Diabetes care is amid exciting times – albeit it sounds like something odd to say with the NHS in the turmoil it is now. Yet planning, strategic choices made – along with a strong focus on evidence base along with data to guide has taken us into a place where one can look to the future with a degree of optimism albeit tempered with acknowledgement of present pressures – financial and workforce.

Let’s take type 2 diabetes care – a strong focus on prevention – not only from the national team – but also in localities has been a key feature of many clinical areas – whether it be via national programmes such as the NDPP or local variations to them. A similar scenario exists in reversal or remission of type 2 diabetes – although debates can become parochial as to the perfect diet – whether it be a low calorie one or a low carb one – there is no dispute that as a health system, the will from many are there to tackle this issue with energy – albeit it would do all well to remember that it isn't necessarily the intervention that is key – but more its sustainability due to its tolerance and in present times, the issue of affordability.

Type 2 diabetes treatment is going through a revolution with the advent of evidence base around end organ outcomes relevant to SGLT2-inhibitors or GLP_1 analogues – and the challenge is more about its adoption into clinical practice. NICE have updated their guidance though debates remain as regards whether it is modern enough – a difficult challenge for NICE as it balances its role of being a body who reviews evidence yet in the context of cost effectiveness.

Safety within hospitals continue to be a focus – with work being done on variation, mapping and monitoring of systems and inpatient diabetes teams. Similarly, foot care focus continues to follow the trend of investment in previous years – with a continued focus on data, improvement, and presence of specialist teams in all hospitals.

The focus in recent times has understandably been on the pandemic and its aftermath – or indeed its continued presence. Its impact on care process has not been insignificant and with data showing care process completion association with mortality, a lot of focus continues to be on the recovery process. Primary care are to be lauded for the efforts being put in – and as a system, we look forward to continuing to support them.

Type 1 diabetes care has transformed with the explosion of technology – reflected in national audits – yet work ahead remains on improved choice of devices – as well as the lure of the holy grail of Closed loops – perhaps the next best thing to a cure at this point of time. Yet issues with access based on your deprivation and ethnicity continue thus focus in this area, along with investment has been a positive step forward. In the same arena of type 1 Diabetes – gradual expansion of eating disorder services post the pilot sites and evidence have also been a step forward.

Other areas of work involve focus on genetic diabetes, local teams – identification of relevant patients – and thus treatment modification based on their genetic background. Focus has also been on areas such as transitional care – a perennial Achilles heel in diabetes care – an area of investment – backed by a data driven accountability to measure success as they evolve. Throw in work around young type 2 diabetes, better care irrespective of deprivation or ethnicity – and improved ways of getting user feedback – and we indeed have a full plate.

In parallel, the GIRFT process has evolved – using Model Hospital data to look at variations in the three key areas of inpatient diabetes care, foot care and type 1 diabetes – all focus in general as mentioned earlier. This goes hand in hand with further data driven process – and deep dives into each region looking into markers of all relevant areas – and pushing for improvement.

It would be amiss not to mention the work and progress made in the area of Language Matters and how much it continues to be a focus of the national team – with strong feedback from those living with diabetes about its relevance in their day to day lives. Further work is ongoing in the arena of peer support to see how we can connect people further.

Thus, in summary? Exciting times – with many plans – yet with a focus on less centralisation and encouraging more of local leadership to drive things forward as times progress. The success or failure in a healthcare system depends – at the end of the day – on outcomes. With dropping amputations, admissions and cardiovascular events improved access for technology, and ambitious national programmes which others look and learn from – we are making progress – yet as ever, there is much to do too. A moment to thank the thousands of colleagues across diabetes care who continue to deliver in extraordinary times – and especially primary care – without whose support any of these outcomes could be possible.

The Diabetes Professional Care conference to be held on November 16 and 17 gives us an opportunity to thank all – as well as listen to ideas or indeed constructive criticism.

We, as a team, hope to see you there – and thank you again.