DIABETES ACTION PLAN 2010

DIABETES ACTION PLAN 2010
QUALITY CARE FOR DIABETES IN SCOTLAND
3.11 Insulin therapy
Where we want to be:
We need to ensure that people living with diabetes can safely manage their insulin
therapy to maximise their quality of life.
Why we want to get there:
Type 1 diabetes affects 0.4 to 0.5% of the population. A 70% increase in prevalent cases
of type 1 diabetes in those aged under 15 is predicted in Europe between 2005 and
2020 3 . Despite advances in the care of people with type 1 diabetes, the condition
continues to be associated with substantial mortality and morbidity with an estimated
shortening of lifespan on average of 15 years. Rates of cardiovascular disease are
increased 3.6 fold in men and 7.7 fold in women.
Supporting those with type 1 diabetes to manage insulin from diagnosis and those with
type 2 diabetes who move to insulin therapy requires a team effort with nurses, dietitians,
doctors, pharmacists and others working in partnership with the individuals with diabetes
and their carers.
Actions we will take:
1. The SDG will prioritise the recommendations from the type 1
diabetes SLWG report as part of developing services for those with
type 1 diabetes.
2. Local insulin strategies will be reviewed for people with type 1 and 2
diabetes (responsibility: diabetes MCNs).
Healthcare Quality Dimensions: safe; timely.
3.11.1 Intensive insulin therapy for people with type 1 diabetes
Where we want to be:
Over the next three years we want to see significant progress in patient access to
intensive insulin therapy. For example, the provision of insulin pumps needs to reflect
guidance on eligibility.
Why we want to be there:
Intensive insulin therapy 4 aims to resemble as much as possible the natural pattern of
insulin release from the pancreas in order to keep blood glucose levels at near normal
rates. It is not necessarily about more insulin but about changing how insulin is taken.
There is unequivocal evidence that intensive insulin treatment reduces microvascular
complications in type 1 diabetes. For most people this involves mutiple dose injection.
3 The Lancet, Volume 373, Issue 9680, Pages 2027 - 2033, 13 June 2009 doi:10.1016/S0140-6736(09)60568-7
4 Insulin intensification might be used to describe any regimen more intensive than twice-daily mixtures, but usually
refers to either a basal/bolus multiple delivery of insulin (MDI) regimen, or to continuous subcutaneous insulin infusion
(CSII or insulin pumps), guided by self-monitoring of blood glucose (SMBG), and self-adjustment of insulin doses.
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