The great escape

Diabetes care: The technology has transformed. Now access must catch up

Few areas of healthcare demonstrate the transformative potential of HealthTech quite as clearly as diabetes. Over the past 50 years, advances in diagnostics, monitoring and insulin delivery have fundamentally changed how people manage the condition.

What once required repeated finger-prick tests, handwritten records and careful calculations can increasingly be managed through connected devices that monitor glucose levels continuously and, in some cases, automatically adjust insulin delivery.

For people living with diabetes, these developments offer something far more valuable than technological convenience. They provide greater freedom, confidence and control over a condition that requires attention every day.

For the NHS, they offer opportunities to prevent complications, reduce avoidable hospital attendances and make better use of already stretched clinical resources.

Yet, despite this progress, access to diabetes technology remains inconsistent across the country. While the UK has established care pathways and has made important commitments to funding innovation, the availability of approved technology does not necessarily translate into access for patients.

Regional differences in funding, workforce capacity and implementation mean that people who could benefit from the same technology do not always have the same opportunity to receive it.

This is increasingly the challenge facing our industry. We have technologies capable of transforming diabetes care. The question is whether the healthcare system can deliver them consistently, sustainably and equitably.

From finger-prick testing to the artificial pancreas

The evolution of diabetes technology is a remarkable example of how successive innovations can fundamentally change the experience of living with a long-term condition.

The introduction of home blood-glucose monitoring in the 1980s, followed by its wider adoption during the 1980s and 1990s, marked an important turning point in diabetes care. For the first time, people could routinely monitor their own glucose levels and make more informed decisions about their diet, lifestyle and treatment.
Over subsequent decades, digital devices made it possible to store readings and identify trends, giving patients and clinicians a more complete picture of how glucose levels changed throughout the day.

Continuous glucose monitoring represented another significant advance. Small wearable sensors, connected to smartphones and other devices, can now collect glucose data throughout the day and night, reducing reliance on repeated finger-prick testing and providing a much clearer picture of glucose fluctuations.

More recently, hybrid closed-loop systems have taken this a step further by connecting continuous glucose monitors with insulin pumps.

Sometimes described as an artificial pancreas, these systems use algorithms to automatically adjust insulin delivery in response to changing glucose levels, although users still need to manage certain aspects of their treatment.

For eligible people with type 1 diabetes, the benefits can be substantial. Better glucose management can reduce the risk of hypoglycaemia and other complications, while giving individuals greater flexibility in their daily lives.

Fewer severe episodes also mean fewer potentially avoidable emergency attendances, creating benefits for patients and the wider healthcare system.

This progress illustrates something important about HealthTech innovation.
 Transformative improvements do not always come from a single breakthrough. They frequently emerge through successive developments in diagnostics, medical devices, digital technology and medicines, brought together to address a clinical need.

Diabetes is a particularly powerful example of what can be achieved when these different areas of innovation work together.

Innovation is only valuable if patients can access it

The challenge is that technological progress has not been matched by equally consistent adoption across the NHS.

Hybrid closed-loop systems provide a useful example. National funding has helped support their introduction in England, following positive NICE guidance and considerable work by clinical leaders, including Professor Partha Kar OBE. This represents an important commitment to making innovative diabetes technology available to eligible patients.

However, national funding does not automatically guarantee local access. Uptake varies between regions, and the ability of individual services to introduce these technologies depends on considerably more than the availability of devices.

Patients need training, ongoing support and access to healthcare professionals who understand the technology. Clinical teams need the capacity to identify eligible patients, introduce new systems and provide assistance when problems arise.

Industry already plays an important role in supporting this process through education, technical assistance and collaboration with NHS services.

Where these arrangements are well established, technology can be integrated more effectively into routine care.

Where they are not, patients may experience delays or miss out altogether.

This creates a particularly concerning situation for people living in less advantaged communities. If access depends on the capacity and resources of individual services, there is a risk that innovation reinforces existing health inequalities, rather than helping to address them.

There is also the question of long-term funding. The current national funding arrangements for hybrid closed-loop technology are time-limited, raising important questions about how Integrated Care Boards will support existing users and newly eligible patients in the future.

For people who have already experienced the benefits of these systems, continuity of access matters enormously. Introducing a technology that transforms someone’s ability to manage his or her condition, only to leave uncertainty over its future availability, is not a sustainable approach to care.

These challenges are not unique to diabetes. Across HealthTech, we repeatedly encounter situations in which regulatory approval, positive clinical guidance and demonstrated patient benefit are not enough to secure consistent adoption.

This is why the conversation needs to move beyond the technology itself and towards the funding, infrastructure and service arrangements required to make it work.

Making better use of the data we already collect

There is another significant opportunity that has yet to be fully realised: the enormous amount of information generated by modern diabetes technologies.

Continuous glucose monitors and connected insulin-delivery systems can provide detailed information about an individual’s condition. However, different manufacturers operate different digital platforms, and interoperability between these systems remains a challenge.

For healthcare professionals managing large groups of patients, this fragmentation can make it difficult to bring information together and identify those who may need additional support.

Improving interoperability could fundamentally change how diabetes services operate.

Rather than relying primarily on scheduled appointments and retrospective assessments, clinicians could potentially use integrated data to identify patients whose glucose management is deteriorating and intervene before more serious complications develop.

It could also support more effective remote monitoring, allowing people to manage their condition at home while ensuring that healthcare professionals retain appropriate oversight.

This is particularly relevant to the NHS’s ambition to shift towards prevention and deliver more care closer to home. Diabetes technology already generates much of the information needed to support more proactive management. The challenge is making that information accessible and useful across different services and systems.

The opportunity extends beyond people already diagnosed with diabetes. Earlier identification of people at risk of developing type 2 diabetes, combined with appropriate lifestyle interventions and ongoing monitoring, could help delay or prevent the progression of the condition.

However, technology must be supported by appropriate clinical pathways, evidence and professional oversight. Collecting more data is not an end in itself. Its value lies in enabling better decisions, earlier intervention and improved outcomes.

A shared responsibility for industry and the NHS

The HealthTech industry has an important role in addressing these challenges, but progress will require collaboration rather than individual companies working in isolation.

Through ABHI’s Diabetes Group, we are bringing companies together to identify common barriers to procurement, funding and implementation. While companies continue to compete and drive improvements in their technologies, they share a common interest in ensuring that effective innovations reach the patients who need them.

That means working with national policymakers, NHS leaders, clinicians, healthcare professionals and commissioners to identify where implementation is falling short and what practical changes are required.

It also means recognising that successful adoption involves more than purchasing equipment. Training, clinical capacity, technical support and long-term funding all need to be considered alongside the initial cost of a device.

There is considerable potential for further innovation. Improvements in sensor technology could eventually make monitoring less intrusive and allow devices to remain in place for longer. Advances in connected systems may further reduce the daily burden of managing diabetes.

Longer-term developments in regenerative medicine could open entirely new approaches to treatment.

These are exciting possibilities, but they should not distract us from the opportunity immediately in front of us.

We already have technologies that can make a meaningful difference to people’s lives. We have established clinical pathways, positive guidance and examples of successful implementation. What we need now is a more consistent approach to translating those advantages into everyday care.

Ultimately, the measure of progress in diabetes care should not simply be how sophisticated our technology becomes. It should be whether people living with diabetes can access the right support and treatment, regardless of their postcode or socioeconomic circumstances.

The evolution of diabetes technology demonstrates what our industry can achieve through sustained innovation. The next challenge is ensuring that the benefits of that innovation are available to everyone who needs them. 

Ravi Chana is Executive Director, Diagnostics at ABHI