Delivering joined-up care for people with type 2 diabetes: rationale, challenges and examples

Abstract

Approximately 3.8 million people in the UK have type 2 diabetes mellitus (T2DM) and are, as a consequence, at risk of developing micro- and macrovascular disease. The rapid increase in T2DM prevalence places a considerable burden on secondary healthcare. New classes of glucose-lowering medications (sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide 1 receptor agonists) can improve macrovascular outcomes for people with T2DM; however, these options have brought another layer of complexity to managing this disease. In combination, these factors are calling into question the suitability of the primary–secondary care healthcare model and prompting healthcare professionals to investigate alternative solutions. Bringing high-quality care to people with diabetes and meeting their complex needs requires integrated multidisciplinary expertise in the community. However, setting up such systems within the National Health Service (NHS) can be challenging. The complexities of the internal market (in NHS England), lack of training and expertise, inadequate information technology systems and resistance to change on a systemic and individual level all constitute significant barriers to establishing easy-to-access integrated care. When barriers are removed, successful integrated care systems can be established, which improve care for people with diabetes and alleviate pressure on secondary care centres.