Members' Business: Emma Harper: 100 years of Insulin - 1 September 2021
The next item of business is a members’ business debate, in the name of Emma Harper, on 100 years of insulin. The debate will be concluded without any question being put. That the Parliament celebrates 100 years since the discovery of insulin; recognises that this is one of the greatest medical breakthroughs in history, which went on to save millions of lives around the world; further recognises that, following the discovery of insulin, Scotland played its part in developing the insulin pen, which has made it much easier for people to administer the lifesaving drug, and that Professor Sheila Reith, a type 1 diabetic, doctor and mother, led this work in Scotland; notes the further advances in the treatment and management of diabetes, including through digital technology; understands that there are more than 312,000 people living with diabetes in Scotland; further notes that the inequalities attached to diabetes are stark, with rates of type 2 diabetes 80% higher in the most deprived communities, and that people living in poverty are more than twice as likely to develop life-changing complications; understands that there is work to do to support further advancements in diabetes care and treatment, and supports Diabetes Scotland’s vision of a world where diabetes can do no harm. I welcome the opportunity to bring the 100 years of insulin debate to the chamber this evening, and I thank all colleagues who have supported it. I thank Diabetes Scotland for its briefing ahead of the debate and for the amazing work that it does to continually support people living with diabetes, particularly during the Covid pandemic. If exposed to Covid, people with diabetes are at higher risk of severe illness, hospitalisation and even death. Figures released
early in the pandemic showed that 20 per cent of Covid-related deaths were of people with diabetes. Insulin is life saving for all people who are diagnosed with type 1 diabetes. Insulin is a hormone excreted by the pancreas directly into the blood stream so that glucose can move from the blood circulation into the cells of our body. Insulin is vital for metabolism and survival. Type 1 diabetes occurs when the beta cells in the pancreas fail and the pancreas is unable to produce any insulin at all. I note for the record that I am one of those people with type 1 diabetes. My twae sisters and my mum also have type 1, but that is a whole other story.
This year, it is 100 years since the discovery of insulin, which is one of the most significant advances in the history of medicine. Insulin was discovered in April 1921. Frederick Banting, Charles Best and Scotsman John James Rickard Macleod initially isolated insulin from the pancreatic islets of dogs, then James Collip assisted with purified cattle insulin so that it could be administered to human patients with type 1. Before 1921, it was extremely rare for people with type 1 diabetes to live for more than a year or two. In 1921, injection was the only delivery method for insulin, and that is still the case in 2021. When my wee sister Buffy was diagnosed at nine years old in 1977, my mum reused a small glass syringe and steel needles by sterilising them in boiling water. It worked, but it was not very practical. By the time I was diagnosed in 1979, plastic syringes, which were supposed to
be for one-time use, were available. They caused less pain and were easier to use. Scotland has played its part in supporting the development of technology to treat diabetes. As well as Scotsman John Macleod, my motion mentions Dr Sheila Reith, who was a consultant at the Southern General hospital in Glasgow. Her daughter had type
1, and Dr Reith had the idea for a more portable insulin cartridge, pen-like delivery device. Dr Reith worked with colleague Dr Ireland in the late 1970s, and the Penject device, as it was called then, was subsequently created. Insulin pen delivery devices have evolved and are still used today as part of multidose therapy for people with type 1 and type 2 diabetes.
One hundred years on from the discovery of insulin, where are we now? Insulin is still the safest method of reducing blood glucose levels, and things have improved significantly. Advances in technology, such as insulin pumps, closed-loop systems, which are basically an external pancreas, and digital blood glucose monitoring devices—buttons in our arms—are helping people to live better with fewer complications. As members can see on my phone’s screen, green is good for me today. My apologies for the prop, Presiding Officer. Diabetes complications are a huge cost burden on the national health service in Scotland, but advances, such as the pumps, are so good that such complications can be reduced. In Scotland, 312,000 people have diabetes, and the rate of diabetes is 80 per cent higher in the most deprived communities. Type 2 diabetes is a health inequality issue.
It is estimated that the Scottish NHS spends £1 billion on diabetes—10 per cent of its budget. Therefore, avoiding complications will benefit people with diabetes and also our NHS. Managing type 1 diabetes is a complex issue. A 2014 Stanford University study found that people living with type 1 diabetes make an extra 180 decisions each day compared with someone who is not diabetic—that is one extra decision every five minutes while awake. Those decisions include finding out what their glucose level is now; working out how many carbs are on their plate and whether those are fast or slow carbs; whether they should eat now or wait for two hours; whether they might go hypoglycaemic when driving home; whether they should programme their pump to deliver insulin slowly or quickly; and whether they have replacement supplies in their car, at home or in their office in case the cannula pump gets pulled out. Having diabetes is not a piece of cake; it is complicated. We have amazing support from our NHS staff. Our endocrinologists, dietitians, specialist nurses and healthcare support workers are fantastic in supporting patients, and I thank them for their work.
There is a lot in the Scottish Government’s refresh of the diabetes improvement plan, which I welcome, including continued collaboration with the third sector and stakeholders. I bring to the minister’s attention the work of the brothers Anthony and Ian Whittington and their fixing dad, fixing families and fixing us programmes. They helped their dad to lose 5 stone in weight. He reversed his type 2 diabetes by engaging in the fixing dad social prescribing programme, which Ian and Anthony created. That worked. Perhaps fixing
dad could help to inform actions to include in the diabetes refresh strategy as it evolves. I agree with Diabetes Scotland that everyone should have free and equal access to what they need to live healthy lives. In a recent survey of more than 1,000 people living with diabetes in Scotland, one in five said that they were having difficulty getting key diabetes technology devices. I therefore welcome the fact that the diabetes plan mentions access to diabetes technology in priority 2 and the commitment to review access to diabetes technology. Can the minister provide information on the timescales for that review and when the review of the data will be available? That will no doubt help to inform future care approaches. Could guidance be produced for all Scottish health boards to ensure that all who could benefit from diabetes tech can access it free of charge? Now is the time to ensure that everyone can access what they need. I would be grateful if the minister committed to that in her closing speech.
There are many issues to address and speak about, many of which I could not cover. I look forward to hearing colleagues’ contributions on the 100-year anniversary of insulin. I thank Emma Harper for bringing to the Parliament such a noteworthy motion, which is an acknowledgement and celebration of the 100-year anniversary of the discovery of insulin.
In November 1920, a group of highly talented and determined individuals came together at the University of Toronto in Canada to help one another in the pursuit of a single purpose: to understand the cause of type 1 diabetes. Understanding the cause meant having a chance of treating the condition and drastically improving the lives of millions of people across the world. The discovery of insulin and its rapid clinical deployment effectively transformed type 1 diabetes from a fatal diagnosis into a medically manageable chronic condition. It became the first life-saving treatment for diabetes. Scotland has a rich history and tradition of innovation, and Scots have always been at the forefront of the advancement of humanity. Scotland’s legacy with the development of the insulin pen is no exception. Dr Sheila Reith, Dr John Ireland and John Paton—all medical
specialists in the greater Glasgow area—began their journey to improve the lives of people with diabetes roughly 60 years after the first pioneers from the University of Toronto discovered insulin. The invention and subsequent refinement of the insulin pen has been such a success that the vast majority of insulin used worldwide is now administered through the use of an insulin pen. That increases the accuracy of doses, reduces pain and, most important, promotes ease of use. Insulin pens have had the effect of allowing those with diabetes to more constantly manage their condition and reduce serious complications related to the disease. However, it is not nearly enough to refine ways of managing diabetes. There is still much work to be done in reducing the number of people in Scotland who have diabetes.
The prevalence of type 2 diabetes is still a significant health challenge and a leading cause of ill health in Scotland. The latest data show us that an all-time high of roughly 312,000 individuals in Scotland now live with diabetes, and 6,400 people died from complications related to diabetes in 2019 alone. In addition to those figures, it has been estimated that roughly 10 per cent of those with diabetes remain undiagnosed.
The Scottish Government has taken positive steps towards tackling those issues, and it has made significant progress since introducing the previous diabetes improvement plan in 2014. With ever-increasing access to technologies to help adults and children, as well as prevention campaigns such as the think, check, act scheme, and £42 million-worth of investment in a type 2 diabetes prevention framework, the Scottish Government is committed to making Scotland a healthier country. However, we can do more, and that progress must continue. The centenary of the discovery of
insulin represents an important opportunity to improve prevention, treatment and care for all people in Scotland who are affected by diabetes. The diabetes improvement plan for 2021 to 2026 reflects the current challenges facing people who are living with diabetes. It is an important step forward that builds on all the progress to date and supports the continued improvements in diabetes care. However, those improvements will be meaningful only if there is fair and equal access for everyone in Scotland. That is why I am so pleased to see equality of access identified as one of the eight priority areas in the improvement plan.
Many factors can impact on and disadvantage diabetes care and outcomes for people, and it is vital that those are addressed. Back in 2018, I met a number of patients living with type 1 diabetes in my constituency and campaigned alongside them to have the FreeStyle Libre system approved for use in Fife, after it received Scotland-wide approval in 2017. The system has been shown to offer life-changing improvements for people with diabetes who use insulin intensively, thereby reducing the complications of diabetes, including blindness, amputation and renal failure, and helping them to live healthier and fuller lives. I will never forget the strength of feeling and the overwhelming emotional response from local people living with diabetes to the news of NHS Fife’s supplementary approval for use of the FreeStyle Libre system. I once again thank Emma Harper for bringing the debate to the chamber, and acknowledge its celebration of the 100th anniversary of the discovery of insulin. I hope that the future of medical innovation surrounding the care and treatment of diabetes will be just as groundbreaking as previous innovations, and that it will bring about a world in which diabetes can do no harm.
I thank Emma Harper for bringing the debate to the chamber. I declare an interest as a practising doctor, as noted in my entry in the register of members’ interests. We have heard about insulin and its invention from other members, so instead of going back to that, I will answer a simple question: what is insulin, and why is it important? Just behind the stomach sits an organ called the pancreas. In a healthy person, it makes insulin in response to blood sugar levels. The insulin drops the levels of blood glucose and drives it into the cells, giving them energy. People
who have type 1 diabetes unfortunately cannot produce insulin because their own immune system is attacking and destroying the cells that produce insulin in the pancreas. Type 1 diabetes is an autoimmune condition, and there is nothing that patients can do about contracting it. We have incredible new insulin delivery methods that can improve people’s lives, but not everyone has access to them. I urge the Scottish Government to look at that, as was mentioned earlier. However, type 1 diabetes accounts for less than 10 per cent of the story. Type 2 diabetes presents a huge and growing concern in Scotland and around the world. In Scotland, the number of new cases
has been growing year on year, with the majority among those aged over 40. Diabetes is a huge problem for us in the national health service. It accounts for 10 per cent of the entire NHS budget. Of that money, 80 per cent—8 per cent of the entire NHS budget—is spent on dealing with complications of diabetes such as loss of sight, loss of feeling, heart attacks and strokes. Diabetes also affects our black and Asian communities far more, with large numbers of people in those communities going completely undiagnosed. We need to prevent people from contracting type 2 diabetes, so I have been working hard to get people active. I visited the Woodland Trust in Dumbarton, which provides an incredible area for
our families to explore. I also visited the RSPB’s site close to Bearsden, where people with anxiety can be referred; it also provides wonderful areas for exploration and even picnics. I am also a paths champion for Ramblers to encourage the upkeep of paths so that we can enjoy the countryside. By doing that, I hope to promote simple activity and mindfulness to get Scotland moving, especially with such amazing nature on our doorstep. I have met representatives from supermarkets to promote healthy eating and healthy, rather than unhealthy, foods. What Sandesh Gulhane describes in relation to Ramblers and outdoor access is often referred to as social prescribing. Does he think that there are challenges in
how we market that language? Some folk do not know that outdoor access might be social prescribing. Absolutely—social prescribing is a very important part of general practitioners’ armoury. It is about getting patients to understand the importance of eating well or being able to exercise. People think that exercise is going to the gym and sweating and feeling horrible at the
end of that session, but that is not what we mean when we encourage them to exercise. We are talking about them just going for a walk and enjoying it. NHS Lothian can use social prescribing to refer patients to get that exercise. The profession can take that forward, and I hope that the Scottish Government supports what I am doing to help prevent people from contracting type 2 diabetes.
The invention of insulin by Drs Macleod and Banting has, quite simply, saved millions of lives. It is a testament to how amazing the discovery is that, 100 years on, it is still the mainstay of treatment and is, rightly, being lauded in the Parliament as a medical miracle. However, let us not pat ourselves on the back. Let us try to reduce and prevent new cases of type 2 diabetes. That would be a legacy that Drs Macleod and Banting would be proud of. I thank Emma Harper for helping to bring the debate to the chamber and I recognise how close the issue is to her heart. I also thank Diabetes Scotland for its work and the informative briefing.
We often forget how far, scientifically, we have come in comparison to 100 years ago. We have already heard that, 100 years ago, diabetics did not have many ways to treat their condition and did not lead long lives, because there was little medicine to provide for them at that time. Thankfully, we have seen a remarkable leap in technology and medicine to help people live with diabetes. We have already heard the statistic tonight that 312,000 people in Scotland have diabetes, which equates to one in 20 people in Scotland, so it is likely that all members know people whose lives are affected by it. I have close family and friends who are diabetic and rely on insulin in order to live their daily lives. My dad has been diabetic for many years, so I have seen at first hand the changes that have come as he has lived with his condition, particularly technological advances in monitoring his blood sugars and administering insulin. I have
also seen the universal power of insulin transcending borders. Once, on a family holiday to Rome, my dad forgot his insulin; I am not sure whether Emma Harper has ever had that experience. The Italian medics advised us to go to the Vatican pharmacy to see whether they had any of the insulin that is prescribed in the UK. Alas, the pharmacy did not have any, but
the medical staff assured is that Italian insulin works just as well and duly prescribed him some. Louisa Gault from Port Glasgow is one of my younger constituents; she is eight and was diagnosed as a type 1 diabetic during lockdown, having been rushed to accident and emergency, thanks to the quick action of her GP and practice nurse, after her mum and dad, Jan and Joe, noticed the four Ts—toilet, tired, thinner and thirsty. During an extremely challenging time for the NHS, the family has embarked on a rollercoaster journey in which insulin has played a huge part. Louisa is now insulin dependent and her intake of carbohydrates is closely monitored.
At the age of eight, she already makes many of the decisions that Emma Harper referred to. Louisa’s family members have described all that as a huge learning curve, but they have commended the support of our NHS, particularly at the Royal hospital for children in Glasgow and Inverclyde Royal hospital, as well as charities, such as the Juvenile Diabetes Research Foundation. At a young age, Louisa has demonstrated great courage and a desire to show that she will not let diabetes hold her back. She is a budding gymnast and tells her mum and dad that she wants to be a diabetic nurse one day, so I hope that the Minister for Public Health, Women’s Health and Sport will take note to reserve a future training place for her. The reason why I mention Louisa tonight is to reflect on how far we have come in the past 100 years. Life has been changed and been dramatically improved by developments in medicine, such as insulin. Just think where we could be when Louisa is an adult,
and indeed beyond that, with another 100 years of research and development. However, we must ensure that everyone who needs access to advances has it. We know that constant glucose monitors, for example, allow a greater level of freedom for people with diabetes by allowing them to understand their bodies and what works for them. However, as has been alluded to, access to those technologies is not always equal, due to variations in what health boards can provide.
I know that members will agree with me that we must do better to bring a more equal level of quality care to those living with diabetes. The Government has an opportunity to issue strong guidance to health boards to ensure that high-tech monitoring equipment is available to all patients who require it. Diabetes Scotland has called for a greater public health approach to be taken to help our children to understand our foods and make healthier choices to reduce the risk of developing type 2 diabetes. We need far more work in that field to help us to develop as a healthy society. I hope that the minister will say something about that in her closing remarks. With actions such as those that I have talked about, we can help people to have healthier lives and make Scotland a happier place, and we can create a world where children such as Louisa can thrive.
I am pleased to speak in this members’ business debate on 100 years of insulin, and I thank my friend and colleague Emma Harper for bringing it to the chamber. Emma is passionate about education on and the care and treatment of diabetes, and no better person could have introduced the debate. Thanks to a helpful briefing from Diabetes Scotland, we have learned that more than 312,000 people in Scotland live with diabetes and that the condition is creating one of the fastest-growing and potentially most devastating health crises of our time. The number of people who are diagnosed has more than doubled in the past 20 years. That is the bad news. The better news is that, with advancements in technology from blood glucose monitors to insulin pumps and looping, there is a range of options that can support someone with taking insulin, checking blood sugars and managing their condition.
Thanks to 100 years of insulin, for people living with type 1 diabetes, it is no longer the death sentence that it was prior to 1923, when Scottish doctor John Macleod and his Canadian colleague Frederick Banting jointly received a Nobel prize for the discovery of insulin. Prior to the discovery, it was exceptional for people with type 1 diabetes to live for more than a year or two. Despite the great medical and technological advances that have been made since then, sadly, people living with diabetes are being hit hard by Covid. Almost 20 per cent of
coronavirus-related deaths in Scottish hospitals are of people with diabetes. The figure was released at the start of the pandemic, so it might be a bit higher now. As we have heard, the condition has also exacerbated inequality, with rates of diabetes 80 per cent higher in our most deprived communities. In addition, people living in poverty are more than twice as likely to develop life-changing complications, such as heart problems and strokes. In Diabetes Scotland’s recent survey of more than 1,000 people living with diabetes,
one in five said that they are having difficulty accessing key diabetes technology. Therefore, while we celebrate 100 years of insulin, we must look to the improvements that can be made for all people who are living with diabetes now, wherever they live and whatever their background. I was shocked to learn just how many people are living with type 2 diabetes—according to the briefing, the figure is 90 per cent of those with diabetes. I was almost as shocked as I was when I was diagnosed with the condition two years ago. Fortunately, after a short spell on medication and a change in diet and lifestyle, I managed to reverse the condition in three months. It is preventable and can be reversed. The care and advice that I received—including diagnosis at my general practitioner and national health service support services for eye care and dietary advice—were exemplary.
Of course, no one could have predicted lockdown lifestyle in early 2020, and now many of us find that a lot of repair work is needed to reduce our sugar levels. However, it can be done, and I am determined to do it again. We must recognise that structural factors make it difficult, and sometimes impossible, for people to make healthy choices. The Government must continue to address the social determinants of health inequality and the reality of the damage that poverty can do.
I have family members living with type 1 diabetes, and I hear from them how relentless and overwhelming managing it can feel. Emma Harper articulately outlined those difficulties. Diabetics must be supported at every level. Thankfully, much support can be found online from Diabetes Scotland, NHS Inform and information websites by way of dietary advice, including some delicious healthy eating recipes, and exercise and lifestyle advice.
In conclusion, we must ensure the best diabetes care for everyone, no matter their postcode or background. Of course we know that new technologies can change the lives of type 1 diabetes sufferers. Indeed, I feel fortunate that I can keep my condition at bay without the need for insulin, which so many people rely on. However, the onus is on me.
Type 2 diabetes is preventable, so let us stem the tide of this mushrooming condition by making healthy food and lifestyle information available for everyone. We can save the NHS a fortune and take control of our own wellbeing. I thank Emma Harper for bringing the debate to the Parliament.
I was really interested to see the motion on the agenda and to hear Emma’s contribution this evening, knowing about the expertise that she brings to the subject from her role as a nurse and, as I have learned, as a patient. I also have some experience of working with patients who use insulin. I spent many years working as a dietitian in the NHS and, in my early career, I covered diabetic clinics along with a specialist diabetic nurse and other members of a multidisciplinary team. Diabetes is a condition that patients manage and live with, and I learned so much about the adaptability, resilience and humour of people following a diagnosis of such a life-changing condition. The experience also gave me a lifelong admiration for the dedication of NHS staff and how they build relationships with patients who face having to overcome enormous hurdles during many years of treatment. I give a big shout out to all those staff, from the porters
to the caterers, the medical and clerical staff, and particularly to my colleagues among the allied health professionals, which is a group of incredibly dedicated health service workers. As the motion points out, insulin is one of the greatest medical breakthroughs in history. It changed the lives of many millions of people by changing the diagnosis of type 1 diabetes from a death sentence to a life worth living. Before insulin, it would have been unusual for someone to live past two years after diagnosis, so 100 years of insulin is definitely worth celebrating.
There are so many elements that members could bring to tonight’s debate, including diabetes diagnosis, diabetes treatment, and diabetes as a life. However, in such a short debate, we only have time to raise one or two issues. In the short time I have, I want to talk a little about tackling the inequalities around diabetes care, particularly the link between inequality and diabetes outcomes. I thank Diabetes Scotland for its briefing, which reminded me of the realities of living with diabetes, particularly for someone who comes from a more deprived background.
Although insulin means that type 1 diabetes is no longer necessarily a death sentence, type 2 diabetes is still on the increase, and the day-to-day complications in heart health, eye care and foot care mean that it is an incredibly hard condition to live with. It is important to acknowledge that living with diabetes can be relentless, and managing it can feel overwhelming. Managing lifelong conditions can take its toll on individuals and their families, so it is important that we, as parliamentarians, acknowledge our role in fighting for services and for every possible advance to be made, and made accessible to all. The poorest people in Scotland are more than twice as likely to have diabetes at any age than the average person, and once they have the condition, those who live in the most deprived homes are twice as likely to develop complications through diabetes than those who are in less deprived areas. Those stark figures show the reality for so many. Where someone is born and where they live unfairly lays out their future, particularly when it comes to health.
Tackling the root causes of health inequalities has to be key right here in the Scottish Parliament. We need to tackle inequality in income, access to suitable housing, and access to healthy food. We need to acknowledge the role that we all have in the Parliament and we need policies that transfer power and wealth. The great achievements in diabetes care can continue, but we have to work hard in this place of power to ensure that the factors are in place to give economic justice to all. The briefing from Diabetes Scotland gives us the stark figures. Rates of diabetes are 80 per
cent higher in the most deprived communities in Scotland. That is unacceptable and we must act. Let us celebrate 100 years of insulin, and let that remind us that things can change. With the correct structural changes in society, we can head towards Diabetes Scotland’s vision of a world in which diabetes can do no harm.
I, too, thank Emma Harper for bringing the debate to the Parliament. As the motion states, “there are more than 312,000 people living with diabetes in Scotland”, a number that has more than doubled in the past 20 years. My younger cousin was diagnosed with type 1 diabetes at a similar age to Paul O’Kane’s constituent, and I very much recognise that my aunt had to take many of the same decisions that Emma Harper has talked about this evening, and they were not popular with a cousin who had three non-diabetic cousins. We need a greater focus on prevention if we are to reduce the number of people being diagnosed with diabetes. About 90 per cent of people with diabetes have type 2, and reducing levels of obesity will help to prevent further diagnoses. Tackling the obesogenic environment will be central to achieving that, and I look forward to the Government introducing legislation to restrict the use of promotions on food and drink that are high in fat, sugar and salt.
We must address the health inequalities that continue to plague Scotland. Obesity rates are highest among those from the most deprived communities, and no one should be subject to food insecurities in 21st century Scotland, but it is still the case that food banks are being used. According to a report published by the UK Parliament Select Committee on Food, Poverty, Health and Environment, the inability to “access a healthy, balanced diet” places people at greater risk of developing obesity, as they may be “both overnourished with calories and at the same time undernourished in relation to key nutrients.” As I have mentioned, our food environment is saturated with low-cost, unhealthy foods.
The select committee found that “healthy food has been shown to be three times more expensive, calorie for calorie, than less healthy alternatives.” We cannot expect people to eat healthier diets until we address the fundamental issues of poverty and access to affordable, healthy food. We also need to address unequal access to care, as has been highlighted tonight. Many complications arising from diabetes are preventable, as they arise mainly through poor glycaemic control—or when blood sugar levels are too high. In the past few years, great advancements have been made in the development of technologies that help people to maintain good glycaemic control.
However, those technologies are not available to all, and there is a postcode lottery in Scotland. Constituents have written to me about being unable to access that technology, which monitors glucose levels day and night and can make a substantial difference to how people with diabetes manage their condition. Some people with diabetes have had to pay for those technologies themselves, but not everyone is able to do so. Diabetes Scotland is calling for clear guidance to health boards that technology such as glucose monitors, insulin pumps and looping should be made available to all those who need them, and I urge the cabinet secretary to give serious consideration to that. I would be grateful if the minister had anything to say on the matter. Covid-19 has highlighted the health inequalities that continue to plague Scotland, and we cannot afford their widening further. Health and wealth are inextricably linked, and the poorest people in the UK are 2.5 times more likely to have diabetes at any age than the average person.
People with diabetes in deprived areas or from minority ethnic backgrounds are less likely to have key health checks, putting them at increased risk of developing complications. We need to ensure that everyone has access to the resources that they need to manage their condition and prevent complications, with dedicated information campaigns that raise awareness of the symptoms and encourage people to get checked. Having a long-term health condition can undoubtedly take a huge toll on mental health, and having diabetes makes people more vulnerable to developing a serious illness if they catch Covid-19. The pandemic may have been a particularly distressing time for people with diabetes. Some people with diabetes will have been shielding, which may have put them at greater risk of isolation and loneliness, and others may have had appointments postponed, all of which can have a serious impact on mental health. People with diabetes are more likely to experience anxiety and depression, and research conducted by Diabetes UK found that seven out of 10 people with diabetes feel overwhelmed by their condition and are not getting the emotional support that they need.
It is vital that we do not view diabetes simply as a physical condition in isolation from mental health. We need to talk more openly about how long-term conditions can affect mental health, ensuring that emotional support is integrated into physical healthcare. There have been incredible advancements in diabetes care and treatment since the discovery of insulin, and we must now do more work to ensure that everyone can benefit from them. If we give people the tools, resources and support that they need to manage their diabetes, we can substantially improve their quality of life. 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.
2021-09-06 20:12
