Members' Business: Emma Harper: 100 years of Insulin - 1 September 2021

Members' Business: Emma Harper: 100 years of Insulin - 1 September 2021

Show Video

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

Show Video

Other news