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Fit for the future or stuck in the past?

Type 1 diabetes screening is testing the government’s health ambitions.

By Ahmed Moussa

Credit – DC Studios/Shutterstock

Anyone with Type 1 Diabetes (T1D) will remember when they first learned they had the condition. Many will have felt shocked. Genetics can play a part, but it can strike anyone at any time in their lives.1 2

A late diagnosis can be life-changing. There are many examples of people presenting at the hospital for an emergency diagnosis triggered by a severe lack of insulin, resulting in diabetic ketoacidosis (DKA), a potentially life-threatening diabetes complication.3 Across England and Wales alone, nearly a quarter of all new T1D cases had a DKA diagnosis.4

Troublingly, misdiagnosis is common. A retrospective study in 2019 suggested that up to 40 per cent of adults over 30 in England who had T1D are initially misdiagnosed with type 2 diabetes.5 This, combined with unequal access and uptake of life-changing technologies between ethnicities and socioeconomic groups (including insulin pumps and continuous glucose monitors),6 7 means a postcode lottery in diabetes care persists.8

But it doesn’t have to be this way. A blood test, which identifies risk before symptoms appear, can help patients prepare for disease progression and avoid late diagnosis leading to complications like DKA.9 10 11

Other European countries, such as Italy, have begun to implement identification and care for people in the early stages of type 1. However, despite people already being diagnosed through research studies, the UK currently lacks NHS-funded and coordinated care pathways which involve nationwide screening for early-stage T1D, meaning people are potentially experiencing preventable DKA.

The government has a golden opportunity to put this right. In Fit for the Future, the ten-year health plan for the NHS, ministers express enthusiasm about three interlinking shifts: leveraging technology; moving from reactive treatment to preventive healthcare; and transferring beyond hospitals to community-based services.

The design and implementation of comprehensive pre-symptomatic care pathways and targeted testing for those at high risk for T1D meet these criteria and deliver a win-win scenario for patients and taxpayers. T1D hospital costs are six times higher than for those without the condition and require 10 times more emergency care. By reducing DKA incidents, there’s a possibility of reducing the pressure on emergency care from T1D, enabling access for UK patients to clinical trials.12

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This is a powerful illustration of how the government could deliver a virtuous circle when it comes to improving the nation’s health.

In this scenario, prioritising prevention and access to new technologies, treatments and medicines creates a healthier society. This supports a more sustainable NHS and drives national economic growth. A growing economy and a health system which promotes innovation make the UK a prime destination for global life sciences investment, fuelling the next wave of medical breakthroughs that will help British patients.

The alternative is the familiar vicious cycle in which rising health burdens drain the economy, stifling investment and promoting inequality. This would leave the UK trailing Europe, the US and China and let one of our growth-driving industries wither on the vine.

The reality is already knocking on our door. Foreign investment in the UK’s life sciences sector declined by a staggering 58 per cent between 2021 and 2023.13 14

But it is the impact this vicious circle has on patient access to new medicines in the UK that is most concerning. Currently, the UK spends considerably less than most comparator countries on medicines – just 9 per cent compared with a typical 15-18 per cent spent by our European counterparts.15 This is amplified by the context that the UK’s evaluation models for determining patient access to new drugs and treatments – set by NICE – haven’t kept pace with inflation since 2014.

Inevitably, this has consequences. Consider this one, salient fact: UK patients on the NHS can access only 48 per cent of new medicines, compared with 85 per cent in the US.16

If this is to change, we must ensure the systems that evaluate and approve new medicines are as advanced as the science that powers them. Only then can early detection pathways support access to new medicines.

This would see the government updating the threshold that NICE sets for its Quality Adjusted Life Year assessments, which estimate the health benefits of new medicines, from the current maximum.

It would be a move that aligns them with inflation, annual growth rates and the cost of developing medicines over the last 11 years.

In tandem, reducing the current levies set by the voluntary scheme for branded medicines pricing, access and growth (VPAG), currently set at 23 per cent and forecast to rise to 28 per cent by next year, would see more medicines reach UK patients.

With this approach, the government would clearly signal its commitment to the UK’s life sciences sector, which it could underscore by setting out an ambitious target to make it the fastest-growing market in the G7. This is what Fit for the Future should look like: a future where our health system identifies and manages T1D risk before symptoms develop, an example of a preventative healthcare model that reduces emergency care and sets the UK as a more competitive market for clinical trials. This is about more than the future of life sciences or even the NHS. It is a test of our national ambition and our appetite for implementing real change. We can’t afford to fail it.

  1. Diabetes UK. What causes Type 1 Diabetes? Available at: https://www.diabetes.org.uk/about-diabetes/type-1-diabetes/causes. [Last accessed: October 2025] ↩︎
  2. Insel RA, et al. (2015). Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care; 38(10):1964-1974 ↩︎
  3. Diabetes UK. What is DKA (diabetic ketoacidosis)? Available at: https://www.diabetes.org.uk/about-diabetes/looking-after-diabetes/complications/diabetic-ketoacidosis. [Last accessed: October 2025] ↩︎
  4. Royal College of Paediatrics and Child Health. (2024). National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23. Available at: https://www.rcpch.ac.uk/sites/default/files/2024-04/npda_2022-23_report_on_care_and_outcomes.pdf. [Last accessed: October 2025]. ↩︎
  5. Thomas, N.J., Lynam, A.L., Hill, A.V. et al. (2019). Type 1 diabetes defined by severe insulin deficiency occurs after 30 years of age and is commonly treated as type 2 diabetes. Diabetologia; 62: 1167–1172. Available at: https://doi.org/10.1007/s00125-019-4863-8. [Last accessed: October 2025] ↩︎
  6. Royal College of Paediatrics and Child Health. (2021). National Paediatric Diabetes Audit (NPDA) annual reports. 2021. rcpch.ac.uk/sites/default/files/2022-04/National NPDA report 2020-21 Summary Report.pdf. [Last accessed: October 2025] ↩︎
  7. Talbo MK, et al. (2022). Associations Between Socioeconomic Status and Patient Experience With Type 1 Diabetes Management and Complications: Cross-sectional Analysis of a Cohort From Québec, Canada. Canadian Journal of Diabetes;46(6):569-577 ↩︎
  8. Dlugatch R, Rankin D, Evans M, Oliver N, Ng SM, Lawton J. (2025) Understanding inequities in access to diabetes technologies in children and young people with type 1 diabetes: Qualitative study of healthcare professionals’ perspectives and views. Diabet Med;42(4) ↩︎
  9. Insel RA, et al. (2015). Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care; 38(10):1964-1974 ↩︎
  10. Ziegler AG, et al. (2020). Yield of a Public Health Screening of Children for Islet Autoantibodies in Bavaria, Germany. JAMA;323(4):339-351 ↩︎
  11. Mathew TK, Zubair M, Tadi P. (2023). Blood Glucose Monitoring. StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK555976/. [Last accessed: October 2025]. ↩︎
  12. Stedman M, Lunt M, Davies M, et al. (2020). Cost of hospital treatment of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) compared to the nondiabetes population: a detailed economic evaluation. BMJ Open; 10:e033231 ↩︎
  13. UK government. (2023). Life sciences competitiveness indicators 2023. Available at: https://www.gov.uk/government/publications/life-sciences-sector-data-2023/life-sciences-competitiveness-indicators-2023#section-5-investment-environment. [Last accessed: October 2025]. ↩︎
  14. UK government. (2024). Life sciences competitiveness indicators 2024: summary. Available at: https://www.gov.uk/government/publications/life-sciences-sector-data-2024/life-sciences-competitiveness-indicators-2024-summary. [Last accessed: October 2025 ↩︎
  15. Association of the British Pharmaceutical Industry (ABPI). (2025). Spending Review – NHS must invest more in proven innovations, says ABPI. Available at: https://www.abpi.org.uk/media/news/2025/june/spending-review-nhs-must-invest-more-in-proven-innovations-says-abpi/. [Last accessed: October 2025 ↩︎
  16. PhRMA. (2023). Global Access to New Medicines Report. Available at: https://cdn.aglty.io/phrma/global/resources/import/pdfs/2023-04-20%20PhRMA%20Global%20Access%20to%20New%20Medicines%20Report%20FINAL-1.pdf. [Last accessed: October 2025] ↩︎

This article has been written and funded by Sanofi and reviewed by Sanofi for compliance with the ABPI Code of Practice.

MAT-XU-2503571 (v2.0) October 2025

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