Latest National Diabetes Audit results published

Care of people with diabetes varies dramatically across England and Wales but there have been improvements nationally in all three key treatment targets, the latest National Diabetes Audit results have revealed.

The National Diabetes Audit 2015-16 found that the percentage of people with type 1 diabetes achieving NICE-recommended treatment targets for glucose control, blood pressure and cholesterol varied from 11 per cent in some Clinical Commissioning Groups (CCG) to 34 per cent in others.

More people with type 2 diabetes achieve treatment targets, but there was a sixteen percentage point variation, from 33 to 49 per cent, across localities, according to report published today by NHS Digital in partnership with Diabetes UK.

What’s striking about this audit is how large some of the differences are between GP practices and between specialist services

The variation between CCGs is matched or exceeded by variation between general practices within CCGs and between specialist services, the results showed.

However, the last six years have seen improvements nationally in all three treatment targets in both type 1 (1.6 percentage points) and type 2 diabetes (5.1 percentage points).

Other findings from the audit – commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme – include:

• Older people are more likely than younger ones to achieve all three treatment targets; the difference for those with type 2 diabetes is greater (46 per cent of people aged 65 to 79 achieved all three treatment targets compared with 27 per cent of people aged under 40) than for those with type 1 diabetes (24 per cent of people aged 65 to 79 and 18 per cent for those aged under 40).
• People with type 2 diabetes are more likely to achieve all three treatment targets – 40 per cent of people with type 2 diabetes achieved all three treatment targets compared to only 18 per cent of people with type 1 diabetes.
• The percentage of people with type 1 diabetes in England and Wales receiving all eight NICE-recommended care processes has fallen eight percentage points – from 45 per cent in 2013-14 to 37 per cent in 2015-16. For people with type 2 diabetes, the decline is greater – from 68 per cent in 2013-14 to 54 per cent in 2015-16. These declines are almost entirely due to reductions in delivery of the urine albumin care process (the check for early kidney disease).
• The percentage of people diagnosed with diabetes that have been offered structured education within one year of diagnosis has increased markedly, from 10 per cent in 2009 to 82 per cent in 2014 for those with Type 2 diabetes (this has increased from five per cent to 39 per cent for those with type 1 diabetes).
• People with learning disabilities who have type 1 diabetes are slightly more likely to get their annual checks whilst those with type 2 diabetes are slightly less likely to get them.

Dr Bob Young, a consultant diabetologist and clinical lead for the audit, said: “What’s striking about this audit is how large some of the differences are between GP practices and between specialist services. High achieving services are often found in localities serving socially deprived or ethnically diverse communities. This shows that patient characteristics are not a barrier to good care.

“Achieving treatment targets is central to staying healthy with diabetes. GP and specialist services need to work together and all aim for the level of the best. Everyone with diabetes should be confident they are getting high quality care.”

Chris Askew, chief executive of Diabetes UK, said: “It is shocking to see this level of variation for people with diabetes achieving their NICE recommended treatment targets, and not just at CCG level but also from one GP surgery to another.

“Achieving treatment targets is absolutely vital when it comes to staying healthy with diabetes as doing so helps people reduce their risk of developing serious and life-threatening complications such as amputation, blindness, heart disease, stroke and kidney disease.

“At the moment people with type 1 diabetes and younger people are clearly struggling the most when it comes to achieving these targets and we particularly want to see more done to support them, such as ensuring they attend structured education, are offered psychological support and proper care planning, all of which will give them the best tools to help them control their condition.

“It is positive that more CCGs and general practices have taken part in this year’s audit than in recent years. High levels of participation enables us to shine a light on the issue and showcase what good care looks like.”

To read the report, click here.