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22/143 HSDR Improving services for people living with Diabetes - supporting information

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Published: 14 November 2022

Version: 1.0- November 2022

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In collaboration with Diabetes UK, two thematic areas have been identified where research is especially needed to help improve services for people with diabetes, and are the focus of this funding call from the Health and Social Care Delivery (HSDR) Programme.

Theme 1: Diabetes and mental health

Effective diabetes management is highly dependent on the individual with diabetes (often alongside a parent or carer) requiring constant self-management and regular contact with health and care services. The emotional and psychological impact of this can be overwhelming, as highlighted in Diabetes UK’s Too often missing report and research has shown that living with diabetes is associated with a variety of mental health issues, including depression, anxiety and other psychiatric disorders. This can impact people’s ability to manage their condition which has implications for their long-term health and greater use of NHS services.

The NHS Diabetes Programme recognises the importance of appropriate mental health support to make living with diabetes easier. However, a number of evidence gaps remain to inform what and how mental health support should be delivered across a range of diabetes care pathways. Following a 2019 international research workshop involving people with lived experience of diabetes, health professionals and researchers, Diabetes UK set out a series of recommendations to address unmet need related to the mental health and well-being of people living with diabetes including; supporting people to engage with their diabetes, support for significant others and learning from best practice to improve models of care and integration between diabetes and mental health services and professionals. A James Lind Alliance Priority Setting Partnership (JLA PSP) for type 2 diabetes also identified research priorities related to improving psychological support for people living with diabetes and the delivery of person-centred care.

The 2018 All Party Parliamentary Group for Diabetes (APPG) Diabetes and Mental Health report highlighted that children and young people with diabetes and their families are not getting access to the psychological support they need. Despite NICE Guidance indicating children and young people (CYP) with a diagnosis of diabetes (type 1 or type 2) and their families should be offered an ongoing integrated care package, including support from mental health professionals who have an understanding of diabetes, gaps remain in the accessibility and provision of integrated psychological care for children and young people. Recent research funded by NIHR has also revealed how CYP with diabetes can be difficult to engage with diabetes care and support services which can impact their ability to effectively self-manage.

Theme 2: Ageing well with diabetes

Over a third of people living with diabetes are over the age of 65 and are likely to face further challenges managing their diabetes and have additional care needs. Older adults with diabetes are a diverse population, with large variability in the types of challenges being faced when living with multiple conditions which may include additional physical and/or cognitive impairment that can impact on diabetes management and may require adjustments to how people manage their diabetes as they get older. There is also variation with regard to socioeconomic, cultural and ethnicity factors and the support and service needs of older people living with diabetes.

Where older people live can also impact the ability to manage diabetes effectively themselves or by others, as can a loss of independence due to other health conditions, such as for people living with type 1 diabetes and dementia. A review of care home residents with diabetes found shortfalls in all aspects of diabetes care provided in care homes, resulting in poor diabetes control, reduced quality of life and increased rates of hospitalisation and emergency department visits. The review calls for better care planning for residents with diabetes living in care homes as well as enhanced education of health care professionals (HCPs) providing care and access to specialised diabetes specific support in the community. This is likely to be equally important to those living in other settings, such as in their own home. Given the diversity of care needs older people living with diabetes face and challenges to effectively manage diabetes symptoms, individualised care that is regularly reviewed and adapted is important to continue to meet people’s needs as they get older with diabetes.

During the COVID-19 pandemic, services had to adapt to support older people living with diabetes who were particularly vulnerable to complications from COVID-19 infection. This led to a significant increase in the use of remote service delivery and an increase in inequalities in some cases for those without access to internet and limited understanding of technology. It remains unclear if and how this could potentially benefit health and social care professionals, multi-disciplinary teams and older people living with diabetes, particularly in the delivery of services and support, such as peer support, in the longer term.

Diabetes UK conducted a series of virtual workshops involving older people with lived experience of diabetes (type 1 and type 2) researchers and HCPs to identify the important research priorities to be addressed, this will inform how services can be improved and adapt to meet the needs of people with diabetes as they grow older.

Relevant NIHR studies

All applicants should ensure they do not duplicate the existing evidence base or overlap with ongoing research funded by NIHR, and other funders.

NIHR recently published an evidence collection on the challenges facing diabetes services and highlights some areas where NIHR funded research is helping to improve engagement, health outcomes and experiences of diabetes services for individuals with diabetes.

Theme 1: Diabetes and mental health

Below is an example of research currently underway across the NIHR Programmes in the area of diabetes and mental health;

Theme 2: Ageing well with diabetes