Benefits of the guidance | Right Decisions

Benefits to individuals with T2DM

This guidance promotes a focus on diabetes prescribing with:

structured person-centred review of the appropriateness, efficacy, and tolerability of treatment, utilising the 7-step approach to medication reviews.
consideration and support for non-pharmaceutical management reduce medication burden.

The positive impact felt by people from their diabetes medicines is acknowledged, although meaningful patient orientated outcome data is not readily available at this stage. Individuals with T2DM also benefit from peer support, available from a variety of groups.

“I was very isolated because I had taken early retirement. I blamed myself for my diabetes and felt ashamed about it. During the pandemic, I had to shield and had little social contact. However, after contacting the Diabetes Scotland Volunteer Support Coordinator, I joined a weekly peer support Zoom call. The group was welcoming and provided a “lifeline” for me, helping me to understand diabetes better and accept my condition. The peer support has brought me company and laughter and I feel part of a community and less lonely.” Janice, diagnosed with T2DM 9 years ago (and living with other conditions).

In line with international evidence, there is a general shift away from a single disease approach to person centred care in the context of multimorbidity. It is therefore important to consider this document in the broader context of polypharmacy guidance and a holistic approach to care.

It must be accepted that guidelines are written to provide general advice and there will be some people who require a more person-centred approach to account for the complexities of multi-morbidity.

Benefits to clinicians

This guidance provides a practical toolkit and examples of high-quality approaches to prescribing in T2DM.

It includes case studies, process for review (see polypharmacy in diabetes) and links to additional resources to identify those requiring review of therapy (see using data to drive change and national therapeutic indicators).

Incorporating the guidance here in the Right Decisions Service allows easy access for clinicians to the guide, alongside resources and shared decision-making tools for use in daily practice.

People with diabetes report a range of experiences at diagnosis, highlighting the need for person-centred care and a holistic approach to management. The following quotes are from people with lived experience of T2DM in Diabetes: my information, my support ¹¹, produced by The Health and Social Care Alliance Scotland.

“The GP was very thorough. I got much help and guidance from the Practice Nurse. I get regular checks and discussions and am invited to raise questions at any time. I use ‘My Diabetes My Way’ to check on results and to check progress… I feel that I am well supported – given the current pressures on the Health Service.”

“I was told ‘you have diabetes, and it is all because of what you put in your mouth’… I left his surgery in tears and was comforted by the reception staff who were very kind… This was an awful way to be told you have any illness.”

Benefits to organisations/Health Boards

Included in this guide is a suite of data indicators that can help focus resources on areas that will benefit from review (see using data to drive change and national therapeutic indicators).

Case studies provide examples of how to implement quality improvements prescribing in diabetes, using a person-centred approach.

Previous guidance considered variation between boards with regards to prevalence, cost and improvements in HbA1c. However newer agents can affect longer term outcomes, independent of HbA1c values, and therefore comparisons using the previous parameters are inadequate to show the whole system effect.

Diabetes prescribing accounts for 11.8% of the total medicines spend in primary care in Scotland (for the year to end March 2022).

The figure below shows the relative spend on diabetes medicines and classes. Click on the image to view a larger version. Boards should reflect on the relative split of this spend, considering therapies which have less evidence and/or effectiveness.

Relative spend on diabetes medicines and classes (financial year ending March 2022)

Medication and devices used in diabetes Total spend	Section	Section spend	Class of diabetes medication and devices	Spend
£142,322,223	Insulins	£34,109,276	Short-acting insulins	£13,875,219
	Insulins	£34,109,276	Intermediate and long-acting insulins	£20,234,057
	Antidiabetic drugs	£70,157,783	Sulfonylureas	£1,970,483
			Metformin	£6,953,361
			DPP-4 inhibitors	£11,222,683
			Pioglitazones	£260,691
			GLP1 analogues	£21,115,564
			SGLT2 inhibitors	£28,607,278
			Other	£27,723
	Treatment of hypoglycaemia	£569,314	Glucose	£355,791
	Treatment of hypoglycaemia	£569,314	Glucagon	£213,523
	Diagnostic and testing	£37,485,849	Blood glucose testing strips	£10,470,113
			Interstitial fluid sensors	£25,573,648
			Other	£1,442,088

Additionally due to the complications of T2DM and co-morbidities, prescribing costs are attributable to management of hypertension, dyslipidaemia, diabetic neuropathy and others. People with diabetes have a significant impact on hospital resources (accounting for a greater proportion of beds) with more frequent emergency admissions and longer stays.¹² Additionally individuals with T2DM, accounting for age, require twice as much support as those without T2DM.

Therefore, the reduction in whole system costs of managing secondary co-morbidities and complications will outweigh any short-term increase in medicines costs.