Hansard

I am absolutely delighted to respond to the debate on behalf of the Government, and I thank Emma Harper for lodging the motion.

Given that almost the full multidisciplinary team is in the chamber this evening, I should declare that I am a pharmacist. I hope that that ensures that we make better policy in this place.

I join Ms Harper in celebrating the fact that it is 100 years since the discovery of insulin and take the opportunity to highlight the progress that has been made in diabetes treatment and care in Scotland. Diabetes presents a significant challenge across the world, and Scotland is no exception. We know from the 2019 diabetes survey that approximately 312,000 people in Scotland have been diagnosed with diabetes and that, of that number, just under 88 per cent have type 2. The Scottish Government is committed to delivering safe and effective person-centred healthcare, treatment and support to those who are living with diabetes.

As we know, insulin is the most effective diabetes treatment. We have heard about the group of scientists in Canada, one of whom was John James Rickard Macleod, the Scottish physiologist who discovered insulin. Prior to that, diabetes was a death sentence, and those who lived with it beyond a couple of years were the exception. Insulin is still one of the greatest medical discoveries of the last century and, as members have commented, it is still in daily use.

A hundred years since the discovery of insulin, diabetes treatments continue to evolve. In the 1970s, Dr Sheila Reith, a consultant physician here in Scotland, worked with colleagues on developing the insulin pen. Like Emma Harper’s mum, Sheila had a young daughter with type 1 diabetes. Finding the daily injections with glass syringes and steel needles extremely frustrating, she set out with colleagues to make treatment easier, creating a prototype insulin pen as a simple, cheap alternative to traditional injections. After much testing, the NovoPen was released on the open market in 1988. It just shows the length of time required to develop such innovations.

We do not underestimate the impact of these discoveries on people who live with diabetes. They have not only transformed treatment and care but have opened the door for many other innovations in diabetes treatment.

Diabetes is a clinical priority for the Scottish Government. In 2014, we published the first diabetes improvement plan, which outlined eight priority areas and a focused set of actions to be overseen by the Scottish diabetes group. We recognise that the needs of people living with diabetes continue to change—indeed, that has been particularly evident during the Covid-19 pandemic—and we continue to respond to the needs of those living with diabetes and the services that provide care and support.

In February, we published a refreshed diabetes improvement plan, which builds on the significant progress that has been made in diabetes care in Scotland. We know that there is more that we can do, and the plan clearly sets out that ambition. We will track progress over the life of the plan and continue to demonstrate the improvements that are being made. Indeed, each of the commitments in the plan has an associated outcome measure and a plan for data collection, and we are committed to sharing regular updates with the diabetes community as we progress.

Emma Harper raised this very issue in her speech. We collect a huge range of data in the Scottish care information diabetes collaboration, and I should also point out that there is no single review point. Our approach is about sharing that information and learning time and time again and having a dynamic situation in which we continue to improve through quality improvement methodology. We will measure the data over time and track progress against the data in the Scottish diabetes survey. We will continue to improve care and ensure that we share the information with the wider diabetes society.

As members have pointed out, there is no doubt that the on-going development of new technologies has transformed lives. The diabetes improvement plan sets out our continued approach to increasing the provision of technologies such as insulin pumps and continuous glucose monitors. We know that these technologies reduce clinical complications such as hypoglycaemic episodes and admissions to hospital, and they also have a positive impact on quality of life by providing more flexibility in daily life and reducing anxiety. In December 2016, the First Minister announced £10 million of additional funding to support this approach, and in March we allocated another £5 million to health boards to allow them to increase access to these technologies.

In fact, the latest diabetes survey showed that insulin pump therapy in under-18s was at its highest level since data on it were first collected, at nearly 40 per cent. That is likely to be a key factor in the substantial improvements in glycosylated haemoglobin, which is a measure of the good control of diabetes that has first been seen in Scottish children over the past decade.

We know that advances in technology continue to benefit people who are living with type 1 diabetes, and we are also aware of the role of technology in type 2 diabetes care models. We know that obesity and type 2 diabetes are closely linked. Through targeted and evidence-based interventions, we can help people to manage their weight, improve their physical activity and reduce the risks of type 2 diabetes and its complications.

We published the type 2 diabetes early detection and intervention framework in 2018, along with a five-year plan to take it forward. This financial year, we will invest £7 million to enable boards to implement and enhance treatment pathways for those who are at risk of, and living with, type 2 diabetes. That is 40 per cent more than last year’s budget of £5 million—a £2 million increase. That funding will enable boards to establish and deliver targeted weight management services and community interventions, which are usually delivered in groups, and through specialist NHS services for more complex cases.

Scotland is an international exemplar in type 2 diabetes remission, due to the ground-breaking DiRECT study, which was led by scientists at Glasgow university and funded by Diabetes UK. The DiRECT study has changed the treatment paradigm for type 2 diabetes, as it shows conclusively for the first time that a dietary approach can put type 2 diabetes into remission, as Rona Mackay has described. For that reason, our funding to all health boards supports that remission service for people living with type 2 diabetes.

We know the impact that diabetes can have on people, and, if we continue to implement our diabetes improvement plan, there will be a strong focus on health inequalities. We know that both type 2 diabetes and excess weight disproportionately affect those who are living in deprivation and that women live with further disadvantage compared with men in terms of weight-related morbidities. One of the biggest challenges with type 2 diabetes is the delivery of appropriate and accessible self-management education. We know that people from areas of deprivation face more barriers to accessing that, and that will be a focus of our inequalities work.

I loved hearing about Louisa Gault. Raising the story of a young person who was diagnosed with type 1 diabetes during the pandemic, the challenges that she faces and the ambitions that she has was wonderful at reminding us of the impact that the condition has on people from a very young age. She is taking 180 extra decisions every day but is still planning to become a gymnast and a diabetes nurse. I am more than happy to do anything that I can to support her in her ambitions.

I will finish by acknowledging the significant advances in diabetes treatment and care over the past century. Insulin and the technologies that followed its discovery have been life changing for people with diabetes, and we continue to support world-class innovations in that area. The Covid-19 pandemic has undoubtedly had an impact on people with diabetes—there are new challenges for the staff, for the services and for the people who are experiencing diabetes. We will keep on learning, sharing our learning and improving the services.

We are very grateful for the continued efforts of Diabetes Scotland and to the clinical community for its unwavering commitment. By combining our efforts, we can make a real difference to those who are living with diabetes in Scotland. I look forward to continuing the constructive and productive discussions and to continuing our improvement of diabetes care in Scotland.