The Diabetes Improvement Plan has established eight priority areas to improve outcomes for people living with diabetes in Scotland. The Scottish Government, through the Scottish Diabetes Group, and NHS boards has committed to implementing a programme of work to improve the quality of care and outcomes within these identified priority areas.

One such priority is type 1 diabetes, which includes commitments to supporting early optimisation of glycaemic control, appropriate and timely access to technologies to improve glycaemic control and quality of life, and supporting improvements in care and outcomes for children and for adults living with type 1 diabetes.

To support this priority, SIGN has developed this toolkit for healthcare professionals which provides recommendations on optimising glycaemic control in people with type 1 diabetes adapted from published guidelines that contain relevant information. The recommendations have been identified using systematic literature searches, approved using formal consensus methods and adapted, where required, to align with the clinical context in NHSScotland. The evidence which supports these recommendations is available in the source guidelines which are linked throughout the toolkit.

Further information has been added by the development group whose membership includes multidisciplinary clinical expertise, third sector representation and people with lived experience. This information is intended to support implementation of the recommendations and includes links and resources which users can access as required.

The toolkit is aimed at 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, pharmacists and staff from social care teams, but may also be of interest to people living with type 1 diabetes, their carers and families. A separate decision support toolkit is planned for people with type 1 diabetes.

Dr Moray Nairn - Programme Manager, SIGN.  moray.nairn@nhs.scot

Jamie Savage - Information Scientist, RDS team, Healthcare Improvement Scotland. jamie.savage@nhs.scot 

Chair of development group:

Professor Brian Kennon, Consultant Diabetologist & National Lead for Diabetes, Queen Elizabeth University Hospital, Glasgow. brian.kennon@ggc.scot.nhs.uk 

Senior responsible owner 

Dr Roberta James, SIGN Programme Lead.

Authorship

The content in this toolkit has been developed by a multidisciplinary development group which includes healthcare professionals and people with lived experience. 

Review and approval

The content of this toolkit was reviewed by the SIGN editorial team (February 2024) and signed off by the SIGN Programme Lead (March 2024).

The content will be considered for update 3 years from publication. Any minor updates brought to the  attention will be dealt with on an "as needed" basis.

Updates will be reviewed and approved in line with the SIGN editorial governance process.

Content updates on the Right Decisions platform will be carried out by the SIGN team, with support from the Right Decision Service team when required.

RDS automated alerts when review is due will be sent to the Programme Manager responsible for the project, and the generic SIGN inbox, sign@sign.ac.uk.

Six months prior to the deadline for update (ie 3 years after publication) a scoping review will be conducted to identify new evidence that may require the recommendations in the toolkit be be updated. The results of the scoping review will be circulated to the original development group for comment, and to identify any other new areas for inclusion. Their responses, along with the review results, are submitted to the Evidence Directorate Work Programme Committee for consideration for update or revalidation.

Content will be updated using the development processes outlined in the SIGN methodology manual, SIGN 50: a guideline developer's handbook.

Amendments will be developed by a multidisciplinary group of clinicians and people with lived experience, subject to peer review, and signed off by the SIGN editorial team.

Copyright

Copyright information for the source of content within this app/website is shown below.

Elsevier has granted SIGN permission to reuse and adapt content from the following publications:

American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan—2022 Update. Endocr Pract. 2022;28(10):923-1049.

American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract. 2021 Jun;27(6):505-537.

The American Diabetes Association has granted SIGN permission to reuse and adapt content from the following publications:

American Diabetes Association Professional Practice Committee. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Supplement_1):S46-59.

American Diabetes Association Professional Practice Committee. 5. Facilitating Behavior Change and Well-being to Improve Health Outcomes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Suppl 1):S60-S82.

American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Supplement_1):S97-112. 

American Diabetes Association Professional Practice Committee. 14. Children and Adolescents: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Supplement_1):S208-31.

The National Institute for Health and Care Excellence (NICE) has granted SIGN license to adapt, reproduce and distribute content from the following publications:

© NICE (2015) Type 1 diabetes in adults: diagnosis and management. Available from www.nice.org.uk/guidance/ng17 All rights reserved. Subject to Notice of rights.

© NICE (2015) Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Available from www.nice.org.uk/guidance/ng18 All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. It is subject to regular review and updating and may be withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

The University of Wisconsin Population Health Institute County Health Rankings & Roadmaps have granted SIGN permission to adapt and reuse the following publications:

The University of Wisconsin Population Health Institute. County Health Rankings model (2014). www.countyhealthrankings.org

Booske B, Athens J, Kindig D, Remington P (2010). Different perspectives for assigning weights to wider determinants of health [online]. Madison, US: Population Health Institute, University of Wisconsin. Available at: www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf (accessed on 27 Nov 2023).

The Joslin Diabetes Center, Inc. has granted SIGN permission to reproduce the Diabetes Eating Problem Survey – Revised tool for the purposes of clincial care for a period of 5 years. Full details on the tool can be found in:

Markowitz JT, Butler DA, Volkening LK, Antisdel JE, Anderson BJ, Laffel LM. Brief screening tool for disordered eating in diabetes: Internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes. Diabetes Care 2010;33:495-500.

Requesting permission to reuse SIGN materials

Copyright of this toolkit is retained by SIGN except for the materials noted above which are used under licence. 

This review is licensed under the Creative Commons Attribution-Noncommercial-NoDerivatives 4.0 International Licence.  This allows for the copy and redistribution of SIGN toolkits as long as SIGN is fully acknowledged and given credit. The material must not be remixed, transformed or built upon in any way. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc-nd/4.0/.

Please cite the toolkit as: Scottish Intercollegiate Guidelines Network (SIGN). Optimising glycaemic control in people with type 1 diabetes (SIGN 170). Edinburgh: SIGN; 2024. [cited dd mmm yyyy]. Available from URL: http://www.sign.ac.uk.

Users wishing to use reproduce or republish SIGN material for commercial purposes must seek prior approval for reproduction in any medium by completing the form at https://www.sign.ac.uk/assets/sign_copyright_request.pdf.  Applicants for such permission should be aware that:

• SIGN resources do not endorse specific products.
• Reproduction of SIGN material must be verbatim.
• Within marketing material there must be a clear separation between any SIGN material and product specific information or marketing.
• SIGN does not endorse in any way derivative or excerpted materials based on these guidelines, and it cannot be held liable for the content or use of any such adapted products.
• The use of the SIGN name or logo for the purposes of advertising or implied endorsement of any derived product or service is strictly forbidden.

Content has been checked for accessibility in line with the relevant RDS standard operating procedure.

Submitting feedback or complaints

The email for the SIGN Programme Manager is available in the "Key contacts" section above and can be used to highlight any feedback or complaints.

Any messages received through the RDS Feedback form will also be forwarded to the Programme Manager.

Monitoring and acting on feedback or complaints

The Programme Manager will address the feedback. If it requires significant amendments, it will be referred to the SIGN Senior Management Team for consideration for the SIGN work programme.

The toolkit was user tested by the group of clinicians and people with lived experience in the guideline development group throughout its development.

The toolkit was available for open consultation in October to November 2023. Responders were asked to comment on the ease of navigation, look and content of the toolkit. All comments were addressed and responses published on the SIGN website.

Terms and conditions

The global terms and conditions which apply to all Right Decision Service toolkits can be viewed here. This includes the aims, background, scope, governance and ownership of the Service. Accessibility and browser compatibliity statements are provided by Tactuum Ltd, the company which provides the underpinning technology for the Right Decisions platform.

Disclaimer
The content within this app/website is based on current recommendations and best practice, however it is intended to be applied alongside sound clinical judgement.  As such, Healthcare Improvement Scotland is not responsible or liable for any diagnosis or management decision made on the basis of the information provided via this app/website.

Use of this app within patient care settings should always be in accordance with local policies and guidance with regard to clinical practice and mobile device usage.

Healthcare Improvement Scotland is not responsible for the content of any external websites listed, nor do they endorse any commercial product or service mentioned or advised on in any of these websites.

All use of this resource is subject to Scots law and the jurisdiction of the Scottish courts and is subject to this disclaimer.  Any views given on the app/website are not necessarily those of Healthcare Improvement Scotland or anyone connected with us.