Diabetes care for people experiencing homelessness in the UK: insights from a national survey of frontline professionals and the development of an integrated care model

Abstract

Introduction: People experiencing homelessness (PEH) face food insecurity, unstable housing and fragmented services that render conventional diabetes pathways unworkable and amplify complications. Methods: Between January and April 2024, we conducted a nationwide, cross-sectional mixed-methods survey of front-line professionals via NHS, inclusion-health and voluntary-sector networks, analysing quantitative data (n = 104) with ANOVA, Kruskal–Wallis tests and ordinal logistic regression, and subjecting free-text responses to reflexive thematic analysis, before converging findings to develop the Integrated Holistic Diabetes Care Model for Homelessness (IHD-CMPH). Results: Respondents comprised specialist diabetes clinicians (31%), homelessness/inclusion-health staff (38%) and VCSE providers (32%); median perceived Type 1 prevalence among PEH was 20% versus 8% nationally (p < 0.001). Fifty-seven per cent rated diabetes outcomes for PEH as poor or very poor, and 66% reported more frequent amputations and vision loss. Clear organisational policies (OR 1.62, 95% CI 1.06–2.48), cross-sector collaboration (OR 2.76, 1.20–6.36) and outreach-specific training (OR 2.50, 1.50–4.17) were independently associated with better outcomes. Thematic analysis highlighted service fragmentation, inflexible appointments and insufficient homelessness-specific education. Discussion: Diabetes inequities among PEH stem chiefly from modifiable structural failures rather than patient non-adherence. The novel IHD-CMPH, anchored in outreach and mobile screening, provides a scalable framework to operationalise inclusion-health policy, improve glycaemic surveillance and avert avoidable admissions; this first national study translating multi-sector front-line evidence into a coherent policy model offers concrete levers for health-system reform and equity advancement.