Report shows regional variations in diabetes care
Published: 31 Jan 2017
The National Diabetes Audit 2015-16, published by NHS Digital in partnership with Diabetes UK, found that the percentage of patients with Type 1 diabetes achieving NICE-recommended treatment targets for glucose control, blood pressure and cholesterol varied from 11 per cent in some CCGs/LHBs to 34 per cent in others.
In general, more patients with Type 2 diabetes achieve treatment targets, but there is a sixteen percentage point variation, from 33 to 49 per cent, across localities.
The variation between CCGs is matched or exceeded by variation between General Practices within CCGs and between specialist services.
Dr Bob Young, a consultant diabetologist and clinical lead for the audit said:
“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.”
Other findings from the audit – commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme – include:
- The last six years have seen improvements nationally in achievement of all three treatment targets, in both Type 1 (1.6 percentage points) and Type 2 (5.1 percentage points) diabetes
- 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% of people aged 65 to 79 achieved all three treatment targets compared with 27% of people aged under 40) than for those with Type 1 diabetes (24% of people aged 65 to 79 and 18% for those aged under 40)
- People with Type 2 diabetes are more likely to achieve all three treatment targets – 40% of people with Type 2 diabetes achieved all three treatment targets compared to only 18% 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 5 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
Chris Askew, chief executive of Diabetes UK, said:
“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.
“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.”
(a) The three NICE-recommended treatment targets for all patients with diabetes aged 12 years and over are:
- HbA1c (blood test for glucose control) – HbA1c less than or equal to 58mmol/mol
- Blood pressure (measurement for cardiovascular risk) – blood pressure less than or equal to 140/80
- Serum cholesterol (blood test for cardiovascular risk) – cholesterol less than 5mmol/L