Introduction
This is the third National Diabetes Audit (NDA) report on adults with type 1 diabetes. This report details the analysis behind the findings and recommendations relating to routine diabetes care for people with type 1 diabetes which are published in the parallel State of the Nation report. It covers the period 01 January 2021 to 31 March 2022.
The NDA provides a comprehensive view of diabetes care in England and Wales. It includes results from more than 98% of people with diagnosed diabetes. It measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. NICE guidance recommends that everyone with diabetes is reviewed at least once a year. NICE also recommends treatment targets for glucose control, blood pressure and cardiovascular disease (CVD) risk reduction. The guidelines are based on evidence that regular healthcare checks and achieving the treatment targets maintains health and reduces long term complications.
Over 98% of all general practices in England and Wales participated in the 2021-22 audit and data was extracted from their electronic records. Specialist diabetes services generally take the lead in care for people with type 1 diabetes. Where specialist services have electronic records, extracts from these records can be submitted. This audit also links to outpatient attendance records in Hospital Episode Statistics (HES) which identifies all specialist service attendances irrespective of whether they have an electronic record.
Aims of the Report
This NDA report focusses on NICE guidance and Quality Standards for the routine care of people with type 1 diabetes. Everyone with diabetes should be reviewed at least once a year. Having diabetes can lead to health complications such as blindness, kidney failure, heart disease, stroke and premature death. The review should include blood tests for HbA1c (glucose control), creatinine (kidney function), cholesterol (heart risk), a urine test for albumin (kidney risk), measurements of blood pressure and weight, examination of the feet (foot ulcer risk) and review of smoking habit. These are called the 8 care processes. Retinal screening run by dedicated screening programmes, is the ninth care process. At review, treatment should be adjusted where necessary to achieve NICE recommended HbA1c and blood pressure levels; also, those with high heart risk should be prescribed a statin. These are known as the 3 treatment targets. NICE also has guidance for the use of Continuous Subcutaneous Insulin Infusion (Insulin Pumps) and Continuous Glucose Monitoring Systems (CGMS) .
Measurements of routine diabetes care for people with type 1 diabetes are reported in the publicly available quarterly dashboard (England GP record extracts only, for all ages: NDA England primary care quarterly dashboard), the annual care processes and treatment targets dashboard (GP record extracts plus data submitted by specialist services: NDA Core annual dashboard - England and Wales) and the NDA Type 1 dashboard - England and Wales (using the cohort validated with prescription data and including data on CGMS and pumps). Data are published at national, regional, integrated care board (ICB), sub ICB, local health board (LHB), specialist service levels (all dashboards), and at primary care network (PCN) and practice levels (quarterly and core dashboards only).
This detailed analysis document has 4 sections:
- Information on the creation of the type 1 cohort, and details on use of the HES outpatient attendance data
- Treatment target achievement across sub ICBs (formerly clinical commissioning groups (CCGs) and LHBs for years 2019-20 to 2021-22
- HbA1c levels, the use of glucose technologies and equality of access to these technologies
- Specialist services care
