Diabetes care for adults

The National Institute for Health and Clinical Excellence (NICE) provides recommendations on nine key care processes that adults with diabetes should receive to avoid short- and long-term complications. Here we use data from the National Diabetes Audit to look at eight of these processes.

See also our analysis of care for children and young people with diabetes

How has prevalence of diabetes changed over time?

Diabetes prevalence is calculated using patient registrations from primary and secondary care, where the patient's GP practice participated in the National Diabetes Audit (in England and Wales). We observe a slight increase in prevalence from 4.59% in 2010/11 to 4.87% in 2012/13. The increase is mainly due to an increase in Type 2 diabetes prevalence (from 4.1% to 4.38%); Type 1 diabetes prevalence remained at around 0.4% in all years.

Source: 

National Diabetes Audit, HQIP, IC, Diabetes UK.

How has the proportion of all patients with diabetes receiving recommended care changed over time?

For most recommended care processes for diabetes patients there has not been much change in the last three years. Only approximately 60% of patients with diabetes receive all eight processes of care, and again, this proportion has been stagnant over time. The National Diabetes Audit also found that rates of completion for all processes is lower for patients with Type 1 diabetes (41.3% in 2012/13 for all eight care processes) than Type 2 diabetes (61.9% in 2012/13 for all eight care processes) in all years (figures not shown).

Source: 

National Diabetes Audit, HQIP, IC, Diabetes UK.

How does the proportion of people with diabetes receiving the recommended care processes differ by age?

Analysis by age groups reveals that rates of completion for all eight care processes are much lower for the youngest group (under 40), and especially for people with Type 1 diabetes.

Source: 

National Diabetes Audit, HQIP, IC, Diabetes UK.

How has treatment target achievement for people with diabetes changed over time?

Achivement of treatment targets has improved only for the recommended blood pressure target; however, this is due to the target changing to less than or equal to 140/80 rather just being less than 140/80 in previous audits. The proportion meeting the HbA1c target of less or equal than 58mmol/mol has declined over time and so has the proportion of people with controlled cholesterol. The proportion of people meeting all the treatment targets (patients achieving HbA1c less than or equal to 58mmol/mo, cholesterol less than 5mmol/L and their relevant blood pressure target) increased from 33.7% in 2010/11 to 35.9% in 2012/13. Again, for Type 1 diabetes only 16.2% have met all treatment targets compared to 37.4% for Type 2 diabetes in 2012/13. By age groups we find that the proportion of people under 40 are least likely to meet their treatment targets in 2012/13: 14.7% for Type 1 and 24.3% for Type 2 under age 40 compared to 25.5% for Type 1 and 45.1% for Type 2 in the 80 and over.

Overall, younger people and those with Type 1 diabetes should receive more attention in the future. It would also be interesting to look at A&E visits and unplanned hospital admissions for short and long-term complications for people with diabetes.

Source: 
National Diabetes Audit, HQIP, IC, Diabetes UK
About this data

The prevalence and registration sections of the National Diabetes Audit report are based on data collections from both primary and secondary care. The remainder of the report (including the appendices) includes only patients registered in primary care to ensure that the population-based  denominators are comparable. The vast majority of patients are registered in primary care, with only a relatively small percentage (3.8%) of records appearing only in secondary care submissions.  Here we look at eight processes of care, since eye screening is organised by NHS Diabetes Eye Screening.

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