Turning Policy into Practice: A Call to Action on Diabetes

Reflections from Dr Sandesh Gulhane MSP following the Parliamentarians for Diabetes Global Network Conference, Malta

There is no single policy that will fix diabetes. No miracle intervention. No quick win. But there is something powerful enough to drive change: shared purpose, honesty, and determination. That was the central message of Dr Sandesh Gulhane’s intervention at the Parliamentarians for Diabetes Global Network Conference in Malta. Practice without policy is limited. Lived experience keeps both honest.

Two Rooms. One Mission.

Dr Gulhane spoke with rare clarity about living in two professional worlds. On some days, he sits in a general practice consultation room, listening to fatigue, fear, resilience, and quiet courage. On others, he stands in Parliament, debating legislation, budgets, and systems. The settings are different, but the purpose is the same: human wellbeing.

In the clinic, the question is personal and immediate: How do I live with this condition? In Parliament, it becomes systemic: How do we build a system that helps people live well in the first place? The statistics debated in legislatures are not abstract. They represent real people, often the very patients seen the day before. Individuals do not stop needing care when policymakers step into the chamber.

A Story That Represents Millions

Dr Gulhane shared the story of a patient, Mikey, a man in his early fifties balancing work, family responsibilities, stress, convenience food, and exhaustion. Over time, this accumulated into type 2 diabetes, hypertension, high cholesterol, and early liver disease. Mikey said quietly, “Doctor, I feel I did this to myself. I failed.” The response captured the essence of the global diabetes crisis: This is not failure. This is life. This is the world we live in. Food environments have changed faster than human biology. Highly processed food is cheap and engineered for overconsumption. Advertising is relentless. Time to cook is scarce. Exhaustion competes with physical activity. This is not simply about individual choice. It is about systems. Diabetes, in this framing, is not only a medical condition. It is also a policy outcome.

Why Policy Must Enable, Not Only Punish

Personal responsibility matters, but willpower alone cannot succeed in environments that make unhealthy choices easy and healthy choices difficult. Policy determines the conditions in which responsibility is realistic. Too often, governments rely primarily on punitive approaches such as taxes, restrictions, and bans. Dr Gulhane argued for balance and incentives. When the United Kingdom introduced a tiered levy on sugary drinks, manufacturers reduced sugar content. Choice remained, but population health improved. When incentives align with public health goals, behaviour changes without stigma or moral judgement. Parliamentarians must shape environments that support healthy lives, not merely issue warnings.

One Global Problem. Unequal Realities.

Diabetes manifests differently across countries and communities. In some settings, diagnosis itself is a challenge. In others, insulin is priced beyond reach. Conflict zones strain fragile health systems. Indigenous and marginalised populations experience persistent structural inequities. There is no universal solution. However, shared foundations are essential everywhere:

• Ending stigma, particularly in workplaces
• Supporting early diagnosis
• Ensuring access to essential medicines
• Investing in population level education

A cure may emerge one day. Until then, systems must prevent, treat, and empower people today.

Technology Exists. Access Does Not.

From the discovery of insulin to modern digital platforms, innovation is not the barrier. Scale and equity are. Automated insulin delivery systems are transformative. Patients describe sleeping through the night again. Families describe peace of mind. The cost of denying these technologies is higher than the cost of providing them, measured in complications, hospital admissions, and lost productivity. Access should never depend on geography, chance, or personal finances.

Type 2 Diabetes: Policy Written in Blood Sugar

The fastest growth in type 2 diabetes is seen in low income communities, areas with limited access to fresh food, populations under chronic stress, and among Black and South Asian communities. This pattern is not random. It reflects policy decisions made over decades. As Dr Gulhane noted, we must stop asking people to swim against a current that society itself created.

New Drugs Are Tools, Not Solutions

New metabolic and weight management medications are highly effective, and access matters. However, medication alone is not enough. Without nutrition support, physical activity, adequate sleep, stress management, and community connection, their long term impact is limited. Medical innovation must be supported by environments that enable sustained health.

Pay Earlier, Not Later

Diabetes already consumes a significant share of health budgets, largely due to preventable complications. Health systems are already paying, but at the most expensive stage. Prevention is not cheaper because it is simplistic. It is cheaper because it works.

A Clear Call to Action

Drawing on his experience as both clinician and legislator, Dr Gulhane outlined a practical agenda:

1. Guarantee equitable access to advanced diabetes technology
2. Fund prevention with the same seriousness as treatment
3. Translate research into community benefit
4. Change environments, not just individual behaviour
5. Teach health in schools with the same priority as literacy
6. Promote joyful and achievable physical activity
7. Invest in mental health as a core component of diabetes care
8. Engage with the food industry while holding it accountable

And above all, never blame individuals for conditions that society helped create.

The Lesson That Matters Most

When Mikey returned for follow up, his clinical indicators had improved and medications had been reduced. More importantly, his outlook had changed. He explained simply, “I realised I wasn’t doing this alone.” That insight, Dr Gulhane reminded the audience, captures the task ahead. No person living with diabetes should feel alone. No clinician should feel alone. No policymaker should feel alone. There is no single policy that will solve diabetes. Health must be integrated across every sector. This is a shared responsibility, and a shared opportunity to act.