Continuing diabetes care in Spain

Key rules

• Referral: Your family doctor must refer you to hospital endocrinology; only emergencies skip this step.
• CGM funding: Each region sets its own CGM criteria, so check your destination region before you commit to a place.
• Pump continuation: If you already use a pump, you can generally continue after hospital assessment, but the brand may be limited to regional tender models.
• Eye screening: Retinal photography is arranged by primary care or your endocrinology team, usually every 1 to 2 years.

Start with your family doctor

Your way into public diabetes care is your médico de familia (family doctor). Register at your health centre first. Then ask for a referral to hospital endocrinology. Without a referral you can only go to emergency care (urgencias). Some regions also let you reach gynaecology or ophthalmology through primary care.

The hospital or regional health service sends your appointment by letter, SMS, app or phone. You can also collect it at your health centre. Waits run from weeks to several months, depending on region and specialty. Once a specialist follows you, they give you your review appointments.

Private care and mutuas such as MUFACE use different routes. This page covers the public system for adults. Children are seen by paediatric endocrinology.

Who looks after you

• Type 2 diabetes: your family doctor and practice nurse manage it in primary care.
• Type 1 diabetes, complex or poorly controlled cases, pregnancy, and pump or CGM users: a hospital endocrinology unit follows you. These units usually work with a diabetes nurse educator (educador en diabetes). Visits are typically every 3 to 6 months.

If complications appear, you are referred on to ophthalmology, nephrology or podiatry.

Education and routine monitoring

Ask your practice nurse or the hospital diabetes nurse educator for structured diabetes education. You will need it for a pump in any case.

Expect these checks:

• HbA1c blood test, typically every 3 to 6 months.
• Once a year: kidney function, urine albumin, lipids, feet and eyes.
• Cardiovascular risk control.

How often visits happen and which services exist differ by region and hospital.

Eye screening (retinopathy)

Screening is usually done by retinography, a digital photo of the back of your eye. It is taken in primary care or through a tele-ophthalmology programme, and doctors read it remotely. Primary care or your endocrinology team arranges it.

• Type 1 usually starts about five years after diagnosis. If you already passed that point, ask for a photo soon after you arrive.
• Type 2 starts at diagnosis.
• With no retinopathy and good control, the interval is typically every 2 years. With risk factors it is every year, and sooner if disease is found.
• Abnormal findings go to hospital ophthalmology.

CGM: funding depends on the region

Each autonomous community's health service decides CGM (continuous glucose monitoring) funding, inside a national framework that has widened over time. Most regions fund it for type 1 diabetes. Criteria differ: some require poor control or hypoglycaemia, some cover all type 1 patients, and some include pregnancy, children or selected insulin-treated type 2 patients. Flash systems (FreeStyle Libre) and real-time CGM are covered differently.

The hospital endocrinology unit usually prescribes it. Supply comes through a pharmacy or the hospital. Before you choose where to live, look up your region's published CGM criteria, or ask the hospital endocrinology unit whether you qualify.

Insulin pumps

If you already use a pump, you can generally continue after an assessment at the hospital. Expect these limits:

• The brand may be restricted to models in the regional tender.
• The unit may ask you to meet local criteria.
• You may have to switch device when your warranty ends.
• Supplies such as infusion sets and reservoirs come through the hospital or regional contract, or through a pharmacy, depending on the region.

Bring your device details and recent HbA1c results to the first visit.

If you want a new pump, the hospital unit evaluates you and proposes it. The hospital or regional health service authorises it. Public funding is mainly for type 1 diabetes when intensive injections have not achieved control. Typical reasons are:

• persistently high HbA1c despite good adherence
• frequent or severe hypoglycaemia, or not noticing lows
• marked glucose swings
• pregnancy or planning one
• children, in some regions

You must have completed diabetes education and be ready to monitor often.

The decision, timeline, checklist and FAQ below help you plan the steps.

Choosing between options

How should you set up CGM and pump access for your diabetes care?

• Continue on your existing pump: You already use a pump: the hospital assesses you, and you may need to use a model from the regional contract.

• Ask for a new pump assessment: Injections have not given control, usually with type 1 diabetes, and you have completed diabetes education.

Your region's health service decides CGM funding, and the hospital endocrinology unit prescribes CGM and starts or manages pumps after a referral from your family doctor.

Timeline and deadlines

• Check your HbA1c blood test (average blood sugar) with your family doctor or specialist: every 3 to 6 months

• Attend hospital endocrinology visits if you have type 1 diabetes, a complex case, are pregnant or use a pump or CGM: every 3 to 6 months

• Have your kidney function, urine albumin, lipids, feet and eyes checked: once a year

Checklist

• Look out for your appointment by letter, SMS, app or phone, or collect it at your health centre.

• Arrange your HbA1c test every 3 to 6 months and the yearly checks of kidneys, lipids, feet and eyes.

• Check your destination region's published CGM criteria, or ask the hospital endocrinology unit whether you qualify.

• Ask primary care or your endocrinology team to book retinal photography (retinography) for diabetic eye screening.

Frequently asked questions

Can I keep using my insulin pump when I arrive in Spain?

Yes, you can generally keep your pump after a hospital assessment, but the brand may be limited to models in the regional contract. The unit may also ask you to meet local criteria or switch device when your warranty ends. Ask your family doctor for a referral to endocrinology first.

Who decides whether I get a publicly funded insulin pump?

A hospital endocrinology unit with pump experience evaluates you and proposes the pump, and the hospital or regional health service authorises it. Pumps are mainly for type 1 diabetes when injections have not given control.

What reasons usually qualify someone for a publicly funded pump?

Typical reasons are persistently high HbA1c despite good adherence, frequent or severe hypoglycaemia, not feeling lows coming on, and large glucose swings. Pregnancy or planning one also counts, and some regions include children. Details are set by each region.

When do I start eye screening if I have type 1 diabetes?

With type 1 diabetes, screening usually starts about five years after diagnosis, while type 2 starts at diagnosis. After that it is usually every 2 years if your eyes are healthy and control is good, and every year if you have risk factors.