Diabetes in Scotland – how Dexcom is advocating for better patient care

Shay Speakman-Brown, Dexcom Head of Market Access discusses diabetes management. The views expressed here are not necessarily those of The Scotsman and it is recommended to always seek NHS advice before commencing any medical treatment.

Since 1999, Dexcom has pioneered game-changing diabetes management technology. Called continuous glucose monitors (CGM), these wearable electronic devices constantly measure a person’s glucose levels and send information to a mobile phone, smartwatch or standalone receiver,* so users can see in real time how their lifestyle decisions affects their diabetes. This availability of information can empower them to make adjustments to their, medicine, diet and activity to help them spend more time in their targeted range§ and creates an opportunity for the NHS in Scotland to reduce the massive costs related to long-term diabetes complications stemming from poor glycaemic control.^{1, 2}

But getting this life-changing technology into the hands of Scots who need it most has proved challenging. Seeking to break down the barriers, the Scottish Intercollegiate Guidelines Network (SIGN) recently updated its guidelines for the first time in 15 years to recommend those who live with Type 1 diabetes get better access to healthcare technology, like Dexcom CGM.³ The new guidelines also include making single hormone closed loop or hybrid closed loop (HCL) systems available to eligible Scots living with Type 1 diabetes and offering CGM to adults, children and young people with Type 1 diabetes who meet the criteria. A HCL takes readings from a CGM and uses an algorithm to tell an insulin pump how much insulin to deliver, with little input required by the user.

For Scotland’s nearly 36,000 people who live with this chronic condition, the new guidelines put it on a similar level to its UK and Ireland counterparts and aims to improve lives.⁴ On paper, they now have the choice and chance for better outcomes by improving glycaemic control via CGM technologies.^5-7 This is important, because poor glycaemic control often leads to expensive, preventable complications later in life, such as kidney failure, retinopathy, cardiovascular diseases and neuropathy.^8,13 And these conditions come with a hefty future price tag. The NHS in Scotland now spends at least £873 million annually on diabetes – around 4.5% of its entire budget – and some health boards now cite funding constraints to reject rising demand for CGM and insulin pumps, even as the number of Scots diagnosed with all types of diabetes rises.1

Notably, using a Dexcom CGM can help reduce the number of hypoglycaemic events that require medical intervention and can help reduce the risk of developing long-term, extremely costly complications mentioned above that only increase the NHS’ financial burden.^2,9 From the day someone gets a CGM, they can optimise how they manage their diabetes and the cost of that sensor is miniscule compared with only one complication, let alone multiple future ones.⁹

Unfortunately, SIGN guidance does not fund or mandate access to CGM. It simply offers welcome recommendations that health boards and healthcare providers should follow for Scots living with Type 1 diabetes. The health boards must still decide how they adopt the guidance, which ultimately leads to a postcode lottery in terms of who gets access to the technology. One health board might cover only a finite number of CGMs and/or insulin pumps, while another might fully adopt the guidance and offer the technology to all with Type 1 who meet the criteria. If this disparity and inequality remains, Scots with diabetes will continue to struggle to access the CGM technology they desperately need and deserve. The investment from the Scottish Government for diabetes technology is £8.8 million in 2024, whilst the projected cost of the condition is set to exceed £1.5 billion in 2035.^1,11

Dexcom continues to advocate for equality and access, so every person living with Type 1 diabetes can take advantage of the new SIGN guidance and choose the technology that’s right for them. We want to see equality and access to technology for all people with Type 1 diabetes and remove any potential postcode lottery. Our goal is to raise awareness of the guidance to everyone who makes decisions about diabetes, use the toolkit to determine what technology is right for each person with diabetes, and give both healthcare providers and Scottish people living with diabetes an informed choice about their technology. Limited or restricted budgets only hinder their opportunity for access, which reduces their opportunity to optimise glycaemic control.

Dexcom has also raised awareness of technology requirements and diabetes burden with members of the Scottish National Party and extended letters in May to MSPs to emphasise that any cuts in healthcare should not come from the diabetes budget. Many have noticed the issues Scots living with Type 1 diabetes face, including Foysol Choudhury MBE MSP, who added: “Adequate, ring-fenced, and recurrent funding is vital now and, in the future, to ensure that choices of and access to this life-changing technology are not restricted”.

Helping Scots with Type 1 diabetes get the access to technologies they need and deserve is only half the battle. SIGN has begun considering new guidelines for the nearly 298,000 Scots who live with Type 2 diabetes. Their ranks have grown by 40% in the last decade to represent 5% of Scotland’s total population.¹²

Whilst Dexcom welcomes the SIGN guidance for Scots living with Type 1 diabetes, we still want to see the same urgency, access, and choices available for Scots living with Type 2 diabetes who require a CGM, particularly those using insulin who are at risk of similar long-term complications as those with Type 1 diabetes.¹³ Diabetes technology like Dexcom CGM could not only improve their physical and mental wellbeing,¹⁴ but it could also save the NHS from expensive long- and short-term costs related to preventable complications stemming from suboptimal health management. Only equal access and proper funding stand in the way of better outcomes for those with diabetes and the NHS itself.

¹^{https://www.diabetes.org.uk/investing-in-care/uk/scotland}

^{2 Roze S, et al. Long-term
Cost-Effectiveness of Dexcom G6 Real-time Continuous Glucose Monitoring Versus
Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.
Diabetes Care. 2020;43(10):2411-2417.}

^{3 Optimising glycaemic control in people with type 1
diabetes. SIGN guideline [SIGN170].}^{https://www.sign.ac.uk/our-guidelines/optimising-glycaemic-control-in-people-with-type-1-diabetes/}

⁴^{Improving the lives of people with diabetes -
gov.scot (www.gov.scot)}

^{5 Aleppo G, et al.
The Effect of Discontinuing Continuous Glucose Monitoring in Adults With Type 2
Diabetes Treated With Basal Insulin. Diabetes Care. 2021;44(12):2729-2737.}

^{6 Lind M, et al.
Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in
Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The
GOLD Randomized Clinical Trial. JAMA. 2017;317(4):379-387.}

^{7 Lind M, et al.
Sustained Intensive Treatment and Long-term Effects on HbA1c Reduction (SILVER
Study) by CGM in People With Type 1 GOLD RCT Diabetes Treated With MDI.
Diabetes Care. 2021;44(1):141-149.}

^{8 DCCT Research Group. The effect of
intensive treatment of diabetes on the development and progression of long-term
complications in insulin-dependent diabetes mellitus. N Engl J Med.
1993;329(14):977-86}

^{9 Heinemann L, et al. Real-time continuous glucose monitoring in adults
with type 1 diabetes and impaired hypoglycaemia awareness or severe
hypoglycaemia treated with multiple daily insulin injections (HypoDE): a
multicentre, randomised controlled trial. Lancet. 2018;391(10128):1367-1377}

^{10 Alva ML, et al. The impact of diabetes-related complications on
healthcare costs: new results from the UKPDS (UKPDS 84). Diabet Med.
2015;32(4):459-66.}

^{11
https://www.diabetes.org.uk/in_your_area/scotland/diabetes_in_your_area_scotland11}^{https://www.gov.scot/news/improving-the-lives-of-people-with-diabetes}

^{12 https://www.diabetes.org.uk/in_your_area/scotland/news/increase-diabetes}

^{13 UKPDS 33. Lancet. 1998;
352:837-853}

^{14 Gilbert TR, et al. Change in hemoglobin A1c and quality of life
with real-time continuous glucose monitoring use by people with insulin-treated
diabetes in the Landmark study. Diabetes Technol Ther. 2021;23(S1):S35-S39.}

^{*Display
devices sold separately and display devices vary by product. For a list of
compatible smart devices, please visit}^{www.dexcom.com/compatibility}^.

^{† For
direct to watch compatible smartphone is required to pair a new Dexcom G7
sensor with an Apple Watch. Dexcom G7 users must continuously have their
smartphone within 20 feet / 6 meters to utilize the Share/Follow features.
Apple Watch is not capable of Share/Follow.}

^{§
Discuss how to use CGM information to manage diabetes with your doctor or
diabetes team.}