# National Diabetes Audit, 2016-17 Care Processes And Treatment Targets Short Report Published 10 November 2017

 
 
The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. 

Key findings 

 
This short report presents the top level findings from the 2016-17 NDA. A full report will be published in March 2018. 
 
Fewer people with Type 1 than with Type 2 and other diabetes receive their annual checks. 
 
The last four years have seen improvements in the combined 3 treatment target achievement in both Type 1 and Type 2 and other diabetes.  
 
Timely offers of structured education have improved over the last three years 

## Contents

| Introduction         |   3 |
|----------------------|-----|
|                      |     |
| Care Processes       |   4 |
|                      |     |
| Treatment Targets    |   5 |
|                      |     |
| Structured Education |   6 |
|                      |     |
| Definitions          |   7 |
|                      |     |
|                      |     |
|                      |     |
|                      |     |

## Introduction

The National Diabetes Audit (NDA) supports improvement in the quality of Diabetes care by enabling participating NHS services and organisations to: 

- 
Assess local practice against NICE guidelines 
- 
Compare their care and care outcomes with similar services and organisations 
- 
Identify gaps or shortfalls that are priorities for improvement  
- 
Identify and share best practice  
- 
Provide comprehensive national pictures of diabetes care and outcomes in England and Wales 
This short report presents the top level findings from the 2016-17 NDA. A full report will be published in March 2018. 

## Audit Conducted In Collaboration With:

 
 
Supported by: 

## Care Processes

All people with diabetes aged 12 years and over should receive each of the nine NICE recommended care processes annually and, when diagnosed, attend a structured education programme. 

## Nine Annual Care Processes For All People With Diabetes Aged 12 And Over

| Responsibility of Diabetes Care providers (included in the NDA 8 Care Processes)       |     |
|----------------------------------------------------------------------------------------|-----|
| 1.  HbA1c                                                                              |     |
|                                                                                        |     |
| (blood test for glucose control)                                                       |     |
| 5.  Urine Albumin/Creatinine Ratio                                                     |     |
|                                                                                        |     |
| (urine test for early kidney disease)                                                  |     |
| 2.  Blood Pressure                                                                     |     |
|                                                                                        |     |
| (measurement for cardiovascular risk)                                                  |     |
| 6.  Foot Risk Surveillance                                                             |     |
|                                                                                        |     |
| (foot examination for foot ulcer risk)                                                 |     |
| 3.  Serum Cholesterol                                                                  |     |
|                                                                                        |     |
| (blood test for cardiovascular risk)                                                   |     |
| 7.  Body Mass Index                                                                    |     |
|                                                                                        |     |
| (measurement for diabetes management)                                                  |     |
| 4.  Serum Creatinine                                                                   |     |
|                                                                                        |     |
| (blood test for kidney function)                                                       |     |
| 8.  Smoking History                                                                    |     |
|                                                                                        |     |
| (question for cardiovascular risk)                                                     |     |
| Responsibility of NHS Diabetes Eye Screening (screening register drawn from practices) |     |
|                                                                                        |     |
| 9.  Digital Retinal Screening                                                          |     |
|                                                                                        |     |
| (photographic eye test for diabetic eye disease)                                       |     |

## Time Series

processes by care process, diabetes type and audit year 
  
Type 1 
Type 2 and other 
2012-
2013-
2014-
13 
14 
15 
HbA1c 
79.8 
80.9 
83.2 
83.7 
84.3 
93.1 
93.5 
94.8 
95.0 
95.1 
Blood pressure 
87.7 
87.0 
89.0 
89.1 
90.3 
95.4 
94.9 
96.1 
95.7 
96.2 
Cholesterol 
77.3 
77.4 
78.7 
79.1 
79.9 
91.9 
92.4 
92.8 
92.7 
92.7 
Serum creatinine 
80.3 
78.8 
80.5 
81.5 
82.7 
93.2 
93.4 
94.5 
94.7 
95.0 
* 
56.5 
63.9 
55.9 
50.2 
50.1 
74.7 
84.4 
74.6 
66.7 
65.2 
Urine albumin
Foot surveillance 
71.5 
70.7 
72.4 
72.9 
69.5 
85.8 
86.2 
86.7 
86.7 
79.4 
BMI 
83.3 
76.8 
74.9 
75.2 
75.3 
90.9 
85.7 
83.1 
82.7 
83.1 
Smoking 
79.2 
77.4 
77.9 
78.5 
79.2 
86.3 
85.5 
85.2 
85.2 
85.5 
Eight care processes    
40.8 
44.5 
38.7 
36.5 
33.7 
61.2 
67.6 
58.7 
53.7 
47.6 

## Key Finding

 
Fewer people with Type 1 than with Type 2 and other diabetes receive their annual checks. 
 
Urine albumin and foot surveillance are most often missed out. 

|   2015- |   2016- |   2012- |   2013- |   2014- |   2015- |   2016- |
|---------|---------|---------|---------|---------|---------|---------|
|     16  |     17  |     13  |     14  |     15  |     16  |     17  |

## Treatment Targets

NICE recommends treatment targets for HbA1c (glucose control), blood pressure and serum cholesterol: 

 Target HbA1c reduces the risk of all diabetic complications.  Target blood pressure reduces the risk of cardiovascular complications and reduces 
the progression of eye disease and kidney disease. 
 Target cholesterol reduces the risk of cardiovascular complications. 

## Time Series

  
Type 1 
Type 2 and other 
2012- 13 
2013- 14 
2014- 15 
2015- 16 
2016- 17 
2012- 13 
2013- 14 
2014- 15 
2015- 16 
2016- 17 
HbA1c  
27.2 
29.4 
29.9 
29.2 
30.2 
64.9 
66.8 
66.1 
65.7 
66.8 
< 58 mmol/mol Blood pressure  
73.4 
76.4 
76.4 
74.2 
75.8 
68.6 
73.6 
74.2 
73.6 
74.2 
< **140/80** 
Cholesterol  
70.2 
71.5 
71.3 
70.8 
69.4 
76.7 
77.8 
77.5 
77.1 
76.0 
< 5mmol/L 
16.1 
18.6 
18.9 
18.1 
18.9 
37.3 
41.4 
41.0 
40.2 
40.8 
Meeting all 
three treatment 
targets 
 

## Key Finding

 
The last four years have seen improvements in the combined 3 treatment target achievement in both Type 1 and Type 2 and other diabetes.  

## Structured Education

Diabetes structured education is quality assured training that provides people with diabetes, their family and their carers with the knowledge and confidence to self-manage a long-term condition. 

Diabetes Structured Education courses deliver information, training and support on how to manage diabetes through diet, physical activity and medication. Essentially they are providing the foundation support for diabetes self-management.  

## Time Series

  
Type 1 
Type 2 and other 
2013 
2014 
2015 
2013 
2014 
2015 
24.4 
35.7 
41.1 
54.0 
69.2 
77.0 
Offered Structured Education within 12 months of diagnosis 
2.3 
3.2 
3.2 
6.4 
6.7 
7.1 
Attended Structured Education within 12 months of diagnosis 

## Key Finding

 
Timely offers of structured education have improved over the last three years 
 
The apparently low rates of attendance may be due to incomplete recording of 
attendance data in GP electronic records. 
 

## Definitions Diabetes

Diabetes is a condition where the amount of glucose in the blood is too high because the pancreas doesn't produce enough insulin.  Insulin is a hormone produced by the pancreas that allows glucose to be used as a body fuel and other nutrients to be used as building blocks. There are two main types of diabetes: Type 1 diabetes (no insulin); Type 2 diabetes (insufficient insulin) 

## Care Processes (Nice Recommends All Of These At Least Once A Year)

Blood Pressure is a measurement of the force driving the blood through the arteries. 

Blood pressure readings contain two figures, e.g.130/80. The first is known as the systolic pressure which is produced when the heart contracts. The second is the diastolic pressure which is when the heart relaxes to refill with blood. 

BMI measurement - Body Mass Index calculated from weight and height to classify under, normal and over-weight Serum creatinine - this blood test is used as measure kidney function Cholesterol - this blood test measures a type of fat that can damage blood vessels Foot check - this examination checks the blood supply and sensation (feeling) in the feet. 

Loss of either is a risk for foot disease Smoking Status - this records whether the person is a smoker. Smoking increases the diabetic risk for heart attacks and stroke HbA1c - this is a blood test for average blood glucose levels during the previous two to three months. 

## Treatment Targets (Nice Defines Target Levels To Reduce Risks Of Complications For People With Diabetes)

HbA1c - the closer this is to normal (less than 42mmol/mol) the lower is the risk of all long term complications of diabetes Cholesterol - reducing cholesterol levels lowers the risk of heart attacks and strokes Blood Pressure - high levels are a risk for heart attacks and strokes; they also drive progression of eye and kidney disease  

## Specialist Service

This is a service (often hospital based but sometimes delivered in a community setting) which includes diabetes specialists working in multidisciplinary teams. These teams usually comprise physicians (diabetologists), diabetes specialist nurses and dieticians; it may also include clinical psychologists www.digital.nhs.uk 
0300 303 5678   
 
enquiries@nhsdigital.nhs.uk 
 
 
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