Diabetes
Overview
Around 4.1 million people in England are living with diabetes, including approximately 215,000 people in south London. Around 90% have type 2 diabetes, with a further 195,000 people estimated to be undiagnosed.
Diagnosis of type 2 diabetes is also increasing among children and young people, with recent data showing that almost 4% of under-18s with diabetes have type 2 diabetes.
Diabetes and its associated complications cost the NHS over £10 billion each year, which is around 6% of the total NHS budget. More than half of this spend is on managing complications, many of which are preventable but can be life-changing.
Since 2014, diabetes has been a priority clinical area for us. We work with partners to support the adoption, spread and evaluation of innovations that improve outcomes for people with type 1 and type 2 diabetes. Our work focuses on supporting self-management and the use of technology to improve care and reduce pressure on the health and care system.
Areas of expertise
- Supporting quality improvement (QI) at practice and primary care network level, including facilitation and clinical masterclasses
- Enabling the adoption and implementation of diabetes technologies, including Hybrid Closed Loop systems
- Supporting self-management and education innovations, such as HEAL-D Online for African and Caribbean communities
Hybrid Closed Loop implementation across south east London
The challenge
The implementation of Hybrid Closed Loop systems under NICE TA943 presented variation across the four NHS Trusts in south east London. These Trusts serve diverse populations of people with type 1 diabetes but differ in caseload size, workforce capacity and the maturity of existing care pathways.
Without a system-level approach, there was a risk of fragmented uptake and inequitable use of NHS England reimbursement funding, which particularly disadvantaged Trusts with the greatest structural barriers.
The solution
A reimbursement allocation framework was agreed in June 2025 to distribute NHS England funding (£866,000) across the four Trusts, through a combination of:
- Fixed block allocations to support NICE-eligible patients not captured in national datasets
- Proportional, activity-based allocations aligned to local type 1 diabetes populations and projected HCL starts
- A performance-based reallocation mechanism to redirect underutilised funding to higher-activity trusts where needed.
342
estimated full-year Hybrid Closed Loop starts, against a projection of 229
100%
of available NHS England reimbursement funding utilised
£77,600
reallocated to higher-activity Trusts when the reallocation mechanism was triggered
Evaluation of an enhanced appointment roll out for people living with type 2 diabetes
The challenge
Early onset type 2 diabetes (EOT2D) is a more aggressive form of type 2 diabetes that develops before the age of 40. People with EOT2D are at greater risk of earlier complications, poorer long-term outcomes, and reduced life expectancy.
Current approaches to managing EOT2D are largely based on evidence from older adults, despite younger people experiencing different challenges and risk factors. Existing healthcare services can also contribute to poorer engagement and outcomes, particularly where transition between paediatric and adult care does not fully meet the needs of young adults.
Findings
- 58% of the eligible population were invited for an enhanced appointment
- Clinical indicators improved over time, including completion of diabetes care processes and achievement of treatment targets
- People attending appointments reported improved knowledge, confidence and motivation to self-manage their diabetes
- Healthcare professionals reported increased confidence and changes to clinical practice following EDEN EOT2D training.
The solution
We supported the rollout and evaluation of an enhanced appointment scheme for people aged 18–39 with type 2 diabetes across south east London.
The enhanced 30-minute appointment, developed through the NHS England T2Day, provided a holistic, young-adult-centred approach by covering key clinical and psychosocial needs, including routine pregnancy and pre-pregnancy counselling, and facilitating timely referral to specialist, mental health, lifestyle and social support services.
We worked with south east London borough leads and primary care teams to support implementation, provide resources, and evaluate the scheme.
Get in touch
If you are looking to improve diabetes detection, education or optimisation, we can support you with quality improvement, digital tools and evaluation to improve outcomes for your population.
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