Diabetes care has transformed – but a postcode lottery threatens to undermine it
This is part of the Pulse Partners series. This article has been paid for by Roche Diagnostics, with editorial input by Pulse. The opinions in this article do not necessarily reflect the views of Pulse.
Professor Naresh Kanumilli
As GPs, we are witnessing something remarkable in diabetes care. Continuous glucose monitoring (CGM), hybrid closed-loop systems and increasingly sophisticated digital platforms, including the use of AI, are transforming what is possible for people living with diabetes.
These technologies are doing far more than generating data. They improve glycaemic management, reduce hypoglycaemia and help prevent the cardiovascular, renal and microvascular complications that continue to drive avoidable morbidity across the NHS.
Yet there is an uncomfortable truth at the heart of this success story. Innovation only matters if people with diabetes can access it. And right now, access to some of the most effective advances in diabetes care depends less on clinical need than on geography. That should concern every GP.
The scale of variation is difficult to ignore. Recent analyses have demonstrated more than a forty-fold difference in CGM prescribing rates across England, ranging from just 0.26 prescriptions per 1,000 population in some areas to 11.59 per 1,000 in others.
Most troubling of all, the burden falls disproportionately on those who already experience poorer health outcomes. Recent evidence suggests that ethnicity and socioeconomic deprivation explain almost half of the variation in CGM prescribing among people with type 1 diabetes and more than three-quarters of the variation among those with type 2 diabetes. In other words, some of the strongest determinants of access are not clinical, but social.
This implementation gap creates a stark disconnect between high-level policy – which promises preventative, closer-to-home care – and the frustrating reality on the ground.
A warning is already emerging elsewhere in the UK. In Scotland, concerns have been raised by the Royal College of Physicians and patient groups that responsibility for funding advanced diabetes technology including hybrid closed loop is increasingly shifting towards local Health Boards operating under significant financial pressure. The lesson is a familiar one. When national clinical ambitions become dependent on local budgets, variation becomes inevitable and equity is often the first casualty.
There is also a misconception that advanced diabetes technology increases the burden on primary care or belongs solely within specialist services.
In reality, the opposite is often true. People with diabetes who are better equipped to understand and manage their condition are less likely to require crisis-driven interventions and are better able to participate in their own care. The greatest burden frequently comes not from the technology itself, but from the bureaucracy surrounding access to it.
GPs should not have to spend valuable clinical time navigating inconsistent local criteria or advocating repeatedly for interventions already supported by national evidence. A system that makes innovation difficult to access creates frustration for clinicians and people with diabetes alike.
As GPs, we sit at the interface between national ambition and local reality. We are often the first to see where implementation succeeds and where it fails. We see the consequences of fragmented commissioning, inconsistent funding and variable access long before they appear in policy reports. That gives us not only a clinical responsibility, but a leadership responsibility: to identify unwarranted variation and advocate for systems that deliver care according to need rather than geography.
The debate, therefore, is no longer whether diabetes technology works. The evidence is compelling, and the direction of travel is clear. The real question is whether we are prepared to help build a system capable of delivering innovation equitably.
If the government is serious about prevention, reducing health inequalities and moving care closer to home, access to diabetes technology cannot remain contingent on postcode. The technology exists. The evidence exists. The guidelines exist. The next frontier in diabetes care is equity.
