In the summer of 2022, DHI facilitated a survey to identify and determine priority themes for diabetes innovation over the next 3 years. The Diabetes Improvement Plan was used as a framework to define the highest priorities and areas for acceleration. A total of 275 people responded, consisting mostly of people with lived experience of diabetes or their families and NHS health and care professionals.   

Key themes and priorities for innovation from the survey findings included the importance of person-centred care; the need for mental health and wellbeing support for people living with diabetes; access to diabetes information and self management resources; and widespread access to diabetes technologies. Respondents offered a variety of innovation ideas, covering areas such as establishing new models of care, enhancing digital connectivity and improving people’s ability to self-manage. The full report based on the survey findings can be found here.   

The response from this survey provided the starting point for the Transforming Diabetes Care through Innovation project. DHI undertook desk research to identify current innovations and projects underway in Scotland that could impact diabetes care within the next five years and identify their level of readiness for adoption. This incorporated grey literature but did not include academic literature as this was out of scope. 

We used the recurring themes from the survey findings to build the base layer of the map. Specific insights relating to the themes were represented in thought bubbles, with the size of the bubble representing how often the insight had been mentioned. Innovation projects were then mapped onto this, revealing the areas with high levels of innovation compared to areas with little innovation. Person-focused innovations were positioned close to the centre of the map, followed by community-based innovations, then service-level innovations.   

The output of stage one was a map of the main challenges and current innovation projects within the diabetes landscape in Scotland (Figure 2). 

To validate the desk research and to understand more about the impact of the current innovation landscape DHI undertook seven interviews with health professionals and academics, and one interview with a person living with diabetes. The interviews were conducted over videoconferencing. We used a virtual whiteboard (Miro) to share the diabetes landscape map (Figure 2) to stimulate discussion and invite them to reflect on how the identified challenges align with their experience. We asked interviewees to highlight any innovation projects or opportunities that resonate with them, tell us about innovation projects not included on the map and suggest any gaps or ideas for innovation.   

The interview data were inductively analysed to identify challenges in innovating diabetes care; innovation projects not currently mapped; and opportunities for innovation not being targeted in the current diabetes innovation landscape. We added innovation projects mentioned in the interviews and refined the diabetes landscape mapping to include the interview findings (Figures 3 and 4).    

In addition, Figure 5 brings together the opportunities for innovation alongside associated ideas in the form of 'how might we...' questions, which emerged from the research activity to date and were used to prompt discussion within the in-person workshops in stage 3. 

The in-person workshops aimed to use the stage two landscape maps (see Figures 3 and 4) as a tool for dialogue to enable people living with diabetes and health professionals to discuss the priority areas and opportunities for future innovation. Four in-person workshops were conducted:   

• Workshop 1: Type 1 Diabetes, Altyre Campus, Forres, 

  (7 participants)  

• Workshop 2: Type 2 Diabetes, Altyre Campus, Forres,

  (3 participants)  

• Workshop 3: Type 1 Diabetes, The ALLIANCE, Glasgow,

  (6 participants)   

• Workshop 4: Type 2 Diabetes, The ALLIANCE, Glasgow,

   (9 participants) 

During the in-person workshops, the diabetes landscape map (Figures 3 and 4) and ‘how might we...’ questions (Figure 5) were presented on the wall and used to engage participants in a rich discussion of the challenge themes which emerged from the survey and interviews. We asked participants to discuss and add ideas for innovations that could impact Scotland in the next five years. 

We then broke into two smaller groups (where numbers permitted) to consider the challenge themes in detail. Participants were asked to reflect on which challenges represented the following types of opportunity or barrier for innovation (see Figure 6): 

A printed version of the landscape map was provided on their table to aid discussion. We gave participants some monopoly-style notes in various denominations and asked them to allocate funding to the challenges they felt were most important to tackle. The most funded challenge for that group was then the focus for the final activity, where we supported participants in completing a printed template for an Innovation Brief. The template helped participants to describe their priority challenge, with the aim of inspiring health and care professionals, academics and industry professionals to respond with ideas for innovation.   

The outputs of the workshops were thematically analysed, including the audio recording, post-it notes added to the landscape map, and the completed Innovation Briefs. As the discussion was centred around the themes presented on the diabetes innovation map, the findings added depth to our understanding of each theme, revealing more detail about the challenges for innovation, opportunities and ideas. We could see which themes were prioritised by participants and identify sub-themes emerging within the discussion across the four workshops.   

We iterated the diabetes landscape map based on these insights, which resulted in a simplified mapping of the challenges. We learned that the challenge themes were interconnected and difficult to discuss separately.    

The virtual workshop validated the findings of the in-person workshops, bringing together people living with type 1 and type 2 diabetes, health and industry professionals to discuss, challenge and deepen the insight gained. 

• Workshop 5: Type 1 and type 2 diabetes combined, hosted on Zoom, 16 participants   

Within this session, we shared the findings from work to date, including the in-person workshops. Challenge areas were clustered to create three potential conversations (1. Education, lifestyle, mental wellbeing and digital/health inequalities, 2. Flexible care pathways and 3. Technology and data). Participants were asked to vote on their preferred conversation, and break-out rooms were created in Zoom for the two conversations with the highest number of votes:   

• Break-out room 1: Education / Lifestyle / Mental Wellbeing / Digital and Health Inequalities  

• Break-out room 2: Technology and Data  

In the break-out rooms, we asked participants to highlight anything from the interim findings that resonated with them, identify gaps and share their perspectives. This resulted in a rich discussion, which deepened our understanding of the innovation challenges.   

Overall, this session was incredibly useful in mixing people with very different perspectives in a way that would not be possible in an in-person session. This included mixing health professionals (n=5), industry professionals (n=2), people living with diabetes (n=9) and one carer of a young person living with diabetes (note one participant was a diabetes industry professional who lives with type 1 diabetes so has been counted in both categories). Previous research has found that combining these groups can be challenging as tensions can be difficult to manage. However, in the virtual workshop, we found these tensions to be highly productive, highlighting a communication disconnect between services/professionals and people living with diabetes about what services are available. In addition, participants came from different regions of Scotland, highlighting variation in the resources and services available.