adapting existing recommendations in this area. SIGN identified, selected and adapted recommendations for optimising glycaemic control in people with type 1 diabetes from existing quality-appraised published guidance.

By bringing these together, and adding further resources to support implementation, it provides a focused information resource available at the point of care for healthcare professionals supporting people with type 1 diabetes.

Diabetes Scotland welcomes the update and in particular the following changes that we would like to see adopted by all Health Boards in Scotland:

Wider access to diabetes technology  

Changes to the SIGN clinical guideline ‘Optimising glycaemic control in people with type 1 diabetes recommend that healthcare professionals now proactively initiate meaningful discussions with all patients with type 1 diabetes about the suitability of a closed-loop system for their individual circumstances. 

The updated guideline also specifically recommends: 

  • Single-hormone closed-loop systems should be available to people with type 1 diabetes, paediatric and adult, who: 
    • under their current diabetes care plan continue to have suboptimal glycaemic control, a high risk of severe hypoglycaemia, or impaired awareness of hypoglycaemia, or 
    • experience diabetes-related distress, measured using a validated tool, that adversely affects their quality of life or ability to manage diabetes, and which is likely to be improved by moving to a closed-loop system. 
  • Adults with type 1 diabetes are offered a choice of continuous glucose monitoring based on their individual preferences, needs, characteristics, and the functionality of the devices available. 
  • All children and young people with type 1 diabetes are offered real-time continuous glucose monitoring, alongside education to support children and young people and their families and carers to use it.  

Support for people with type 1 diabetes and an eating disorder  

The updated SIGN guideline recommends that healthcare professionals now: 

  • Consider early or urgent referral to eating disorder services. 
  • Offer specific family-based behavioural interventions, such as behavioural family systems therapy, if there are difficulties with diabetes distress. 
  • Integrated intensive specialist care with the combined involvement of diabetes professionals and mental health professionals with experience in managing eating disorders is recommended to support people with type 1 diabetes and an eating disorder or compulsive insulin omission for weight control.  

Data collection  

The updated guideline recommends more robust and consistent data collection: 

  • The Scottish Care Information (SCI) Diabetes database should now be used to collect clinical and person-reported outcomes data from people with type 1 diabetes using closed-loop systems to inform quality of care improvements. 

View the SIGN toolkit and read how it was developed.

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