Open Letter: Closure of pilot services for type 1 diabetes and disordered eating (T1DE)
- Dump the Scales
- 2 hours ago
- 4 min read
24 February 2026
Rt Hon Wes Streeting MP
Secretary of State for Health and Social Care
Department of Health and Social Care
39 Victoria Street
London SW1 0EU
Dear Secretary of State
Closure of pilot services for type 1 diabetes and disordered eating (T1DE)
We are writing to express our concern that national funding for the five T1DE pilot sites in England will cease in April 2026 and to call on your support for the establishment of a national network of specialist treatment centres for T1DE.
T1DE is an extremely dangerous condition, which was previously known as “diabulimia”. People affected by T1DE typically take an inadequate amount of insulin in order to control their body weight (insulin restriction). T1DE is difficult to treat because of the complexity of the inter-relationships between eating behaviour, mood, blood glucose concentration, insulin use and weight. For this reason, it is essential that treatment is delivered by a multidisciplinary team with expertise in both eating disorders and diabetes.
In 2019, NHS England established two pilot sites to develop treatment programmes for people with T1DE and a further five sites were commissioned in 2022. Funding for the second wave pilot sites was provided for three years initially and then extended to four years. One of the first wave pilot sites has already had to close as their Integrated Care Board was not willing to continue funding the service at the end of the pilot period. Although one of the second wave sites has been able to secure funding for another 12 months, the others face the prospect of closure. This is despite the very strong recommendation of the Parliamentary Inquiry into T1DE1, led by the Rt. Hon Theresa May and Sir George Howarth, that ongoing funding should be provided to allow the pilot sites to develop into regional centres of excellence.
Insulin restriction in T1DE leads to persistently elevated blood sugar and an increased risk of both acute and chronic complications. There is an increased risk of the life-threatening complication of diabetic ketoacidosis (DKA). People with T1DE often require multiple admissions for treatment of DKA and the length of admission is increased compared to those without T1DE. In addition to DKA, people with T1DE have an increased risk of chronic complications such as chronic kidney disease, peripheral neuropathy and retinopathy.
It is estimated that around 5% of people with type 1 diabetes have severe T1DE. People who restrict their insulin due to T1DE have a mortality rate three times that of people with type 1 diabetes who do not have T1DE, as well as a reduced quality of life.
The T1DE pilots provide treatment within a multidisciplinary service, which has expertise in both eating disorders and diabetes. NHS England’s own evaluation and outcome data published in The Lancet Diabetes & Endocrinology2 have shown that this approach leads to clinically significant reductions in both the HbA1c blood test (which measures how effectively diabetes is being managed and the risk of complications) and the number and length of admissions for DKA. These effects will in time be translated into a reduction in diabetes-related treatment costs. A health economic evaluation of the first two pilots, commissioned by NHSE, suggested that mean expenditure on inpatient admissions fell by more than half and A&E costs fell by a third as a result of the pilot intervention.
A forthcoming report by the Health Services Safety Investigation Body3 is expected to recommend that NHS England/Department of Health and Social Care should develop a strategy to support the integration of services for patients with mental health and diabetes care needs, including those with T1DE.
We urge you to consider extending funding for all seven pilot sites so that they can form the nucleus of a national network of regional or supra-regional treatment centres, which can provide equitable access to treatment across the country, disseminate expertise and continue to develop effective interventions. Non-specialist eating disorders and diabetes services are not able to treat T1DE effectively and closure of the pilot services will leave people with T1DE unable to access treatment, both now and in the future. Closure will also lead to loss of the world-leading knowledge, skill and expertise that has been accumulated by the pilot sites and make it very difficult for specialists to continue doing research in this area.
1Type 1 Diabetes and Disordered Eating: Parliamentary Inquiry (2024) Chaired by Sir George Howarth MP and the Rt. Hon. Theresa May MP
2Ismail, K et al (2024) An integrated diabetes and mental health intervention for people with type 1 diabetes and severe disordered eating: a prospective proof-of-concept cohort study The Lancet Diabetes & Endocrinology, Volume 12, Issue 7, 442 - 444
3 Health Services Safety Investigation Body (2026) Insulin: supporting safe self-administration for patients in the community with a mental health problem
To view a copy of the original letter including the signatures please see the below attachment.