National Paediatric Diabetes Audit NPDA
 National Paediatric Diabetes Audit Report 2012-13 
Part 1: Care Processes and Outcomes 

              National Paediatric Diabetes Audit  
                              Report 2012-13 
                                            
                                   Report 1:  
                                            
                  Care Processes and Outcomes 
                                            
                               October 2014 
    
                               Report produced by the  
                        National Paediatric Diabetes Audit, 
                  Royal College of Paediatrics and Child Health


## List Of Tables And Figures

Table number 
Title 
 
Page number 
1 
Diabetes registrations by country, age and English region in 2012-13 
 
13 
2 
Number of children and young people with diabetes by gender and age 
band, for England and Wales combined in 2012-13 
14
3 
Percentage of children and young people with diabetes by ethnic group in 
2012-13 
15
4 
Percentage of children and young people with diabetes by sex and type, 
for England and Wales in 2012-13 
17 
5 
Percentage of children and young people with diabetes by type and ethnic 
group, England and Wales in 2012-13 
18 
6a 
Type 1 diabetes incidence rates per 100,000 persons by age group and sex 
in 2012-13 
19 
6b 
Numbers of newly diagnosed children and young people with Type 1 
diabetes by country, gender and age group in 2012-13 
19
23 
7 
Percentage of children and young people cared for in a PDU having key 
age-specific care processes recorded (for HbA1c this is all ages) from 2004-05 to 2012-13 
8 
Percentage of children and young people with HbA1c measured, by age 
and sex in 2012-13 
25
29 
9 
Number and percentage of children and young people with diabetes 
achieving the HbA1c target of <58 mmol/mol, ≥58 mmol/mol to ≤80 
mmol/mol, and >80 mmol/mol, by country and sex in 2012-13 
10 
Percentage by HbA1c target band achieved, England and Wales in 2010-11, 
2011-12 and 2012-13 
30 
11 
HbA1c (mmol/mol) target band achieved (number and %) by ethnic group 
for England and Wales in 2012-13 
30 
12 
Mean and standard deviation, median and interquartile ranges for HbA1c in 
mmol/mol by country and English region in 2012-13.  
33
13 
Multiple regression showing the predictive risk factors for patient HbA1c in 
England and Wales in 2012-13 
41 
44 
14 
Logistic regression model of risk factors for proportion of children and 
young people with diabetes in England and Wales with an HbA1c greater than 80 mmol/mol in 2012-13 
 
Figure number 
Title 
Page number
1 
PDUs that submitted data to the NPDA in 2012-13
12
2 
Number of children and young people with diabetes by gender and age band, for England and Wales combined in 2012-13 
14
3 
Percentage of children and young people with diabetes by ethnic group in 2012-13 
16
4a 
Age-Sex Type 1 diabetes incidence rates by country
20
4b 
Time trends in Age-Specific Type 1 diabetes incidence rates for England and Wales combined 
20
5a 
Type 1 diabetes incidence rate by country and English region in 2012-13 
22
5b 
Time trends in the incidence of Type 1 diabetes by country and region from 2010-11 to 2012-13 
21
6 
Percentage of children and young people with diabetes aged 12 years and over, having all care processes recorded from 2004-05 to 2012-13 
23
7 
Percentage of care process incomplete (except HbA1c) by Paediatric Diabetes Unit in 2012-13 
24
8a 
Percentage of males who had their HbA1c measured in England and wales 
26
8b 
Percentage of females who had their HbA1c measured in England and wales
26
9 
Percentage who did NOT have the HbA1c care process completed, England 
and Wales by Paediatric Diabetes Unit in 2012-13 
27
29
10 
Percentage of children and young people achieving the NICE recommended 
HbA1c target of <58 mmol/mol, ≥58 mmol/mol to ≤80 mmol/mol, and >80 
mmol/mol, by country in 2012-13 
11 
Percentage of children and young people with diabetes by HbA1c target band achieved and ethnic group in 2012-13 
31
12 
Percentage achievement of HbA1c target of <58 mmol/mol by Paediatric 
Diabetes Unit in 2012-13 
32
13 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, Wales in 2012-13 
34
14 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, East of England in 2012-13 
34
15 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, Yorkshire and 
the Humber in 2012-13 
35
16 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, East Midlands in 2012-13 
36
17 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, West Midlands in 2012-13 
36
18 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South Central in 2012-13 
36
19 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, North West in 2012-13 
37
20 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, North East in 2012-13 
37
21 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South West in 2012-13 
38
22 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, London in 2012-13 
38
23 
Box and whisker plots of HbA1c by Paediatric Diabetes Unit, South East in 2012-13 
39
40
24 
Funnel plot showing the unadjusted mean HbA1c for PDUs in England and Wales by unit size in 2012-13 
42
25 
Funnel plot showing the adjusted mean HbA1c for PDUs in England and Wales by unit size in 2012-13 
 
43
26 
Funnel plot showing the unadjusted proportion of children and young people with diabetes in England and Wales with HbA1c greater than 80 mmol/mol against unit size 
45
27 
Funnel plot showing the adjusted proportion (%) of children and young people with diabetes in England and Wales with HbA1c greater than 80 mmol/mol against unit size in 2012-13 

Foreword 
 
We are delighted to introduce the third annual National Paediatric Diabetes Audit (NPDA) report prepared by the Royal College of Paediatrics and Child Health (RCPCH) which covers the audit period 2012-13 for the Paediatric Diabetes Units (PDUs) in England and Wales. The NPDA has been running in its entirety for 10 years and has become a powerful measuring tool for providing benchmarked information relating to outcomes and quality of care for children and young people with diabetes. The NPDA has undergone several changes over the last three years including the collection of some new data items and use of median HbA1c for the Audit year, rather than simply relying on the HbA1c value for each individual patient. This has put extra burden on centres submitting data but is clearly important, as it brings the NPDA into line with other international registries and audits, making benchmarking against other countries more meaningful.  The NPDA project team are aware of the challenges that exist when submitting to the Audit, together with the considerable amount of time taken to collect and prepare data that is of good quality and as complete as possible. The NPDA recognises the significant additional investment in Paediatric Diabetes, particularly in England where the 'Best Practice Tariff' together with the quality assurance peer review programme should lead to improved quality of care and outcomes. The first round of peer review visits to PDUs will be complete for both England and Wales by the end of 2014.  We recognise the considerable burden that has been placed on each PDU, not only in submitting their data to the NPDA, but also preparing for their peer review quality assurance visit alongside striving to deliver their diabetes services at 'Best Practice Tariff' standard. Results from the NPDA over the last 10 years have been disappointing, with little evidence of any change in outcomes. Therefore, questions have to be asked as to whether recent investment both of finance and time has made a difference. This year's NPDA report demonstrates some positive changes for England and Wales with a downward trend in the median HbA1c by 2 mmol/mol from the previous year which now represents the third consecutive year where there has been improvement in the national median HbA1c. This may not feel like a large improvement, but is coherent with rates of change seen in other European countries where measures have already been taken to improve outcomes. There is still work to be done as, despite this overall improvement in the median HbA1c, the percentage of children and young people with diabetes who have a median HbA1c less than 58 mmol/mol remains low and the number with an HbA1c greater than 80 mmol/mol remains stubbornly high. Furthermore, children and young people with diabetes from ethnic minority groups perform less well than those from white ethnic backgrounds. However, it is not clear why these differences exist. Of concern is the large variability in outcome measures that persist across regional diabetes networks and PDUs.  Even after statistical adjustments for known confounding influences, such as ethnicity, social deprivation, gender, age and diabetes duration, over 90% of the variation in HbA1c is unaccounted for. This suggests that much of the variation is due to differences in service provision and delivery which needs addressing.  Network working and 'peer review' are paving the way towards the sharing of good practice and the NPDA fully endorse this approach.  It is recommended that PDUs use the 'casemix' adjustments presented in this report to identify their outlier status, and benchmark themselves against others with a similar patient demographic, location or size and work within networks to employ strategies to improve outcomes and reduce variability. Finally, we would like to thank the NHS clinical teams who have provided the data to support this important Audit and applaud the clinical leadership that has led to these improvements. With this strong support of the NPDA together with the work being carried out across the regional diabetes networks, we have confidence in steady ongoing improvements of care across England and Wales. Children and young people with diabetes deserve nothing less. 

 

                       
Dr Justin Warner 
RCPCH NPDA Clinical Lead  
                                                          
Consultant in Paediatric Endocrinology and Diabetes 
                                                                                            
University Hospital of Wales  
 

                         
Dr Fiona Campbell 
Chair of NPDA dataset working group 
Consultant Paediatric Diabetologist 
Leeds Teaching Hospitals NHS Trust 

## 1. Summary Of Key Findings

 
Coverage of children and young people with diabetes by the National Paediatric Diabetes Unit (NPDA) has remained stable.  Records from 25,314 children and young people with diabetes were submitted to the 2012-13 NPDA, compared with 25,390 in 2011-12. The reported year of 2012-13 is the second year of the new dataset and data collection process. A total of 25,221 children and young people under the age of 25 years with a diagnosis of diabetes who were cared for in Paediatric Diabetes Units (PDUs) in 2012-13 were suitable for analysis by the NPDA reporting from 178 PDUs.  This represents 100% of all PDUs where children and young people in England and Wales receive their diabetes care. Key improvements offered by this report are in recording of individual care processes from previous years. The percentage of children and young people diagnosed with diabetes for at least one year and over the age of 12 years at the start of the Audit year with all care processes recorded, as recommended by the National Institute for Health and Care Excellence (NICE), has almost doubled from 6.7% in 2011-12 to 12.1% in 2012-13. This higher proportion is very encouraging, but continues to fall short of similar data from the 2011-12 National Diabetes Audit (NDA) report for adults with diabetes. The proportion of adults receiving all eight adult care processes was 42.4% for Type 1 diabetes for England and Wales. The number of patient visits, or records of HbA1c and other tests submitted per patient, has continued to increase. During 2012-13, there were 106,333 reported visits from 25,221 
patients, an average of four visits per patient. There has been a marked increase in HbA1c measurement. In England, 98.6% of males and females under the age of 25 years had their HbA1c measured, compared with 89% in 2011-12. In Wales, the corresponding figures are 
98.9% and 87%. This shows a continued improvement on 2010-11 when the completion rate for this care process was 85%. There has been a small decrease in the percentage of children and young people with diabetes who achieve an HbA1c less than 58 mmol/mol (from 17.4% in 2011-12 to 15.8% in 2012-13). However, this still represents either an improvement or similarity to 2009-10 and 2010-11 where the figures were 14.5% and 15.8% respectively. The greatest numbers (58.4%) 
of patients have an HbA1c between 58 mmol/mol and 80 mmol/mol. Just over one quarter of children and young people have an unacceptable HbA1c of greater than 80 mmol/mol. A much higher proportion of children and young people with diabetes from ethnic minorities (26.4% to 36.4% depending on the ethnic group) have an HbA1c level greater than the 80 mmol/mol. In 2012-13 the median HbA1c for England and Wales was 69 mmol/mol, down from 71 mmol/mol in 2011-12. This represents the third consecutive year where there has been a sustained fall in the national median HbA1c. However, there is variability between nations and regional networks ranging from a median of 68-72 mmol/mol. Casemix adjustment has demonstrated that only 8% of the variability in the mean HbA1c, and 7% of the variability of the proportion with an HbA1c >80 mmol/mol, across PDUs can be explained by factors such as ethnicity, social deprivation, gender, age and diabetes duration. Therefore, over 90% must be explained by service related factors such as structure, resource and delivery of care.  The NPDA calls for a concerted effort to reduce this variability which is already being addressed through networking and the peer review accountability programme.  The funnel plots presented in this report identify outliers for two measures, mean HbA1c and percentage of patients with HbA1c greater than 80 mmol/mol. 

The NPDA urge PDUs to take notice of this data and implement strategies to improve the status of all PDUs where performance is suboptimal. Alongside this report, there will be a separate complications report covering the 2012-13 hospital admissions data relating to diabetic ketoacidosis hypoglycaemia and 'without complications'. 


## 2. Introduction

The National Paediatric Diabetes Audit (NPDA) report highlights the main findings on the quality of care for children and young people with diabetes mellitus in England and Wales. This is the 10th report and covers data submitted for patients under the age of 25 years and cared for in Paediatric Diabetes Units (PDUs) in 2012-13. This is the third report from the Royal College of Paediatric and Child Health (RCPCH). The NPDA is commissioned and sponsored by the Healthcare Quality Improvement Partnership (HQIP) as part of their National Clinical Audit Programme. The programme is funded by NHS England and the Welsh Government. The NPDA covers the components of the National Service Framework (NSF) for diabetes and includes details on the number of children and young people with diabetes in England and Wales, together with the care processes they receive and outcome measures, including inpatient admissions for diabetic ketoacidosis. This report covers the care process and outcome data only, with complications data to follow in a separate report. The National Diabetes Audit (NDA) for adults reports on the provision of core diabetes care for everyone with diabetes. This provides commissioners with age, ethnicity and social deprivation-related perspectives across the whole population for which they are responsible. The NDA also reports to participating individual General Practices and adult specialist services, allowing them to benchmark their care against their peers. The NPDA reports separately to individual participating PDUs regarding their provision of diabetes care for the children and young people attending their services. Those reviewing the NDA and NPDA reports side-by-side need to be aware of these differences but, equally, those wanting to get the most complete picture of local needs and service provision should consider the two reports together** Following the launch of a new dataset in 2011-12, 2012-13 has been a year of consolidation for the NPDA. Over the 10 years that the NPDA has been the basis for data collection on process and outcome measures of care for children and young people with diabetes, there have been many changes in the way services are structured and delivered. Participation in the NPDA is now a mandatory standard for PDUs and hospital trusts to receive tariff in England. Currently, no such commissioning arrangements exist for Wales. Peer review, as part of a quality assurance programme, has completed its first self-assessment exercise in England with ongoing review visits taking place in 2014.  Wales is following this programme of peer review, which should also be complete by the end of 2014. The NPDA acts as the measuring arm of any quality assurance programme and it is therefore encouraging to see the early signs of improvement in outcome, with a third consecutive yearly fall in the median HbA1c. However, there are variations across regional networks, which will require close and careful monitoring over the next few years. 

 
For the first time this year, each PDU has been provided with their unadjusted and adjusted mean HbA1c and percentage of children and young people that would be expected to have an HbA1c greater than 80 mmol/mol based on the population characteristics of their geographical area. This will allow units to compare their crude outcomes with those adjusted for their 'casemix' which allows a more equitable comparison of Units. Furthermore, the use of funnel plots provides a technique for identifying outliers and is now the recognised statistical methodology for this purpose used by other national audits across England and Wales. 

Data quality is of paramount importance when submitting data and PDUs are reminded to check the data quality report provided by the RCPCH and act on any outstanding issues. The NPDA can only analyse data that fulfil the data entry criteria. Data submitted for patients must include a valid NHS number, date of birth, date of diagnosis and gender to be eligible for any analysis. Furthermore, they must be assigned a PDU PZ code. Care processes and outcomes can only be analysed if the result is a valid response and the date of measurement falls within the Audit year. When submitting data, one row of data represents one visit and multiple entries within one cell of a csv format spreadsheet are unacceptable. In the past, much data submitted had to be excluded, as it does not fulfil these criteria. The NPDA would urge submitting PDUs to check their data quality and accuracy to avoid any data being excluded. The NPDA hope that PDUs will use the data presented in this annual report to continue to benchmark their own centres against others and explore methods of driving up quality of care for their patients. The RCPCH and the NPDA would like to thank every PDU that submitted data to the 2012-13 Audit.  The team recognises that this can be a timeconsuming process, particularly where there is a lack of resource and/or computer software to aid data collection. 

 

 
 
**  
Because the care of adults and children with diabetes is mixed between GP services (this includes 
ALL patients) and hospital, paediatric and community specialist services (these each include SOME patients), the different 'views' that the two national audits NDA and NPDA give to the providers of the services will inevitably include overlapping patients. Thus someone with diabetes attending a specialist service should also appear in the relevant GP report. The NDA integrates data from 
participating specialist and GP services for adults with diabetes so that if a care process or treatment target is recorded by one but not the other both get the complete data reported back to 
them i.e. a 'whole person' view. This makes sense because it reflects the fact that there is no clinical value in duplicating something carried out elsewhere. The population level NDA reports include all 
people with diabetes in a geographical area irrespective of their mix of provider services and use integrated data where they are available. The NPDA runs independently of the NDA and of GP services so its data are not integrated making it possible that GP reports do not include all care processes or treatment targets measured in specialist paediatric units and vice versa. Specialist paediatric diabetes units are primarily responsible for the care of most children and young people with diabetes and for the collection of their care process and outcome data. Although GPs do not provide the majority of care for children 
and young people living with diabetes they do prescribe all their medications. Therefore it is in this age group, and also adults with Type 1 or complex diabetes that attend specialist services not participating in NDA, where lack of data integration is most likely to result in a slightly deficient 'whole systems' view. Furthermore, for under-17s, the age cut-off for the QOF GP incentive scheme means that there is no financial value to the practice in replicating results from external services. Nonetheless, because less than 10% of all people with Type 1 diabetes, and less than 1% of people with diabetes in general are under 17 years old, the overall impact on population level NDA results is minimal.  

## 3. Coverage And Participation

A total of 178 PDUs in England and Wales successfully submitted data to the 2012-13 NPDA. A PDU is defined as a unit which delivers a paediatric diabetes healthcare service. It may represent one or more hospitals, as some services provide care across multiple sites. Data were received from 164 PDUs in England and from 14 PDUs within the six Health Boards in Wales, comprising all services registered with the NPDA for both nations. 

## 4. Demographic And Population Assessment 4.1 Registrations

Records from 25,314 children and young people with diabetes were submitted to the 2012- 13 NPDA, a similar number to the 25,390 submitted in 2011-12. A total of 157 of these patients were registered in two or more regions.  Since multiple patient visits can be entered for each patient, there were a total of 107,657 visits submitted to the 2012-13 NPDA. However, 1,324 of these visit records have been excluded from the 2012-13 analysis for a combination of reasons, including, for example, missing patient NHS number, missing date of birth, more than one valid date of birth for the same NHS number and age greater than 25 years. Therefore, for England and Wales combined, there was a total of 106,333 visits recorded for 25,221 children and young people under the age of 25 years old registered with diabetes and with a valid age and sex attached to their record, reported from 178 PDUs. This equates to approximately four patient visits per annum. 

 
Table 1 shows the breakdown in registration by country, age and English region. The age breakdown categories are the same as in the Census and other Office for National Statistics publications. Within England, the maximum number of registrations across all age groups was observed in the North West and the South East of England regions. It has not been possible to disaggregate the South East region into its two networks because of Census 2011 changes to both regions and local authorities (LAs) within them. In both England and Wales, age groups 10-14 and 15-19 years comprised the two largest groups of registered children and young people with diabetes. 

  
Age Group 
  
0-4 
5-9 
10-14 
15-19 
20-24 
Total 
England and Wales 
1,470 
5,009 
10,759 
7,895 
83 
25,216 
England 
1,384 
4,732 
10,129 
7,474 
82 
23,801 
Wales 
87
278
634
426 
<5 
1,426
Regions in England 


East of England 
152 
515 
1,072 
912 
13 
2,664 
East Midlands 
105 
388 
774 
525 
0 
1,792 
London 
176
548
1,000
722 
<5 
2,449
North East 
67 
212 
522 
369 
<5 
1,172 
North West 
210 
645 
1,420 
883 
44 
3,202 
South Central 
121 
453 
940 
743 
9 
2,266 
South East 
178
597
1,281
871 
5 
2,932
South West 
113 
390 
909 
717 
7 
2,136 
West Midlands 
148 
520 
1,138 
914 
6 
2,726 
Yorkshire and the Humber 
139 
508 
1,123 
833 
<5 
2,605 

157 patients were registered in 2 or more regions. Patient counts reflect unique patients at each level of aggregation, and therefore may not balance across region and country totals. 

## 4.1.1 Registrations By Age And Sex

Table 2 and Figure 2 show registrations for males and females in each age band. Patients in age groups 10-14 and 15-19 comprise the highest proportion of registrations in England and Wales. Slightly more young males have been registered with diabetes than females. 

|                | 0-4    | 5-9    | 10-14    | 15-19    | 20-24    | Total under 25    |
|----------------|--------|--------|----------|----------|----------|-------------------|
| Boys           |        |        |          |          |          |                   |
| 759            | 2,559  | 5,435  | 4,136    | 45       | 12,934   |                   |
| Girls          |        |        |          |          |          |                   |
| 702            | 2,391  | 5,207  | 3,708    | 38       | 12,046   |                   |
| Not Specified* |        |        |          |          |          |                   |
| 9              | 59     | 117    | 51       | 0        | 236      |                   |
| Total under 25 | 1,470  | 5,009  | 10,759   | 7,895    | 83       | 25,216            |

 
* Includes responses '*9 Not Specified*', blank and records where both male and female  
genders had been recorded for the same patient. 

## 4.1.2 Registrations By Ethnicity And Region

Table 3 and Figure 3 show the percentage of children and young people registered with diabetes by ethnic group for 2012-13.  Ethnicity coding is taken from the Information Standards Board (ISB) for Health and Social Care. A fundamental principle of ethnic category data collection is that the person to be categorised is responsible for classifying themselves, and that their reply is their own perception of their ethnic category, and not that of the healthcare professional. However, the Department of Health guidance acknowledges that there are some unavoidable exceptions (such as for those who for reasons of illness are unable to respond or be understood) where it may not be possible or appropriate to collect this data.  The NPDA is not able to verify that this process has taken place. 

 

The majority of children and young people with diabetes are white but there is regional variability. In England, Asians and Mixed ethnic groups were the two next largest. Of 25,374 records, 4,269 had an ethnicity recorded as 'not stated'. The national code of '*not stated'* 
means that the person has been asked and has declined to respond either because they do not wish to provide this information, or due to a genuine inability to choose a response, it does not mean the ethnic category is unknown.  The ethnicity of an additional 759 patients were invalid or left blank, so were classified as 'unknown' in accordance with NHS Data Dictionary ethnicity definitions. 

 
For PDUs in Wales, 99.2% of records provide some form of ethnic origin; the corresponding figure from England is 96.9%, which is significantly improved from 2010-11 when 72.6% of registrations from England specified ethnic origin.  However, 17.7% of records from England are 'not stated' whereas in Wales 2.1% are 'not stated'.  It seems likely that this difference could be due to some PDUs misclassifying 'unknown' ethnicity as 'not stated'. This seems to be particularly prevalent in North East, North West and West Midlands regions.  The NPDA 
has reminded PDUs of the correct process for classifying ethnicity for the 2013-14 data submission. 

 

  
White 
Asian 
Black 
Mixed 
Other 
Not 
stated 
Unknown* 
England and Wales 
70.2 
4.4 
1.8 
2.5 
1.3 
16.8 
3.0 
England 
68.7
4.6
1.9
2.6
1.4
17.7 
3.1
Wales 
94.5
0.8
0.2
1.3
0.4
2.1 
0.8
Regions in England 


East of England 
73.9
2.6
0.4
2.1
0.8
15.1 
5.1
East Midlands 
87.3
6.1
0.9
2.3
0.6
2.1 
0.8
London 
42.6
9.8
10.7
8.5
5.2
19.2 
3.9
North East 
65.4
0.4
0.1
0.3
0.1
33.4 
0.3
North West 
69.1 
3.7 
0.7 
1.0 
1.1 
23.5 
0.8 
South Central 
71.7 
1.8 
0.5 
1.8 
0.4 
19.3 
4.4 
South East 
70.1 
5.3 
2.6 
3.2 
1.9 
12.3 
4.6 
South West 
76.9 
0.7 
0.9 
1.5 
0.2 
11.1 
8.7 
West Midlands 
59.3 
5.9 
0.5 
2.5 
1.6 
28.7 
1.5 
Yorkshire and the Humber 
75.4 
7.0 
0.6 
1.4 
1.0 
14.1 
0.6 

*Unknown includes patients with blank or invalid ethnicity values in all their records 
 
*Unknown includes patients with blank or invalid ethnicity values in all their records 

## 4.1.3 Registrations By Diabetes Type

Over 98% of the records submitted to the Audit had a diabetes type recorded. Table 4 shows the breakdown of diabetes type by sex, country and English region. The vast majority of children and young people with diabetes have Type 1 diabetes, although there is variability across regions in England. In both England and Wales there were slightly more male patients with Type 1 diabetes.  The second major group was those with Type 2 diabetes.  

forms of 
Mellitus* 
Diabetes 
Not Specified 
 
forms of 
Mellitus* 
Diabetes 
Other specified 
forms of 
Diabetes  
Monogenic 
(gene unknown) 
forms of 
Diabetes  
Monogenic 
(gene known) 
Related 
Diabetes 
Cystic Fibrosis 
Type 2 
Mellitus 
Diabetes 
Mellitus 
Type 1 Diabetes 
|                 |
|-----------------|
| Boys            |
| Girls           |
| Boys            |
| Girls           |
| Boys            |
| Girls           |
| Boys            |
| Girls           |
| Boys            |
| Girls           |
| Boys            |
| Girls           |
| Boys            |
| Girls           |
| England and     |
| Wales           |
| 97.0            |
| 94.3            |
| 1.0             |
| 2.7             |
| 0.3             |
| 0.7             |
| 0.3             |
| 0.3             |
| 0.1             |
| 0.0             |
| 0.4             |
| 0.7             |
| 0.9             |
| 1.3             |
| England         |
| 97.0            |
| 94.2            |
| 1.1             |
| 2.8             |
| 0.3             |
| 0.6             |
| 0.3             |
| 0.3             |
| 0.1             |
| 0.0             |
| 0.5             |
| 0.7             |
| 0.9             |
| 1.3             |
| Wales           |
| 98.1            |
| 96.0            |
| 0.5             |
| 1.8             |
| 0.3             |
| 1.2             |
| 0.3             |
| 0.4             |
| 0.0             |
| 0.1             |
| 0.1             |
| 0.1             |
| 0.7             |
| 0.3             |
| Regions in      |
| England         |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
|                 |
| East of England |
| 94.2            |
| 91.7            |
| 0.4             |
| 1.1             |
| 0.3             |
| 0.4             |
| 0.3             |
| 0.2             |
| 0.0             |
| 0.0             |
| 0.5             |
| 0.2             |
| 4.2             |
| 6.4             |
| East Midlands   |
| 97.8            |
| 96.6            |
| 0.9             |
| 2.2             |
| 0.1             |
| 0.4             |
| 0.3             |
| 0.0             |
| 0.0             |
| 0.1             |
| 0.3             |
| 0.2             |
| 0.6             |
| 0.5             |
| London          |
| 96.3            |
| 91.4            |
| 2.0             |
| 5.4             |
| 0.6             |
| 1.1             |
| 0.1             |
| 0.4             |
| 0.2             |
| 0.0             |
| 0.5             |
| 1.0             |
| 0.3             |
| 0.6             |
| North East      |
| 98.5            |
| 96.5            |
| 0.6             |
| 2.9             |
| 0.2             |
| 0.0             |
| 0.0             |
| 0.0             |
| 0.0             |
| 0.0             |
| 0.0             |
| 0.0             |
| 0.6             |
| 0.6             |
| North West      |
| 96.7            |
| 93.7            |
| 0.8             |
| 2.0             |
| 0.2             |
| 0.9             |
| 0.7             |
| 0.5             |
| 0.1             |
| 0.0             |
| 0.8             |
| 1.4             |
| 0.9             |
| 1.5             |

South Central 
98.4 
95.5 
0.7 
2.3 
0.5 
0.6 
0.2 0.7 
0.0 
0.1 0.1 
0.6 
0.1 
0.3 
South East 
97.7 
95.6 
1.3 
2.5 
0.0 
0.4 
0.2 
0.1 
0.0 0.0 
0.1 
0.7 
0.6 
0.6 
South West 
98.4 
95.4 
0.5 
1.9 
0.6 
1.8 
0.3 
0.8 
0.1 
0.0 
0.2 
0.1 
0.0 
0.0 
West Midlands 
97.6 
94.5 
1.7 
4.2 
0.0 0.0 0.0 
0.1 0.1 
0.0 
0.1 
0.2 
0.5 
1.1 
Yorkshire and the 
Humber 
95.5 
93.9 
1.5 
2.6 
0.5 
0.6 
0.3 
0.6 
0.2 
0.0 
1.6 
1.8 
0.4 
0.5 

 
 
* Patients were recorded as 'other specified forms of diabetes mellitus' where there is a recognised cause of diabetes (e.g. post organ transplantation, steroid induced diabetes, post pancreatitis/pancreatectomy) or related to a syndrome (e.g. Prader Willi or Lawrence Moon Biedl Syndrome).  Where the patient has diabetes but the cause is unknown they are classified as 'not specified forms of Diabetes Mellitus'. Monogenic forms of diabetes include neonatal diabetes. Due to rounding to one decimal place, the total may not add to 100 per cent.

## 4.1.4 Registrations By Diabetes Type And Ethnicity

Table 5 shows the breakdown of children and young people with diabetes by type and ethnicity for England and Wales combined. There are a much higher proportion of children and young people with Type 2 diabetes in Asian, Black, Mixed and Other ethnicities compared to the White ethnic group. 

| Diabetes type     |   White  |   Asian  |   Black  |   Mixed  |   Other  |
|-------------------|----------|----------|----------|----------|----------|
| Not               |          |          |          |          |          |
|                   |          |          |          |          |          |
| Type 1            |          |          |          |          |          |
| Diabetes          |          |          |          |          |          |
| Mellitus          |          |          |          |          |          |
| 96.7              |     84.8 |     92.7 |     92   |     92.6 |     95.8 |
| Type 2            |          |          |          |          |          |
| Diabetes          |          |          |          |          |          |
| Mellitus          |          |          |          |          |          |
| 1.0               |      8   |          |          |          |          |
| 8.9               |      5.8 |      4.6 |      4.2 |      2.3 |      4.2 |
| Cystic Fibrosis   |          |          |          |          |          |
| Related           |          |          |          |          |          |
| Diabetes          |          |          |          |          |          |
| 0.5               |      0.3 |      0   |      0.6 |      0   |      0.2 |
| 0.3               |      0.6 |      0.2 |      0.2 |      0   |      0.3 |
| England           |          |          |          |          |          |
| Monogenic         |          |          |          |          |          |
| forms of          |          |          |          |          |          |
| Diabetes (gene    |          |          |          |          |          |
| known)            |          |          |          |          |          |
| and               |          |          |          |          |          |
| Wales             |          |          |          |          |          |
| 0.0               |      0.3 |      0   |      0   |      0   |      0.1 |
| Monogenic         |          |          |          |          |          |
| forms of          |          |          |          |          |          |
| diabetes (gene    |          |          |          |          |          |
| unknown)          |          |          |          |          |          |
| 0.5               |      2.9 |      0.4 |      1.3 |      0   |      0.3 |
| Other             |          |          |          |          |          |
| specified         |          |          |          |          |          |
| forms of          |          |          |          |          |          |
| Diabetes          |          |          |          |          |          |
| Mellitus          |          |          |          |          |          |
| 1.0               |      2.2 |      0.9 |      1.3 |      3.3 |      1   |
| Not Specified     |          |          |          |          |          |
| forms of          |          |          |          |          |          |
| Diabetes          |          |          |          |          |          |
| Mellitus          |          |          |          |          |          |

stated 
Unknown 

## 4.2 Incidence Rates

4.2.1 Incidence rates by country for Type 1 diabetes This section includes age and sex-specific diabetes population incidence rates for Type 1 diabetes for 2012-13. The age-specific incidence rate is defined as the number of newly diagnosed cases of diabetes in a specific age group over a specific time period (i.e. 2012-13 year period) per total number of children and young people in that age group in the general population. Recent evidence suggests that the incidence of Type 1 diabetes in children is rising and may double by 2020, which has important health care implications.5 NPDA 
incidence time trends need to be interpreted with caution, as the increase may be due to better coverage or ascertainment of patients with diabetes, rather than to a true increase in incidence. However, as numbers of cases have stabilised ascertainment is likely to be close to 100%.  
 
 
Table 6a and Figure 4a show Type 1 diabetes incidence rates by age and sex for England and Wales in 2012-13. The age group of 10-14 years had the highest rate of incidence of Type 1 diabetes. In England and Wales, males had a higher rate of incidence than females, except in the 5-9 year age group. As the number of newly diagnosed patients aged 20-24 years cared for in a PDU is small, the incidence rate is not shown. Table 6b shows the numbers of newly diagnosed children and young people with Type 1 diabetes for England and Wales. There were 2,642 newly diagnosed patients with Type 1 diabetes, under the age of 20 years, in England and Wales during 2012-13 cared for in a PDU, with slightly more boys than girls. Figure 3b shows the overall incidence time trends by age over the last 3 audit year cycles. There have been minor changes in incidence but no clear trend in any direction. 

 
England 
Wales 
England and Wales 
 Age Group 
Boys 
Girls 
Boys 
Girls 
Boys 
Girls 
0-4 
14.5 
13.8
19.5
19.4
14.7 
14.1 
5-9 
22.9 
24.3 
23.3 
33.1 
22.9 
24.8 
10-14 
37.7 
31.5
30.7
31.2
37.3 
31.5 
15-19 
8.2 
6.0 
7.9 
5.2 
8.2 
6.0 
Total under 20 
20.3 
18.5
19.9
21.5
20.3 
18.7 

  
England 
Wales
England and Wales
Age 
Group 
Boys Girls 
Not 
Specified Total
Boys Girls
Not 
Specified Total
Boys Girls 
Not 
Specified
Total 
0-4 
251 
229 
<5 
481 
18 
17 
0 
35 
269 
246 
<5 
516 
5-9 
361 
366 
5 
732 
20 
27 
0 
47 
381 
393 
5 
779 
.10-14 
580 
462 
<5 
1,046
27 
26 
0 
53 
607 
488 
<5 
1,099 
15-19 
138 
96 
<5 
235 
8 
5 
0 
13 
146 
101 
<5 
248 
Total 
under 20 1,330 1,153 
11 
2,494
73 
75 
0 
148 
1,403 1,228 
11 
2,642

                                                                                                                                                                       
             *The NPDA has not been able to show rates for the South Central region since it has not been possible 
             to disaggregate the South East region into its two networks due to this no longer existing as an NHS 
             administrative region and population estimates have not been available from ONS since 2011. 
 
                 5b) Time trends in the incidence of Type 1 diabetes by country and region from 2010-11 to 
                                                                                           2012-13 
 

 
*The NPDA has not been able to show rates for the South Central region since it has not been possible to disaggregate the South East region into its two networks due to this no longer existing as an NHS administrative region and population estimates have not been available from ONS since 2011. 

5.

Care processes and treatment targets  

 
Audit question: What proportion of children and young people with diabetes are getting the key age-specific processes of diabetes care, and what proportion achieve treatment targets? The NPDA collects information on the key care processes, recommended by the National Institute for Health and Clinical Excellence (NICE) for children and young people with diabetes.1  The NPDA measures the percentage of children and young people with diabetes who are receiving the seven key processes of care which include: 
x Glycated Haemoglobin A1c (HbA1c) 
x Body Mass Index (BMI) (both height and weight being recorded) 
x Blood pressure x Urinary albumin x Cholesterol x Eye screening x Foot examination Key care processes are recorded to monitor diabetes management and detect long-term complications at the earliest treatable stage. Guidelines specify a starting age of 12 years for commencing all care processes with the exception of HbA1c, which should be recorded in children and young people of all ages. The NPDA incorporates data collection for the agerelevant care process and provides analysis on this information. In the analysis, children and young people were included if they had received a complete year of care, i.e. for 2012-13 had been diagnosed prior to 01 April 2012 and for all care processes, except HbA1c, were 12 years of age or older on 01 April 2012. Furthermore, the data entered needed to be valid and have a date of measurement recorded that was within the Audit year. 

 
5.1
Care processes During 2012-13 there has been a marked improvement in the completion of all the individual key care processes (Table 7). The percentage of children and young people over the age of 12 years with all care processes recorded has almost doubled from 6.7% in 2011-12 to 12.1% in 2012-13 (Table 7 and Figure 6). It is recognised that achieving a 100% completion rate for any particular care process within an audit year is not always possible due to nonattendance at clinics by some patients. Also, there may still be significant under-reporting of the care process being performed, but not recorded for audit purposes. The NPDA cannot validate this without a case note analysis for which it does not have permission. Continued improvement is required even to meet the completion rate of key care processes for adults with diabetes. The proportion receiving all checks in the National Diabetes Audit (NDA) 
2011-12 for adults is 42.4% for those with Type 1 diabetes.2 

 
2004- 05 
2005- 06 
2006- 07 
2007- 08 
2008- 09 
2009- 10 
2010- 11 
2011- 12 
2012- 13 
HbA1c 
73.2 
77.6 
84.7 
89.1 
89.6 
90.1 
92.8 
89.3 
97.6 
BMI 
50.5 
53.0 
60.5 
73.2 
66 
70.2 
75.3 
64.7 
87.9 
Blood Pressure 
44.1 
40.6 
53.3 
60.1 
57.1 
58.8 
62.7 
67.7 
77.3 
Urinary Albumin 
18.7 
23.3 
30.3 
34.1 
32.2 
36.5 
40.3 
40.7 
49.5 
Cholesterol 
18.2 
17.5 
22.6 
32.1 
30.5 
29.9 
34.9 
44.4 
52.7 
Eye screening 
17.7 
15.3 
25.2 
25.7 
26.9 
25.8 
35.8 
36.9 
49.7 
Foot examination 
17.4 
15.4 
21.3 
23.5 
23.1 
24.5 
31.9 
34.4 
39.5 
2.0 
2.6 
3.6 
5.0 
5.2 
4.1 
5.8 
6.7 
12.1 
% (over 12) with all care 
processes recorded 

## 

Units can be identified in Appendix A by their PZ number. There was only one PDU that returned a result of 100% incompleteness, compared with four in 2011-12, with a wide variation for others. This is much improved on 2010-11 when there were 20 PDUs with 100% incompleteness of care processes. 

 
 
*A list of Paediatric Diabetes Unit PZ codes and corresponding Unit names can be found in Appendix A 

## 5.2 Hba1C Analysis

This section focuses specifically on the HbA1c care process as it is recommended as the best indicator of long-term diabetes control.1 The following analysis examines the percentage of children and young people, of all ages, who had their HbA1c checked and recorded as part of a care process. The outcome data for HbA1c are presented in section 6. In the analysis, children and young people with diabetes were included if they had receieved a complete year of care, i.e. for 2012-13 had been diagnosed prior to 01 April, 2012, and had at least one recorded HbA1c value. 

 
Table 8 and Figure 8 show the percentage of children and young people in different age groups by sex and nation that had their HbA1c measured. In England 97.6% of males and females under the age of 25 years had their HbA1c measured and 98.9% in Wales. This is considerably improved from 2011-12, where 89.3% of males and females in England and Wales had their HbA1c measured. 

|                |         |       | Boys    | Girls    |
|----------------|---------|-------|---------|----------|
|                | England | Wales | England | Wales    |
| 0-4            |         |       |         |          |
| 97.7           | 97.1    | 96.4  | 100.0   |          |
| 5-9            |         |       |         |          |
| 97.8           | 99.2    | 97.6  | 99.1    |          |
| 10-14          |         |       |         |          |
| 98.0           | 99.7    | 97.9  | 97.6    |          |
| 15-19          |         |       |         |          |
| 97.3           | 100.0   | 96.8  | 99.3    |          |
| 20-24          |         |       |         |          |
| 87.9           | 0.0     | 94.3  | 0.0     |          |
| Total Under 25 |         |       |         |          |
| 97.7           | 99.5    | 97.4  | 98.2    |          |

## 6. Outcomes Of Care 6.1 Treatment Targets

 Treatment targets can be viewed as part of the process of care or as an 'intermediate outcome', i.e. an intermediary step between a care process of the patient and a 'hard' endpoint such as development of complications.  For 2012-13 the NPDA has reported HbA1c values in accordance with the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), i.e. standardised concentrations of mmol/mol only. HbA1c values submitted to the NPDA using the Diabetes Control and Complications Trial (DCCT) aligned measures of percentage (%) were converted to mmol/mol using the formula: 

IFCC (mmol/mol) = (10.93 x DCT (%)) - 23.50
 
In addition, from 2011-12, multiple HbA1cs have been submitted on each patient to give a more representative measure of diabetes control over the year of care, and to bring the analysis into line with other international reporting audits and registries, making benchmarking more representative. There were a total of 76,011 HbA1c values submitted to the NPDA which could be included in this year's analysis, after excluding 1,570 observations which contained no diagnosis date for the patient. HbA1c values recorded less than three months from diagnosis were then excluded as they are not representative of patients overall diabetes control, leaving 73,068 values. After data cleaning (removal of invalid values, date of measurement outside the Audit year, invalid PDU code, invalid gender), a total of 67,806 HbA1c values were retained. In keeping with other international audits and registries the median HbA1c value, rather than the mean for the year for each patient, was used in the analysis.  Furthermore, there was little difference between means and medians at patient level. There was a total of 21,348 
patients with at least one HbA1c recorded during the Audit year, giving an average of 3.1 
HbA1c values per patient (range 1 to 19). 

 

## 6.1.1 Hba1C Target Achievement

Table 9 shows the percentage of children and young people with diabetes achieving the HbA1c target ranges of less than 58 mmol/mol, equal to or greater than 58 mmol/mol to equal to or less than 80 mmol/mol, and greater than 80 mmol/mol by country and sex in 2012-13. There has been a small decrease in the overall percentage of children and young people with diabetes achieving an HbA1c less than 58 mmol/mol from 17.4% in 2011-12 to 15.8% in 2012-13. However, this still represents either an improvement or similarity to 2009- 10 and 2010-11 where the figures were 14.5% and 15.8%, respectively. The greatest numbers (58.4%) of patients have an HbA1c between 58 mmol/mol and 80 mmol/mol. Just over one quarter of children and young people have an unacceptable HbA1c greater than 80 mmol/mol.  

|                   | HbA1c <58 mmol/mol    |
|-------------------|-----------------------|
| HbA1C             |                       |
| ≥                 |                       |
| 58  to            |                       |
| ≤                 |                       |
| 80 mmol/mol       |                       |
| HbA1 >80 mmol/mol |                       |
|                   | Female Male           |
| specified         | specified             |
| England           |                       |
| 1,479             | 1,724                 |
| %                 |                       |
| 15.3              | 16.5                  |
| Wales             |                       |
| 77                | 82                    |
| %                 |                       |
| 13.4              | 13.4                  |
| England           |                       |
| and Wales         |                       |
| 1,556             | 1,806                 |
| %                 |                       |
| 15.1              | 16.4                  |

 
decline year on year of the percentage of children and young people with an HbA1c greater interpretation of this change, due to the difference in the analysis of HbA1c summarised above. In addition, results are not exactly comparable with those from 2010-11 where only one HbA1c value was submitted to the Audit compared to multiple HbA1cs from 2011-12 onwards. 


 
England 
Wales 
England and Wales 
2010-11 
2011-12 
2012-13 
2010-11 
2011-12 
2012-13 
2010-11 
2011-12 
2012-13 
<48  
4.3 
3.8 
3.6
4.6
3.8
2.8
4.3 
3.8
3.6
≥48 and 
<58 
11.4 
13.6 
12.3 
12.9 
13.5 
10.6 
11.5 
13.6 
12.2 
Total <58 
15.7 
17.4 
15.9 
17.5 
17.3 
13.4 
15.8 
17.4 
15.8 
≥58 and ≤80 
55.5 
56.2 
58.3 
56.8 
55.4 
59.5 
55.5 
56.2 
58.4 
>80 and 
≤102 
21.0 
19.5 
19.1 
17.8 
20.1 
19.7 
20.8 
19.5 
19.1 
>102 and 
≤124 
5.6 
5.0 
4.7
6.0
5.3
5.3
5.7 
5.1 
4.8
>124 and 
≤147 
2.0 
1.7 
1.9 
1.9 
1.9 
2.0 
2.0 
1.7 
1.9 
>147and 
≤169 
0.2 
0.1 
0.0 
0.0 
0.0 
0.1 
0.2 
0.1 
0.0 
>169 
0.0 
0.0 
0.0 
0.0 
0.1 
0.0 
0.0 
0 
0.0 

 

 
White 
Asian 
Black 
Mixed 
Other 
Not 
stated 
Unknown 
Total 
HbA1c <58 
Number 
 
65 
162 
43 
46 
593 
18 
3,345 
% 
15.9 
12.5 
15.7 
12.0 
16.0 
16.3 
18.6 
15.8 
Number 
9,040 
265 
540 
157 
166 
2,127 
54 
12,349 
HbA1  ≥58 to ≤80 
% 
59.4 
51.1 
52.3 
43.7 
57.6 
58.5 
55.7 
58.4 
HbA1 >80 
Number 
3,768 
189 
331 
159 
76 
917 
25 
5,465 
% 
24.8 
36.4 
32.0 
44.3 
26.4 
25.2 
25.8 
25.8 
Total 
 Number 
15,226 
519 
1,033 
359 
288 
3,637 
97 
21,159 
 % 
100 
100 
100 
100 
100 
100 
100 
100 

 Please note: where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c less than 58 mmol/mol for an individual PDU should be interpreted with caution, as it may not truly represent that unit's overall outcome.  Incomplete HbA1c data for a patient is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period. 

See Appendix A for further details for each PDU. 


*A list of PDU PZ codes and corresponding Unit names can be found in Appendix A. 

## 6.1.2 Paediatric Diabetes Unit Variation In Hba1C

Table 12 shows mean and standard deviation, median and interquartile range for HbA1c for England, Wales and the English regions. Overall for England and Wales there has been no change in the mean but a decrease in the median HbA1c by 2 mmol/mol from 2011-12 to 2012-13. The change is more marked in England where the median has reduced by 2 mmol/mol with the mean remaining the same, whereas in Wales the fall in median was 1 mmol/mol with an increase in the mean of 1 mmol/mol. The mean and median values for each region in England are similar, with means ranging between 70 and 75 mmol/mol, and medians between 67 and 72 mmol/mol.  This is an improvement from 2011-12 where the respective figures were between 68 and 76 mmol/mol for mean and 67 to 73 mmol/mol for median HbA1c by region. Every region within England (apart from the median in the North West and mean in South Central) has either shown an improvement or kept the same mean and median HbA1c between 2011-12 and 2012-13.  

25th 
75th 
Interquartile 
 
Mean 
Median 
Standard 
deviation 
percentile 
percentile 
range 
England 
73 (73) 
69 (71) 
18 
61 
81 
20 
Wales 
74 (73) 
70 (71) 
18 
62 
81 
20 
England and Wales 
73 (73) 
69 (71) 
18 
61 
81 
20 
Regions in England 
East 
75 (75) 
72 (72) 
18 
63 
83 
20 
East Midlands 
70 (71) 
68 (68)
17
60
78 
18
London 
73 (74) 
70 (71) 
19 
61 
83 
22 
North East 
72 (73) 
69 (71) 
17 
61 
79 
18 
North West 
72 (72) 
69 (68) 
17 
61 
80 
19 
South Central 
70(68) 
67 (67) 
16 
60 
77 
17 
South East 
73 (74) 
70 (71) 
18 
62 
81 
19 
South West 
72 (73) 
68 (71)
18
61
80 
19
West Midlands 
74 (76) 
71 (73) 
19 
62 
83 
21 
Yorkshire and 
the Humber 
72 (73) 
69 (71) 
17 
60 
80 
19 

 
The following box plots (Figures 13 to Figure 23) show the median, interquartile range and outlying values of HbA1c measurements by region and by PDU (refer to Appendix A for the identification of each PDU). The PDUs have been separated by the various countries and regions in England. 

Please note: Where the % of incomplete HbA1c data is high, or the number of submitted patients low, care must be taken in the interpretation of the results for an individual PDU. Refer to Appendix A for details of incomplete HbA1c data and patient numbers. 

 
respectively. 

Reference lines represent the upper and lower NICE HbA1c targets of 58 mmol/mol and 80 mmol/mol respectively. 



6.2 
Funnel plots of mean HbA1c and %>80mmol/mol by Paediatric Diabetes Unit 
 
'Funnel plots' are recommended as a graphical aid for institutional comparisons, in which an estimate of an underlying quantity is plotted against an interpretable measure of its precision.3 They are named this way because they include 'control limits' constructed from significance limits or confidence intervals, which form a funnel around the target outcome, in an analogy to control charts used for industrial quality improvement. They are flexible, attractively simple and avoid spurious ranking of institutions into league tables. They can be used for comparing proportions and changes in rates, assessing association between outcome and volume of cases. They have been recommended as a method of comparing healthcare providers by the National Clinical Audit Advisory Group.4 Figure 24 shows a funnel plot of unadjusted mean HbA1c for PDUs in England and Wales, obtained from the unit mean of individual patient median HbA1c values. PDUs can be identified using Appendix B which provides the unit size and unadjusted mean HbA1c which can be used as x and y coordinates to find an individual unit. The limits for the outliers have been set as 5% and 2% which was recommended by the National Clinical Audit Advisory Group (4). These limits represent an 'alert' or an 'alarm' respectively for the performance indicator of an individual unit. 


 
*Refer to Appendix B to identify an individual PDU. The National Clinical Audit Advisory Group also recommends that funnel plots should be statistically adjusted to take account of 'casemix' variation between providers' treatment populations.  Adjustment is a method of dealing with over-dispersion in the raw data due to unmeasured risk factors i.e. patient characteristics. NPDA data contains some, but by no means all, the patient risk factors which may affect target achievement. Table 13 shows a multivariate multiple regression analysis of patient risk/predictive factors for HbA1c. A negative regression coefficient denotes a negative effect on the outcome and vice versa for a positive coefficient. The proportion of the variance in values explained by a regression model is given by the R-squared statistic. The R-squared for this model is 0.083 i.e. the variables included explains 8.3% of the variance. 


| HbA1c value (mmol/mol)       | Coef.         |
|------------------------------|---------------|
| 95% Confidence               |               |
| Age (years)                  |               |
| 0.92                         | [0.86-0.99]   |
| Gender                       |               |
|                              |               |
|                              |               |
| Male                         |               |
| 0                            |               |
|                              |               |
| Female                       | 1.12          |
| Not specified                | -2.86         |
| Ethnicity                    |               |
|                              |               |
|                              |               |
| White                        |               |
| 0                            |               |
|                              |               |
|                              |               |
| Asian                        | 4.96          |
| Black                        | 0.79          |
| Mixed                        | 5.54          |
| Other                        | 0.28          |
| Not stated                   | 0.04          |
| Unknown                      | 0.67          |
| Deprivation (quintiles)      |               |
|                              |               |
|                              |               |
| 1st                          | 0             |
|                              |               |
| 2nd                          | 1.18          |
| 3rd                          | 3.22          |
| 4th                          | 5.34          |
| 5th                          | 5.73          |
| Duration of diabetes (years) |               |
| 0.39                         | [0.33-0.44]   |
| Constant                     |               |
| 55.28                        | [54.35-56.21] |

The results of the regression modelling can be used to predict HbA1c values for each patient using the significant risk factors in Table 13. Figure 25 shows a funnel plot of the adjusted mean HbA1c by PDU which takes into account the 'casemix' for each individual PDU.  PDUs can be identified using Appendix B which provides the unit size and adjusted mean HbA1c which can be used as x and y coordinates to find an individual unit.  The adjusted mean HbA1c in this model does not take into account the effect of any remaining unmeasured risk factors, which we know from the R-squared value comprise the majority of the variance. If the variables used for adjustment only explain a small proportion of the differences in patients' HbA1c, the adjusted values will show less variation than the observed values but more than would be present if data was included for all risk factors. This is because many other risk factors are contributing to the variance which has not been included in the model. 

interval 
p-value 
Std. Err. 

The reduction in dispersion can be seen by comparing Figure 25 to Figure 24.  By reference to Appendix B individual PDUs can obtain their unadjusted and adjusted mean HbA1c. The adjusted mean HbA1c gives a measure of performance taking into account the significant variables in the population that influence it. For some units this influences where they lie within the funnel plot and whether they are defined as an outlier or not. 



*Refer to Appendix B to identify an individual PDU. 

 
 
In a similar manner to using the mean HbA1c for a PDU, funnel plots for thresholds can be created using pre-defined 'cut-offs'. Figure 26 shows a funnel plot of the unadjusted proportion of patients with an HbA1c above 80 mmol/mol.  PDUs can be identified using Appendix B, which provides the unit size and unadjusted percentage of patients with an HbA1c greater than 80 mmol/mol which can be used as x and y coordinates to find an individual unit.   

 
*Refer to Appendix B to identify an individual PDU. 

Using a threshold which has been adjusted in the same way as mean HbA1c is problematic because of the reduction in variation mentioned above. An alternative is to fit a logistic regression model, which can be used to predict the probability that HbA1c levels meet or do not meet a defined threshold. 

Table 14 displays a logistic regression model of risk factors for the proportion of children and young people with diabetes with an HbA1c greater than 80 mmol/mol. Logistic regression generates odds ratios (ORs) rather than regression coefficients; an OR of unity means there is no effect, an OR greater than 1 means an increase in the outcome, and vice versa for an OR less than 1. The R-squared for this model is 0.071 i.e. 7.1% of the variability is explained by the variables in the model. 


| Above 80 (mmol/mol)          | Odds Ratio      |
|------------------------------|-----------------|
| 95% Confidence               |                 |
| Age (years)                  |                 |
| 1.17                         | [1.15-1.18]     |
| Gender                       |                 |
|                              |                 |
| Male                         |                 |
| 1                            |                 |
|                              |                 |
| Female                       | 1.13            |
| Not specified                | 1.00            |
| Ethnicity                    |                 |
|                              |                 |
| White                        |                 |
| 1                            |                 |
|                              |                 |
|                              |                 |
| Asian                        | 1.83            |
| Black                        | 1.30            |
| Mixed                        | 2.27            |
| Other                        | 1.01            |
| Not stated                   | 1.04            |
| Unknown                      | 1.15            |
| Deprivation (quintiles)      |                 |
|                              |                 |
| 1st                          |                 |
| 1                            |                 |
|                              |                 |
| 2nd                          | 1.18            |
| 3rd                          | 1.58            |
| 4th                          | 2.06            |
| 5th                          | 2.15            |
| Duration of diabetes (years) |                 |
| 1.03                         | [1.0196-1.0351] |


interval 
p-value 
Std. Err. 

 
*Refer to Appendix B to identify an individual PDU. 


## 7. Conclusions And Recommendations

The results from this 2012-13 NPDA report for England and Wales indicates that those delivering care to children and young people with diabetes are developing strategies demonstrating quality improvement. There have been significant improvements in the recording of individual care processes, albeit that the proportion of patients receiving all seven care processes is still extremely low. The median HbA1c has fallen by 2 mmol/mol since 2011-12, with this rate of fall being consistent with those identified in other European countries in which improvements have already taken place. Furthermore, this now represents the third year where there has been a fall in median HbA1c. Casemix adjustment in mean HbA1c and percentage of patients with poor outcomes (greater than 80 mmol/mol) for each PDU have been reported for the first time in 2012-13, allowing PDUs to observe their outlier status before and after adjustment for their patient characteristics. However, the models of adjustment can only take into account those patient related variables that are collected by the NPDA. For mean HbA1c the model only accounts for just over 8% of the variability and for the proportion of patients with an HbA1c >80mmol/mol the model only accounts for just over 7% of the variability.  Clearly, therefore over 90% of the variability in outcome must be explained by service related factors such as structure, resource and delivery of care. It is likely that the improvements demonstrated in this report have been achieved by the concerted efforts of all PDUs to engage in the work of their regional diabetes networks. The peer review quality assurance programme has facilitated the sharing of all the good practices that influence improved outcomes and it has facilitated their early adoption across the nation. This should lead to a reduction in the variability in outcomes. In England, the Best Practice Tariff introduced in 2012 will undoubtedly start to provide the ability to financially resource PDUs in a manner that will provide improved quality of care. It is still probably too early for the 2012-13 NPDA data collection and report to demonstrate the influence that its introduction may have had. Furthermore, any change is going to be slow as the population of children and young people with diabetes in England and Wales is large. The peer review quality assurance programme, which will complete its first round of site visits for both England and Wales by the end of 2014, will be able to help PDU's to identify their strengths and weaknesses, and encourage all PDUs to develop ongoing work plans to drive up quality of care. All PDUs should utilise the data provided in this report in a positive manner. In addition, discussions and actions at both local and regional network level should be employed to develop the strategies that will lead to the delivery of better quality care and improved outcomes. These will continue to be measured by ongoing participation in the NPDA. Despite the improvements demonstrated in the report, it is not the time to rest on our laurels. There is clearly much work to be done to reduce variability and improve outcomes across England and Wales. PDUs and all healthcare professionals involved in the care of children and young people with diabetes have a responsibility to ensure optimal achievable outcomes for their patients so they can live as normal, and complication free, lifestyles as possible. 

## 8. Acknowledgements And Collaborators

 National Paediatric Diabetes Audit Project Board 
 Dr Jeremy Allgrove, Consultant Paediatric Endocrinologist, Barts Health NHS Trust (IT 
Solutions Adviser) 
 Ms Katie Beddows, Paediatric Diabetes Specialist Nurse, Stockport NHS Foundation 
Trust (Senior User) 
 Dr Fiona Campbell, Consultant Paediatric Diabetologist, Leeds Teaching Hospitals NHS 
Trust 
 Ms Kate Fazakerley, Parent representative 
 Dr Michael Soljak, Clinical Research Fellow, Imperial College London 
 Dr Justin Warner, Clinical Lead, RCPCH and Consultant in Paediatric Endocrinology and 
Diabetes, University of Wales Hospital Project Management 
 Mr Siôn Morris, Project Manager, RCPCH, 
 Dr Alison Elderfield, Project Manager, RCPCH 
 Ms Tyler Moorehead, Programme Manager, RCPCH 

## 

Project Support 
 Ms Naima Hussein, Project Administrator, RCPCH 
 Ms Melanie David-Feveck, Project Administrator, RCPCH 
 
Data Analysis  
 Dr Michael Soljak (Clinical Research Fellow, Imperial College London) 
 Emilie Kottenmeier (Research Assistant, Imperial College London) 
 
National Paediatric Diabetes Audit Dataset Working Group 
 Dr Fiona Campbell, Consultant Paediatric Diabetologist, Leeds Teaching Hospitals NHS 
Trust (Chair) 
 Dr Rakesh Amin, Consultant in Paediatric and Adolescent Endocrinology and Diabetes, 
Great Ormond Street Hospital for Children NHS Trust 
 Dr James Greening, Consultant Paediatric Endocrinologist and Diabetologist, University 
Hospitals Leicester NHS Trust 
 Dr Piyusha Kapila, Consultant Paediatrician, North Middlesex University Hospital NHS 
Trust) 
 Ms Helen Thornton, Paediatric Diabetes Specialist Nurse, St Helens and Knowsley 
Teaching Hospitals NHS Trust 
 
National Paediatric Diabetes Audit Patient Reported Experience and Outcome Measures 
Working Group 
 Dr Deborah Christie, Consultant Clinical Psychologist and Reader in Paediatric and 
Adolescent Psychology, University College London Hospitals NHS Foundation Trust 
(Chair) 
 Ms Judith Campbell, Paediatric Diabetes Specialist Nurse, Central Manchester University 
Hospitals NHS Foundation Trust 
 Ms Kate Fazakerley, Parent representative 
 Professor Peter Hindmarsh, Professor of Paediatric Endocrinology, University College 
London 
 Mr Neil Musgrove, Parent representative 
 Dr Shakeel Rahman, Consultant Paediatrician, Harrogate Health Care NHS Trust 
 Dr Nicola Trevelyan, Consultant Paediatrician, Southampton University Hospitals NHS 
Trust 
National Paediatric Diabetes Audit Collaborators 
 Association of Children's Diabetes Clinicians 
 British Dietetic Association 
 The British Psychological Society 
 British Society for Paediatric Endocrinology and Diabetes 
 Diabetes UK 
 Royal College of Nursing 
 Juvenile Diabetes Research Foundation (JDRF) 
 

## 9. References

 
1.  National Institute for Health and Clinical Excellence. Diagnosis and management of Type 1 
diabetes in children, young people and adults: National Institute for Health and Clinical Excellence, 2004. 2. Health and Social Care Information Centre. National Diabetes Audit 2011–2012 Report 1: 
Care Processes and Treatment Targets. Leeds: Health and Social Care Information Centre, 2013. 
3. Spiegelhalter DJ. Funnel plots for comparing institutional performance. Statistics in 
Medicine 2005;24(8):1185-202 doi: 10.1002/sim.1970 [published Online First: Epub Date]. 
4. National Clinical Audit Advisory Group. Detection and management of outliers: guidance 
prepared by National Clinical Audit Advisory Group: Healthcare Quality Improvement 
Partnership, 2011. 5. Department of Health. National Service Framework for Diabetes: London: Department of 
Health, 2001. 

care 
% of 
processes  
records of 
incomplete 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
outcome 
excluded 
from 
HbA1c 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
to NPDA 
Total no. 
submitted 
of patients 
PDU 
code 
PDU Name 

## Appendix A: Data On Paediatric Diabetes Units In The 2012-13 National Paediatric Diabetes Audit

NOTE: Where the percentage of incomplete HbA1c data is high, or the number of patients submitted low, the validity of the percentage with an HbA1c <58 
mmol/mol (7.5%), mean and median HbA1c for an individual Paediatric Diabetes Unit should be interpreted with caution, as it may not truly represent that unit's overall outcome. Incomplete data is defined as: no HbA1c submitted, invalid HbA1c result, no date attached to the result or date outside the Audit period. HbA1c result less than 3 months from diagnosis are not included in the analysis. 

 
*Eligible patients were those greater than 3 month post diagnosis. 

**For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value and a date of submission which was within the Audit year. 

Where more than one HbA1c was submitted for a patient the median value was used for the Audit year. 

except Hba1c 
analysis 
analysis 
88 
84 
56 
28 
33.3% 
12.5% 
73.9 
68.8 
22.3% 
211 211 
172 
39 
18.5% 
12.8% 
72.8 
68.0 
39.2% 
136 
133 
108 
25 
18.8% 
12.0% 
70.3 
69.4 
30.6% 
148 
145 
123 
22 
15.2% 
29.3% 
66.2 
64.5 
23.4% 
257 
254 
223 
31 
12.2% 
20.6% 
70.0 
68.0 
29.1% 
PZ001 
Singleton Hospital, Abertawe Bro 
Morgannwg University Health Board, 
Wales 
PZ002 
Norfolk and Norwich University 
Hospital, Norfolk and Norwich 
University Hospital Trust, East of 
England 
PZ004 
Northampton General Hospital,  
Northampton General Hospital NHS 
Trust, East Midlands 
PZ005 
Derbyshire Children's Hospital, Derby 
Hospitals NHS Foundation Trust, East 
Midlands 
PZ006 
Doncaster Royal Infirmary, Doncaster and 
Bassetlaw Hospitals NHS Foundation 
Trust, Yorkshire and the Humber 
PZ007 
John Radcliffe Hospital, Oxford 
344 
340 
299 
41 
12.1% 
29.8% 
64.0 
63.0 
29.0% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
75 75 75 
0 
0.0% 
6.7% 
76.2 
70.5 
56.4% 
121 
116 
106 
10 
8.6% 
11.3% 
75.5 
72.1 
38.9% 
126 126 
105 
21 
16.7% 
4.8% 
80.3 
78.0 
39.9% 
to NPDA 
Total no. 
submitted 
of patients 
Radcliffe Hospitals NHS Trust, South 
Central 
PDU 
code 
PDU Name 
PZ009 
Macclesfield District General Hospital, 
East Cheshire NHS Trust, North West 
96 
95 
84 
11 
11.6% 
21.4% 
69.9 
66.3 
30.1% 
PZ010 
Luton and Dunstable Hospital, Luton 
and Dunstable Hospital NHS 
Foundation Trust, East of England 
PZ011 
Glan Clwyd District General Hospital, 
Besti Cadwaladr University Health 
Board, Wales 
PZ012 
Barnet Hospital, Barnet and Chase 
Farm Hospitals NHS Trust, London and 
South East 

55 
53 
47 
6 
11.3% 
12.8% 
76.5 
73.0 
56.1% 
67 
65 
58 
7 
10.8% 
24.1% 
71.2 
68.3 
33.8% 
94 
92 
83 
9 
9.8% 
20.5% 
70.6 
66.1 
22.3% 
90 
89 
55 
34 
38.2% 
10.9% 
70.7 
67.2 
52.0% 
234 
232 
201 
31 
13.4% 
10.5% 
75.0 
72.7 
73.9% 
PZ014 
Chase Farm Hospital, Barnet and Chase 
Farm Hospitals NHS Trust, London and 
South East 
PZ015 
Wythenshawe Hospital, University 
Hospital of South Manchester NHS 
Foundation Trust, North West 
PZ016 
Bassetlaw Hospital, Doncaster and 
Bassetlaw Hospitals NHS Foundation 
Trust, Yorkshire and the Humber 
PZ017 
Dorset County Hospital, Dorset County 
Hospital NHS Foundation Trust, South 
Central 
PZ018 
Worthing Hospital, Western Sussex 
Hospitals NHS, London and South East 
130 
129 
118 
11 
8.5% 
12.7% 
76.4 
71.9 
21.6% 
PZ019 
Basildon Hospital, Basildon and 
Thurrock University Hospitals NHS 
Foundation Trust, East of England 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
38 
36 
34 
2 
5.6% 5.9% 
76.5 
68.7 
64.8% 
118 
117 
0 
117 
100.0% 
NO 
DATA 
NO 
DATA 
NO 
DATA 
92.9% 
114 
113 
93 
20 
17.7% 
11.8% 
78.6 
76.0 
30.6% 
167 
165 
139 
26 
15.8% 
20.1% 
71.5 
68.0 
39.1% 
to NPDA 
Total no. 
submitted 
of patients 
PDU 
code 
PDU Name 
PZ020 
Diana Princess Of Wales Hospital, 
Northern Lincolnshire and Goole 
Hospitals NHS Foundation Trust, 
Yorkshire and the Humber 
PZ021 
Wexham Park Hospital, Heatherwood 
and Wexham Park Hospitals Trust, 
South Central 
PZ022 
West Cumberland Hospital, North 
Cumbria University Hospitals NHS 
Trust, North West 
PZ023 
St George's Hospital, St George's 
Healthcare NHS Trust, London and 
South East 

95 
90 
77 
13 
14.4% 
11.7% 
73.9 
70.0 
19.1% 
64 
60 
55 
5 
8.3% 
18.2% 
69.9 
70.0 
34.7% 
327 
325 
281 
44 
13.5% 
13.2% 
74.9 
72.0 
16.0% 
258 
256 
230 
26 
10.2% 
11.7% 
75.4 
71.0 
67.3% 
PZ024 
East Kent Hospitals NHS Trust, East 
Kent Hospitals University NHS 
Foundation Trust, London and South 
East 
PZ026 
Hull Royal Infirmary, Hull and East 
Yorkshire Hospitals NHS Trust, 
Yorkshire and the Humber 
PZ027 
Friarage Hospital, South Tees Hospitals 
NHS Trust,  Yorkshire and the Humber/ 
North East 
PZ028 
Stoke Mandeville Hospital, 
Buckinghamshire Hospitals NHS Trust, 
South Central 
PZ030 
Leighton Hospital, Mid-Cheshire 
Hospitals NHS Trust, North West 
110 
107 
98 
9 
8.4% 
26.5% 
65.5 
64.0 
40.7% 
PZ031 
St Richard's Hospital, Western Sussex 
Hospitals NHS Trust, London and South 
88 88 
81 
7 
8.0% 
8.6% 
74.0 
72.7 
45.3% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
121 121 
98 
23 
19.0% 
13.3% 
71.0 
67.5 
27.1% 
251 
244 
209 
35 
14.3% 
24.4% 
67.2 
64.0 
34.9% 
143 
139 
124 
15 
10.8% 
12.9% 
73.3 
69.0 
58.7% 
to NPDA 
Total no. 
submitted 
of patients 
East 
PDU 
code 
PDU Name 
PZ032 
Royal Victoria Infirmary, The Newcastle 
Upon Tyne Hospital Trust, North East 
322 
318 
283 
35 
11.0% 
15.6% 
71.8 
67.7 
41.4% 
PZ033 
Queens Hospital, Burton Hospitals NHS 
Trust, West Midlands 
115 
114 
105 
9 
7.9% 
9.5% 
72.3 
69.4 
55.8% 
PZ034 
Royal Hampshire County Hospital, 
Winchester and Eastleigh Healthcare 
NHS Trust, South Central 
PZ035 
Royal Berkshire Hospital, Royal 
Berkshire NHS Foundation Trust, South 
Central 
PZ036 
Whipps Cross University Hospital, 
Whipps Cross University NHS Trust, 
London and South East 

66 
65 
56 
9 
13.8% 
8.9% 
81.2 
76.0 
57.3% 
276 
256 
239 
17 
6.6% 
11.7% 
74.0 
70.0 
45.5% 
242 242 
207 
35 
14.5% 
8.2% 
80.2 
77.1 
60.7% 
293 293 
264 
29 
9.9% 
28.8% 
65.6 
65.0 
57.5% 
PZ038 
Wycombe General, Buckinghamshire 
Hospitals NHS Trust, South Central 
114 
113 
102 
11 
9.7% 
11.8% 
75.5 
72.8 
13.7% 
PZ040 
Birmingham Heartlands Hospital, Heart 
of England NHS Foundation Trust, 
West Midlands 
PZ041 
Addenbrooke's Hospital, Cambridge 
University Hospitals NHS Foundation 
Trust, East of England 
PZ042 
Nottingham Children's Hospital, 
Nottingham University Hospitals NHS 
Trust, East Midlands 
PZ045 
Whittington Hospital, Whittington 
Hospital NHS Trust, London and South 
East 
PZ047 
Airedale General Hospital, Whittington 
74 
73 
66 
7 
9.6% 
10.6% 
70.2 
67.0 
28.3% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
121 
120 
107 
13 
10.8% 
14.0% 
72.9 
70.0 
49.7% 
155 
151 
140 
11 
7.3% 
20.0% 
67.4 
66.3 
21.7% 
120 
122 
101 
21 
17.2% 
11.9% 
78.0 
75.0 
11.9% 
to NPDA 
Total no. 
submitted 
of patients 
Hospital NHS Trust, Yorkshire and the 
Humber 
PDU 
code 
PDU Name 
PZ048 
Lincoln County Hospital, United 
Lincolnshire Hospitals NHS Trust, East 
Midlands 
PZ049 
Warrington General Hospital, 
Warrington and Halton Hospitals NHS 
Foundation Trust, North West 
 
PZ050 
Queen Mary's Hospital for Children, 
Epsom and St Helier Trust, London and 
South East 
PZ052 
Nevill Hall Hospital, Aneurin Bevan 
Health Board, Wales 
92 
91 
66 
25 
27.5% 
12.1% 
76.2 
75.5 
38.2% 

101 
99 
79 
20 
20.2% 
11.4% 
74.3 
73.0 
16.1% 
109 
108 
90 
18 
16.7% 
11.1% 
79.0 
79.0 
30.5% 
385 
380 
325 
55 
14.5% 
10.5% 
73.6 
69.4 
0.0% 
PZ053 
Scunthorpe General Hospital, Northern 
Lincolnshire and Goole Hospitals NHS 
Foundation Trust, Yorkshire and the 
Humber 
PZ054 
Poole General Hospital, Poole Hospital 
NHS Trust, South Central 
194 
193 
161 
32 
16.6% 
14.9% 
70.1 
68.0 
27.8% 
PZ055 
Leicester Royal Infirmary, University 
Hospitals Leicester NHS Trust, East 
Midlands 
PZ056 
West Wales General Hospital, Hywel 
Dda Health Board, Wales 
73 
70 
56 
14 
20.0% 
14.3% 
69.1 
67.2 
8.6% 
PZ057 
Kingston Hospital, Kingston Hospital 
NHS Trust, London and South East 
153 
149 
132 
17 
11.4% 
22.7% 
65.7 
63.8 
82.1% 
PZ058 
Newham General Hospital, Newham 
University Hospital NHS Trust, London 
and South East 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
96 
93 
83 
10 
10.8% 10.8% 
75.4 
73.0 
10.2% 
113 
111 
104 
7 
6.3% 
13.5% 
76.3 
71.0 
64.3% 
195 
190 
161 
29 
15.3% 
22.4% 
70.0 
67.0 
39.3% 
136 136 
112 
24 
17.6% 
13.4% 
71.5 
70.2 
30.8% 
190 
187 
159 
28 
15.0% 
10.1% 
75.8 
72.0 
100.0% 
to NPDA 
Total no. 
submitted 
of patients 
PDU 
code 
PDU Name 
PZ059 
The Royal London Hospital, Barts and 
the London NHS Trust, London and 
South East 
PZ060 
Royal Devon and Exeter, Royal Devon 
and Exeter NHS Foundation Trust, 
South West 
PZ062 
Croydon University Hospital, Croydon 
Health Services NHS Trust, London and 
South East 
PZ064 
Chesterfield Royal Hospital, 
Chesterfield Royal Hospital NHS 
Foundation Trust, East Midlands 
PZ065 
Staffordshire General Hospital, Mid-
Staffordshire NHS Foundation Trust, 
West Midlands 

93 
93 
83 
10 
10.8% 
7.2% 
74.6 
71.0 
29.7% 
212 
210 
175 
35 
16.7% 
14.3% 
75.6 
72.0 
17.4% 
204 
202 
17 
185 
91.6% 
23.5% 
71.6 
66.0 
21.3% 
PZ067 
Royal Cornwall Hospital, Royal 
Cornwall Hospitals NHS Trust, South 
West 
PZ068 
Royal United Bath Hospital, Royal 
United Hospital Bath NHS Trust, South 
West 
PZ069 
Stepping Hill Hospital, Stockport NHS 
Foundation Trust, North West 
140 
138 
122 
16 
11.6% 
20.5% 
68.1 
66.0 
61.0% 
PZ072 
West Suffolk Hospital, West Suffolk 
Hospital NHS Trust, East of England 
129 
127 
108 
19 
15.0% 
20.4% 
67.1 
65.6 
54.7% 
PZ073 
Alexandra Hospital, Worcestershire 
Acute Hospitals NHS Trust, West 
Midlands 
PZ074 
Alder Hey Hospital, Alder Hey 
Children's NHS Foundation Trust, North 
248 
246 
211 
35 
14.2% 
16.6% 
72.4 
69.0 
25.4% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
167 
169 
149 
20 
11.8% 
16.1% 
68.5 
66.0 
29.5% 
189 
179 167 
12 
6.7% 
1.2% 
81.6 
80.3 
11.1% 
220 220 
189 
31 
14.1% 
12.2% 
75.0 
72.1 
51.0% 
to NPDA 
Total no. 
submitted 
of patients 
West 
PDU 
code 
PDU Name 
PZ075 
St. Mary's Hospital, Isle of Wight 
Healthcare NHS Trust, South Central 
53 53 
45 
8 
15.1% 
17.8% 
75.7 
68.3 
38.5% 
PZ076 
Colchester General Hospital, 
Colchester Hospital University NHS 
Foundation Trust, East of England 
PZ078 
North Staffordshire Hospital, University 
Hospital of North Staffordshire NHS 
Trust, West Midlands 
 
PZ080 
Sunderland Royal Hospital, City 
Hospitals Sunderland NHS Trust, North 
East 

51 
50 
42 
8 
16.0% 
35.7% 
61.7 
59.3 
97.8% 
63 63 
59 
4 
6.3% 
17.0% 
75.7 
69.5 
24.3% 
96 96 
83 
13 
13.5% 
8.4% 
73.5 
71.6 
48.8% 
94 94 
83 
11 
11.7% 
8.4% 
81.8 
78.7 
40.6% 
112 
103 
88 
15 
14.6% 
17.1% 
69.2 
66.1 
27.4% 
PZ082 
Evelina Children's Hospital at St 
Thomas Hospital, Guy's and St Thomas' 
NHS Foundation Trust, London and 
South East 
PZ084 
Kidderminster General Hospital, 
Worcestershire Acute Hospitals NHS 
Trust, West Midlands 
PZ085 
 Princess Royal University Hospital, 
Bromley, South London Healthcare 
NHS Trust, London and South East 
PZ086 
Hinchingbrooke Hospital, 
Hinchingbrooke Health Care NHS Trust, 
East of England 
PZ088 
Royal Surrey County Hospital, The 
Royal Surrey County Hospital NHS 
Foundation Trust, London and South 
East 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
81 81 
73 
8 
9.9% 
16.4% 
77.3 
74.0 
51.7% 
106 
104 
21 
83 
79.8% 
14.3% 
83.2 
81.0 
62.1% 
190 
187 
172 
15 
8.0% 
14.5% 
71.2 
67.3 
24.1% 
262 
260 
222 
38 
14.6% 
15.8% 
71.5 
66.8 
45.6% 
to NPDA 
Total no. 
submitted 
of patients 
PDU 
code 
PDU Name 
PZ089 
Northwick Park Hospital, North West 
London Hospitals NHS Trust, London 
and South East 
PZ090 
Pontefract General Infirmary, The Mid-
Yorkshire Hospitals NHS Trust, 
Yorkshire and the Humber 
PZ091 
East Lancashire Diabetic Service, East 
Lancashire Hospitals NHS Trust, North 
West 
PZ092 
Princess of Wales Hospital, Abertawe 
Bro Morgannwg University Health 
Board, Wales 
PZ094 
The Princess Royal, Royal Shrewsbury 
Hospitals NHS Trust, West Midlands 
260 
257 225 
32 
12.5% 
16.0% 
73.0 
70.0 
49.9% 

65 
34 
28 
6 
17.6% 
14.3% 
72.7 
67.5 
21.2% 
86 86 
70 
16 
18.6% 
20.0% 
69.6 
65.3 
50.0% 
225 
222 
216 
6 
2.7% 
13.9% 
72.3 
68.3 
28.2% 
350 
337 
295 
42 
12.5% 
27.5% 
67.1 
65.0 
26.6% 
PZ096 
Derriford Hospital, Plymouth Hospitals 
NHS Trust, South West 
176 
175 
153 
22 
12.6% 21.6% 
66.4 
65.0 
20.2% 
PZ097 
City Hospital Birmingham, Sandwell 
and West Birmingham Hospitals NHS 
Trust, West Midlands 
PZ099 
East and North Herts NHS Trust - 
incorp: Queen Elizabeth II , The Lister, 
East and North Hertfordshire NHS 
Trust, East of England 
PZ100 
North Devon District Hospital, Northern 
Devon Healthcare NHS Trust, South 
West 
PZ101 
Leeds Children's Hospital, Leeds 
Teaching Hospitals NHS Trust, 
Yorkshire and the Humber 
PZ102 
Hillingdon Hospital, Hillingdon Hospital 
153 
143 
131 
12 
8.4% 
13.0% 
76.5 
72.7 
22.4% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 5
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
84 84 84 
0 
0.0% 
11.9% 
78.5 
74.5 
21.5% 
126 
124 
107 
17 
13.7% 
17.8% 
74.8 
71.6 
35.2% 
195 193 
156 
37 
19.2% 
12.8% 
76.9 
75.5 
56.2% 
to NPDA 
Total no. 
submitted 
of patients 
NHS Trust, London and South East 
PDU 
code 
PDU Name 
PZ104 
Royal Albert Edward Infirmary, 
Wrightington, Wigan and Leigh NHS 
Foundation Trust, North West 
PZ105 
St Luke's Hospital, Bradford Teaching 
Hospitals NHS Trust, Yorkshire and the 
Humber 
PZ106 
Victoria Hospital, Blackpool, Fylde and 
Wyre Hospitals NHS Trust, North West 
112 
111 
94 
17 
15.3% 
17.0% 
70.4 
69.8 
51.8% 
PZ107 
Queen Elizabeth Hospital, Gateshead 
Health NHS Foundation Trust, North 
East 

92 
91 
83 
8 
8.8% 
14.5% 
67.7 
65.6 
38.3% 
102 102 
92 
10 
9.8% 
28.3% 
69.7 
65.0 
51.2% 
343 
339 
286 
53 
15.6% 
22.4% 
70.2 
67.2 
65.4% 
249 
247 
215 
32 
13.0% 
19.1% 
69.7 
67.2 
19.0% 
PZ108 
Birmingham Children's Hospital, 
Birmingham Children's Hospital NHS 
Foundation Trust, West Midlands 
PZ109 
Southampton General Hospital, 
Southampton University Hospitals NHS 
Trust, South Central 
PZ110 
Ormskirk District General Hospital, 
Southport and Ormskirk NHS Trust, 
North West 
 
PZ111 
Hereford County Hospital, Wye Valley 
NHS Trust, West Midlands 
67 
66 
60 
6 
9.1% 
21.7% 
68.9 
67.2 
27.2% 
PZ112 
Scarborough General Hospital, 
Scarborough and North East Yorkshire 
Healthcare NHS Trust, Yorkshire and 
the Humber 
PZ113 
University Hospital of Wales, Cardiff 
and Vale University Health Board, 
226 
225 
192 
33 
14.7% 
10.9% 
77.8 
76.2 
37.5% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
85 
84 
69 
15 
17.9% 
15.9% 
67.0 
66.7 
25.0% 
115 
111 
83 
28 
25.2% 
20.5% 
74.2 
68.0 
17.5% 
116 
114 
101 
13 
11.4% 
10.9% 
73.3 
71.0 
50.9% 
158 
157 
153 
4 
2.5% 
16.3% 
69.7 
66.0 
51.0% 
to NPDA 
Total no. 
submitted 
of patients 
Wales 
PDU 
code 
PDU Name 
PZ114 
York District Hospital, York Teaching 
Hospital NHS Foundation Trust, 
Yorkshire and the Humber 
PZ118 
University Hospital Lewisham, 
Lewisham and Greenwich NHS Trust, 
London and South East 
PZ119 
Darent Valley Hospital, Dartford and 
Gravesham NHS Trust, London and 
South East 
PZ120 
North Tyneside General Hospital, North 
Shields, Northumbria Healthcare NHS 
Foundation Trust, North East 

95 95 
87 
8 
8.4% 
20.7% 
68.2 
67.0 
77.0% 
121 
120 
103 
17 
14.2% 
8.7% 
75.7 
71.6 
39.5% 
185 
182 
157 
25 
13.7% 
10.2% 
78.4 
75.0 
52.6% 
247 
246 
213 
33 
13.4% 
15.5% 
74.5 
71.6 
47.6% 
PZ121 
George Eliot Hospital, George Elliot 
Hospital NHS Trust, West Midlands 
76 76 
53 
23 
30.3% 20.8% 
74.4 
74.0 
41.9% 
PZ122 
University Hospital Coventry, 
University Hospitals Coventry and 
Warwickshire NHS Trust, West 
Midlands 
PZ125 
Maidstone Hospital, Maidstone and 
Tunbridge Wells Area and NHS Trust, 
London and South East 
PZ126 
Medway Maritime Hospital, Medway 
NHS Foundation Trust, London and 
South East 
PZ127 
James Paget Hospital, James Paget 
University Hospitals NHS Foundation 
Trust, East of England 
PZ128 
Pilgrim Hospital, United Lincolnshire 
94 
91 
73 
18 
19.8% 
19.2% 
68.7 
66.0 
48.9% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
75 75 
65 
10 
13.3% 
18.5% 
70.8 
69.5 
57.0% 
171 
168 
152 
16 
9.5% 
13.8% 
73.3 
71.0 
19.8% 
115 113 
86 
27 
23.9% 
10.5% 
74.9 
70.0 
47.3% 
172 
171 
153 
18 
10.5% 
9.8% 
75.9 
73.0 
26.7% 
to NPDA 
Total no. 
submitted 
of patients 
Hospitals NHS Trust, East Midlands 
PDU 
code 
PDU Name 
PZ129 
Harrogate General Hospital, Harrogate 
and District NHS Foundation Trust, 
Yorkshire and the Humber 
PZ130 
Chelsea and Westminster Hospital, 
Chelsea and Westminster Hospital NHS 
Trust, London and South East 
PZ131 
Peterborough General, Peterborough 
and Stamford Hospitals NHS Trust, 
East of England 
PZ132 
Ysbyty Gwynedd Hospital, Besti 
Cadwaladr University Health Board, 
Wales 

241 
231 
188 
43 
18.6% 
22.3% 
72.0 
69.8 
54.4% 
186 
183 
165 
18 
9.8% 
20.6% 
72.1 
68.5 
54.6% 
164 
162 
144 
18 
11.1% 
17.4% 
71.5 
69.0 
30.7% 
PZ133 
James Cook University Hospital, South 
Tees Hospitals NHS Trust, North East 
140 
139 
122 
17 
12.2% 
21.3% 
68.9 
64.4 
35.0% 
PZ134 
Trafford General Hospital, Trafford 
Healthcare NHS Trust, North West 
69 69 
64 
5 
7.2% 
12.5% 
76.0 
72.0 
23.8% 
PZ135 
Royal Alexandra Hospital, Brighton and 
Sussex University Hospitals NHS Trust, 
London and South East 
PZ136 
Royal Manchester Children's Hospital, 
Central Manchester University 
Hospitals NHS Foundation Trust, North 
West 
PZ137 
Musgrove Park Hospital, Taunton and 
Somerset NHS Foundation Trust, South 
West 
PZ138 
Warwick Hospital 
92 
91 
79 
12 
13.2% 
10.1% 
76.2 
75.0 
29.0% 
PZ139 
Bristol Royal Hospital for Children, 
471 
466 
403 
63 
13.5% 
24.8% 
69.0 
66.0 
30.4% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
63 
61 
54 
7 
11.5% 
5.6% 
75.7 
72.1 
16.7% 
138 
128 
102 
26 
20.3% 
13.7% 
77.8 
74.5 
66.9% 
to NPDA 
Total no. 
submitted 
of patients 
University Hospitals Bristol NHS 
Foundation Trust, South West 
PDU 
code 
PDU Name 
PZ140 
Tameside General, Tameside Hospital 
NHS Foundation Trust, North West 
66 
63 
53 
10 
15.9% 
5.7% 
79.4 
76.0 
39.5% 
PZ141 
South Tyneside District Hospital, South 
Tyneside NHS Foundation Trust, North 
East 
PZ143 
King George Hospital, Barking, 
Havering and Redbridge University 
Hospitals NHS Trust, London and South 
East 
PZ144 
Good Hope Hospital, Heart of England 
NHS Foundation Trust, West Midlands 
146 
144 
125 
19 
13.2% 
8.8% 
77.9 
72.7 
52.4% 

113 
112 
95 
17 
15.2% 
19.0% 
69.0 
67.2 
59.1% 
114 
113 
94 
19 
16.8% 
10.6% 
78.8 
79.2 
51.2% 
128 
125 
110 
15 
12.0% 
10.0% 
73.8 
70.5 
19.1% 
120 
119 
100 
19 
16.0% 
13.0% 
74.5 
71.6 
66.7% 
104 104 
91 
13 
12.5% 
15.4% 
74.6 
73.8 
63.1% 
PZ145 
Milton Keynes Hospital, Milton Keynes 
Hospital NHS Foundation Trust, South 
Central 
 
PZ146 
Southend General Hospital, Southend 
University Hospital NHS Foundation 
Trust, East of England 
PZ149 
Barnsley District General Hospital, 
Barnsley Hospital NHS Foundation 
Trust, Yorkshire and the Humber 
PZ150 
Cumberland Infirmary, Cumbria 
Partnership NHS Foundation Trust, 
North East 
PZ151 
Queen Elizabeth Hospital Lewisham 
and Greenwich NHS Trust, London and 
South East 
PZ152 
Torbay Hospital, South Devon 
108 
105 
93 
12 
11.4% 
5.4% 
77.9 
75.0 
28.5% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
54 
50 
44 
6 
12.0% 
6.8% 
68.7 
66.1 
23.2% 
66 
62 
56 
6 
9.7% 
12.5% 
72.6 
72.0 
25.0% 
152 
147 
128 
19 
12.9% 
7.8% 
81.4 
80.3 
44.8% 
170 170 
141 
29 
17.1% 
16.3% 
71.7 
68.9 
20.0% 
to NPDA 
Total no. 
submitted 
of patients 
Healthcare NHS Foundation Trust, 
South West 
PDU 
code 
PDU Name 
PZ153 
Whiston Hospital, St Helens and 
Knowsley Teaching Hospitals NHS 
Trust, North West 
PZ156 
Queen Elizabeth, Kings Lynn, Queen 
Elizabeth Hospitals NHS Trust, East of 
England 
PZ157 
Royal Free and University College 
Hospital, Royal Free Hampstead NHS 
Trust, London and South East 
PZ158 
Epsom General Hospital, Epsom and St 
Helier University Hospitals NHS Trust, 
London and South East 

110 
109 
101 
8 
7.3% 
15.8% 
73.1 
68.0 
28.2% 
135 135 
99 
36 
26.7% 
15.2% 
73.6 
71.5 
70.7% 
142 
141 
127 
14 
9.9% 
19.7% 
69.4 
66.1 
39.0% 
147 
143 
128 
15 
10.5% 
14.8% 
71.1 
69.5 
44.3% 
149 
147 
124 
23 
15.6% 
5.7% 
72.1 
69.0 
32.6% 
PZ159 
Basingstoke and North Hampshire 
Hospital, Basingstoke and North 
Hampshire NHS Foundation Trust, 
South Central 
PZ162 
Bishop Auckland General Hospital, 
County Durham and Darlington NHS 
Foundation Trust, North East 
PZ163 
North Tees General Hospital, North 
Tees and Hartlepool NHS Trust, North 
East 
PZ164 
Rotherham General Hospital, The 
Rotherham NHS Foundation Trust, 
Yorkshire and the Humber 
PZ167 
University Hospitals of Morecambe Bay 
NHS Foundation Trust, University 
Hospitals of Morecambe Bay NHS 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
39 
37 
35 
2 
5.4% 
20.0% 
66.5 
66.0 
53.3% 
121 
119 
99 
20 
16.8% 
8.1% 
78.7 
74.0 
69.1% 
165 
164 
146 
18 
11.0% 
15.8% 
67.2 
65.3 
32.7% 
to NPDA 
Total no. 
submitted 
of patients 
Trust, North West 
PDU 
code 
PDU Name 
PZ168 
Grantham and District Hospital, United 
Lincolnshire Hospitals NHS Trust, East 
Midlands 
PZ169 
Salisbury District Hospital, Salisbury 
NHS Foundation Trust, South Central 
108 
106 
90 
16 
15.1% 
8.9% 
74.0 
73.3 
43.3% 
PZ170 
Arrowe Park Hospital, Wirral University 
Teaching Hospital NHS Foundation 
Trust, North West 
PZ171 
Broomfield Hospital, Mid-Essex 
Hospital Services NHS Trust, East of 
England 

75 75 75 
0 
0.0% 
12.0% 
74.4 
70.5 
13.2% 
155 155 
139 
16 
10.3% 
15.1% 
69.9 
67.3 
57.5% 
129 129 
115 
14 
10.9% 
23.5% 
64.7 
63.9 
36.3% 
PZ172 
Watford General Hospital, West Herts 
Hospitals NHS Trust, East of England 
198 
195 
170 
25 
12.8% 
9.4% 
73.0 
70.6 
39.4% 
PZ173 
Yeovil District Hospital, Yeovil District 
Hospital NHS Foundation Trust, South 
West 
PZ174 
Kettering General Hospital, Kettering 
General Hospital Trust, East Midlands 
117 
115 
100 
15 
13.0% 13.0% 
72.6 
69.0 
37.8% 
PZ175 
Queen Mary's Hospital, South London 
Healthcare NHS Trust, London and 
South East 
PZ176 
St Peter's Hospital, Ashford and St 
Peter's Hospitals NHS Trust, London 
and South East 
PZ177 
Royal Bolton Hospital, Bolton Hospital 
NHS Foundation Trust, North West 
108 
107 
87 
20 
18.7% 
14.9% 
69.7 
68.0 
4.5% 
PZ178 
Manor Hospital, Walsall Healthcare 
NHS Trust, West Midlands 
113 113 
19 
94 
83.2% 
5.3% 
77.9 
73.0 
38.0% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
114 
114 
104 
10 
8.8% 
26.9% 
71.5 
66.8 
29.1% 
196 
193 
175 
18 
9.3% 
13.1% 
75.3 
73.0 
59.4% 
146 
145 
128 
17 
11.7% 
17.2% 
67.9 
66.1 
21.0% 
105 
104 
92 
12 
11.5% 
12.0% 
81.2 
77.8 
44.1% 
to NPDA 
Total no. 
submitted 
of patients 
PDU 
code 
PDU Name 
PZ179 
Countess of Chester Hospital NHS 
Foundation Trust, Countess Of Chester 
Hospital NHS Foundation Trust, North 
West 
PZ180 
King's Mill Hospital, Sherwood Forest 
Hospitals NHS Foundation Trust, East 
Midlands 
PZ181 
Ipswich Hospital, The Ipswich Hospital 
NHS Trust, East of England 
222 
219 
189 
30 
13.7% 
15.9% 
74.8 
73.8 
29.3% 
PZ182 
West Middlesex University Hospital, 
West Middlesex University Hospital 
NHS Trust, London and South East 
PZ183 
Royal Preston Hospital, Lancashire 
Teaching Hospitals NHS Foundation 
Trust, North West 

57 57 
41 
16 
28.1% 
24.4% 
68.7 
67.0 
10.8% 
93 93 
77 
16 
17.2% 
19.5% 
67.6 
66.1 
12.7% 
201 
199 
173 
26 
13.1% 
16.8% 
73.3 
70.0 
19.6% 
PZ184 
Eastbourne District General Hospital, 
East Sussex NHS Trust, London and 
South East 
PZ185 
Bronglais General Hospital, Hywel Dda 
Local Health Board, Wales 
44 
43 
42 
1 
2.3% 
23.8% 
68.9 
68.3 
10.8% 
PZ186 
Huddersfield Royal Infirmary, 
Calderdale and Huddersfield NHS 
Foundation Trust, Yorkshire and the 
Humber 
PZ187 
Wrexham Maelor Hospital, Besti 
Cadwaladr University Health Board, 
Wales 
PZ188 
Royal Gwent Hospital, Aneurin Bevan 
Health Board, Wales 
199 199 
165 
34 
17.1% 
9.1% 
77.4 
73.0 
47.4% 
PZ189 
Royal Glamorgan Hospital, Cwm Taf 
81 
80 
69 
11 
13.8% 
20.3% 
70.7 
69.0 
9.5% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
32 
29 
11 
18 
62.1% 
72.7% 
53.9 
47.5 
50.8% 
79 
72 
62 
10 
13.9% 
9.7% 
87.7 
87.0 
53.8% 
45 45 
36 
9 
20.0% 
11.1% 
68.6 
69.0 
48.0% 
to NPDA 
Total no. 
submitted 
of patients 
Health Board, Wales 
PDU 
code 
PDU Name 
PZ190 
Withybush General Hospital, Hywel 
Dda Health Board, Wales 
52 52 
47 
5 
9.6% 
4.3% 
76.0 
72.0 
27.1% 
PZ191 
Ealing Hospital, Ealing Hospital NHS 
Trust, London and South East 
124 
120 
105 
15 
12.5% 
7.6% 
83.3 
80.3 
81.1% 
PZ193 
Neath Port Talbot Hospital, Abertawe 
Bro Morgannwg University Health 
Board, Wales 
PZ195 
Central Middlesex Hospital, North West 
London Hospitals NHS Trust, London 
and South East 
PZ196 
Great Ormond Street Hospital, London, 
Great Ormond Street Hospital for 
Children NHS Trust, London and South 
East 

93 
91 
74 
17 
18.7% 
5.4% 
74.7 
71.0 
4.2% 
121 
114 
104 
10 
8.8% 
10.6% 
74.3 
71.3 
22.3% 
90 
84 
74 
10 
11.9% 
5.4% 
81.5 
76.5 
30.5% 
380 
342 
304 
38 
11.1% 
33.2% 
64.1 
61.8 
89.9% 
PZ199 
North Middlesex University Hospital, 
North Middlesex University Hospital 
NHS Trust, London and South East 
PZ200 
The Princess Alexandra, The Princess 
Alexandra Hospital NHS Trust, East of 
England 
PZ202 
St Marys Hospital, Imperial College 
Healthcare NHS Trust, London and 
South East 
PZ203 
University College Hospital, University 
College London Hospitals NHS 
Foundation Trust, London and South 
East 
PZ213 
East Surrey Hospital, Surrey and 
Sussex NHS Trust, London and South 
166 
162 
133 
29 
17.9% 
11.3% 
71.6 
68.9 
34.8% 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
97 97 
84 
13 
13.4% 
21.4% 
67.9 
65.3 
73.1% 
161 
155 
135 
20 
12.9% 
17.0% 
71.0 
67.0 
33.5% 
135 
132 
123 
9 
6.8% 9.8% 
80.5 
77.1 
49.2% 
228 
227 
197 
30 
13.2% 
26.4% 
68.2 
66.1 
34.2% 
to NPDA 
Total no. 
submitted 
of patients 
East 
PDU 
code 
PDU Name 
PZ215 
King's College Hospital, King's College 
Hospital NHS Trust, London and South 
East 
PZ216 
Tunbridge Wells Hospital, Maidstone 
and Tunbridge Wells Area and NHS 
Trust, London and South East 
PZ218 
Frimley Park Hospital, Frimley Park 
Hospital NHS Trust, London and South 
East 
PZ219 
Sheffield Children's Hospital, Sheffield 
Children's NHS Foundation Trust, 
Yorkshire and the Humber 

82 
81 
69 
12 
14.8% 
10.1% 
77.7 
75.0 
57.5% 
119 
118 
96 
22 
18.6% 
31.3% 
67.3 
64.8 
12.1% 
179 179 
154 
25 
14.0% 
13.6% 
73.6 
70.0 
12.7% 
143 
142 
123 
19 
13.4% 
14.6% 
77.2 
73.5 
62.2% 
124 
123 
112 
11 
8.9% 
15.2% 
75.5 
73.0 
23.0% 
PZ220 
Bedford Hospital, Bedford Hospital 
NHS Trust, East of England 
124 
122 
104 
18 
14.8% 
7.7% 
79.1 
76.0 
66.2% 
PZ221 
The Great Western Hospital, Great 
Western Hospitals NHS Foundation 
Trust, South West 
PZ222 
New Cross Hospital, The Royal 
Wolverhampton Hospitals NHS Trust, 
West Midlands 
PZ223 
Sandwell General Hospital, Sandwell 
and West Birmingham Hospitals NHS 
Trust, West Midlands 
PZ225 
Worcester Hospital, Worcestershire 
Acute Hospitals NHS Trust, West 
Midlands 
PZ226 
Dewsbury and District Hospital, The 
Mid Yorkshire Hospitals NHS Trust, 
Yorkshire and the Humber 
care 
% of 
processes  
records of 
incomplete 
except Hba1c 
mol) 
HbA1c 
Median 
(mmol/
Mean 
/mol) 
HbA1c 
(mmol
58 
mol 
% with 
mmol/
HbA1c<
% 
from 
HbA1c 
analysis 
outcome 
excluded 
from 
HbA1c 
analysis 
Patients 
outcome 
excluded 
HbA1c 
Patients 
used for 
out-come 
analysis ** 
HbA1c 
analysis* 
Total no. 
of patients 
eligible for 
167 
163 
143 
20 
12.3% 
11.9% 
76.1 
73.0 
47.6% 
277 
275 
152 123 
44.7% 
13.8% 
72.3 
69.4 
64.9% 
to NPDA 
Total no. 
submitted 
of patients 
PDU 
code 
PDU Name 
PZ228 
Prince Charles Hospital, Cwm Taf 
Health Board, Wales 
69 69 
65 
4 
5.8% 
35.4% 
62.1 
59.0 
3.9% 
PZ230 
Conquest Hospital, East Sussex NHS 
Trust, London and South East 
49 46 
40 
6 
13.0% 
15.0% 
73.2 
70.8 
34.2% 
PZ231 
Salford Royal Hospital, Salford Royal 
NHS Foundation Trust, North West 
140 140 
126 
14 
10.0% 
17.5% 
71.5 
67.5 
23.3% 
PZ232 
Queens Hospital, Barking, Havering and 
Redbridge University Hospitals NHS 
Trust, London and South East 
PZ234 
North Manchester General Hospital, 
The Pennine Acute Hospitals NHS 
Trust, North West 

156 
155 
103 
52 
33.5% 
7.8% 
74.1 
72.7 
79.2% 
296 296 
239 
57 
19.3% 
15.5% 
70.3 
67.0 
49.0% 
PZ238 
Queen Alexandra Hospital, Portsmouth 
Hospitals NHS Trust, South West 
221 
216 
189 
27 
12.5% 
13.2% 
70.3 
69.0 
36.2% 
PZ240 
Russell's Hall Hospital, The Dudley 
Group of Hospitals NHS Foundation 
Trust, West Midlands 
PZ242 
Cheltenham and Gloucester Hospital, 
Gloucestershire Hospitals NHS Trust, 
South West 
 
*Eligible patients were those greater than 3 month post diagnosis. 
**For HbA1c to be included in the analysis the patient needed a valid date of diagnosis, a valid submitted value and a date of submission which was within the Audit year. 
Where more than one HbA1c was submitted for a patient the median value was used for the Audit year. 
PZ003 
PZ003 Pinderfields General Hospital, Wakefield (submitted via PZ090) The Mid Yorkshire Hospitals NHS Trust 
PZ013  
PZ013 Furness General Hospital (submitted via PZ167) University Hospitals of Morecambe Bay NHS Foundation Trust 
PZ029 
PZ029 Fairfield General Hospital, Bury, PZ206 Rochdale Infirmary and PZ044 Royal Oldham Hospital (Submitted via 
PZ234) The Pennine Acute Hospitals NHS Trust Fairfield General Hospital, Bury 
PZ043 
PZ043 St Mary's Hospital for Women and Children Manchester (submitted via PZ136) Central Manchester University 
Hospitals NHS Foundation Trust NW 
PZ044 
PZ044 Royal Oldham Hospital (submitted via PZ206) The Pennine Acute Hospitals NHS Trust Submitted via PZ234 
PZ046 
PZ046 Horton Hospital (submitted via PZ007) Oxford Radcliffe Hospitals NHS Trust SC 

 
*The following Paediatric Diabetes Units submitted their data through other Units: 
 

PZ095 
PZ095 Royal Shrewsbury Hospital (submitted via PZ094) The Shrewsbury and Telford Hospital NHS Trust WM 
PZ116 
PZ116 Nottingham University Hospital (submitted via PZ042) Nottingham University Hospitals NHS Trust EM 
PZ161 
PZ161 Darlington Memorial Hospital and PZ160 Bishop Auckland General Hospital (submitted via PZ162) County 
Durham and Darlington NHS Foundation Trust 
PZ208 
PZ208 Westmoreland General Hospital (submitted via PZ167) University Hospitals of Morecambe Bay NHS 
Foundation 
PZ210 
PZ210 University Hospital of Hartlepool (submitted via PZ163) North Tees and Hartlepool NHS Trust NE 

## 10. Appendix B: Unadjusted And Adjusted Paediatric Diabetes Unit Co-Ordinates For Funnel Plots

| Unadjusted     |   Adjusted   |
|----------------|--------------|
| Proportion (%) |              |
| PDU code       |              |
| PDU            |              |
| Mean           |              |
| size           |              |
| with HbA1c >80 |              |
| HbA1c          |              |
| mmol/mol       |              |
| PZ001          |              |
| 108            |         70.3 |
| PZ002          |              |
| 56             |         73.9 |
| PZ004          |              |
| 172            |         72.8 |
| PZ005          |              |
| 223            |         70   |
| PZ006          |              |
| 123            |         66.2 |
| PZ007          |              |
| 299            |         64   |
| PZ009          |              |
| 84             |         69.9 |
| PZ010          |              |
| 106            |         75.5 |
| PZ011          |              |
| 105            |         80.3 |
| PZ012          |              |
| 75             |         76.2 |
| PZ014          |              |
| 47             |         76.5 |
| PZ015          |              |
| 55             |         70.7 |
| PZ016          |              |
| 58             |         71.2 |
| PZ017          |              |
| 83             |         70.6 |
| PZ018          |              |
| 118            |         76.4 |
| PZ019          |              |
| 201            |         75   |
| PZ020          |              |
| 93             |         78.6 |
| PZ021          |              |
| 139            |         71.5 |
| PZ022          |              |
| 34             |         76.5 |
| PZ024          |              |
| 281            |         74.9 |
| PZ026          |              |
| 230            |         75.4 |
| PZ027          |              |
| 55             |         69.9 |
| PZ028          |              |
| 77             |         73.9 |
| PZ030          |              |
| 98             |         65.5 |
| PZ031          |              |
| 81             |         74   |
| PZ032          |              |
| 283            |         71.8 |
| PZ033          |              |
| 105            |         72.3 |
| PZ034          |              |
| 124            |         73.3 |
| PZ035          |              |
| 209            |         67.2 |
| PZ036          |              |
| 98             |         71   |
| PZ038          |              |
| 102            |         75.5 |
| PZ040          |              |
| 207            |         80.2 |
| PZ041          |              |
| 239            |         74   |
| PZ042          |              |
| 264            |         65.6 |
| PZ045          |              |
| 56             |         81.2 |

Proportion (%) 
Mean 
with HbA1c >80 
HbA1c 
mmol/mol 

|                |                |
|----------------|----------------|
| Unadjusted     | Adjusted       |
| PDU code       | PDU            |
| Proportion (%) |                |
| size           |                |
| Mean           | with HbA1c >80 |
| HbA1c          | mmol/mol       |
| PZ047          |                |
| 66             | 70.2           |
| PZ048          |                |
| 107            | 72.9           |
| PZ049          |                |
| 140            | 67.4           |
| PZ050          |                |
| 101            | 78.0           |
| PZ052          |                |
| 66             | 76.2           |
| PZ053          |                |
| 79             | 74.3           |
| PZ054          |                |
| 161            | 70.1           |
| PZ055          |                |
| 325            | 73.6           |
| PZ056          |                |
| 56             | 69.1           |
| PZ057          |                |
| 132            | 65.7           |
| PZ058          |                |
| 90             | 79.0           |
| PZ059          |                |
| 161            | 70.0           |
| PZ060          |                |
| 159            | 75.8           |
| PZ062          |                |
| 83             | 75.4           |
| PZ064          |                |
| 112            | 71.5           |
| PZ065          |                |
| 104            | 76.3           |
| PZ067          |                |
| 17             | 71.6           |
| PZ068          |                |
| 175            | 75.6           |
| PZ069          |                |
| 122            | 68.1           |
| PZ072          |                |
| 108            | 67.1           |
| PZ073          |                |
| 83             | 74.6           |
| PZ074          |                |
| 211            | 72.4           |
| PZ075          |                |
| 45             | 75.7           |
| PZ076          |                |
| 167            | 81.6           |
| PZ078          |                |
| 189            | 75.0           |
| PZ080          |                |
| 149            | 68.5           |
| PZ082          |                |
| 83             | 81.8           |
| PZ084          |                |
| 59             | 75.7           |
| PZ085          |                |
| 88             | 69.2           |
| PZ086          |                |
| 83             | 73.5           |
| PZ088          |                |
| 42             | 61.7           |
| PZ089          |                |
| 21             | 83.2           |
| PZ090          |                |
| 172            | 71.2           |
| PZ091          |                |
| 222            | 71.5           |
| PZ092          |                |
| 73             | 77.3           |
| PZ094          |                |
| 225            | 73.0           |
| PZ096          |                |
| 153            | 66.4           |
| PZ097          |                |
| 28             | 72.7           |
| PZ099          |                |
| 216            | 72.3           |
| PZ100          |                |
| 70             | 69.6           |
| PZ101          |                |
| 295            | 67.1           |
| PZ102          |                |
| 131            | 76.5           |

Proportion (%) 
Mean 
with HbA1c >80 
HbA1c 
mmol/mol 
|                |                |
|----------------|----------------|
| Unadjusted     | Adjusted       |
| PDU code       | PDU            |
| Proportion (%) |                |
| size           |                |
| Mean           | with HbA1c >80 |
| HbA1c          |                |
|                |                |
| mmol/mol       |                |
|                |                |
| PZ104          |                |
| 107            | 74.8           |
| PZ105          |                |
| 156            | 76.9           |
| PZ106          |                |
| 94             | 70.4           |
| PZ107          |                |
| 84             | 78.5           |
| PZ108          |                |
| 286            | 70.2           |
| PZ109          |                |
| 215            | 69.7           |
| PZ110          |                |
| 92             | 69.7           |
| PZ111          |                |
| 60             | 68.9           |
| PZ112          |                |
| 83             | 67.7           |
| PZ113          |                |
| 192            | 77.8           |
| PZ114          |                |
| 153            | 69.7           |
| PZ118          |                |
| 83             | 74.2           |
| PZ119          |                |
| 69             | 67.0           |
| PZ120          |                |
| 101            | 73.3           |
| PZ121          |                |
| 53             | 74.4           |
| PZ122          |                |
| 157            | 78.4           |
| PZ125          |                |
| 87             | 68.2           |
| PZ126          |                |
| 213            | 74.5           |
| PZ127          |                |
| 103            | 75.7           |
| PZ128          |                |
| 73             | 68.7           |
| PZ129          |                |
| 65             | 70.8           |
| PZ130          |                |
| 152            | 73.3           |
| PZ131          |                |
| 153            | 75.9           |
| PZ132          |                |
| 86             | 74.9           |
| PZ133          |                |
| 122            | 68.9           |
| PZ134          |                |
| 64             | 76.0           |
| PZ135          |                |
| 144            | 71.5           |
| PZ136          |                |
| 188            | 72.0           |
| PZ137          |                |
| 165            | 72.1           |
| PZ138          |                |
| 79             | 76.2           |
| PZ139          |                |
| 403            | 69.0           |
| PZ140          |                |
| 53             | 79.4           |
| PZ141          |                |
| 54             | 75.7           |
| PZ143          |                |
| 102            | 77.8           |
| PZ144          |                |
| 125            | 77.9           |
| PZ145          |                |
| 95             | 69.0           |
| PZ146          |                |
| 100            | 74.5           |
| PZ149          |                |
| 110            | 73.8           |
| PZ150          |                |
| 91             | 74.6           |
| PZ151          |                |
| 94             | 78.8           |
| PZ152          |                |
| 93             | 77.9           |
| PZ153          |                |
| 141            | 71.7           |

Proportion (%) 
Mean 
with HbA1c >80 
HbA1c 
mmol/mol 

|                |                |
|----------------|----------------|
| Unadjusted     | Adjusted       |
| PDU code       | PDU            |
| Proportion (%) |                |
| size           |                |
| Mean           | with HbA1c >80 |
| HbA1c          | mmol/mol       |
| PZ156          |                |
| 128            | 81.4           |
| PZ157          |                |
| 44             | 68.7           |
| PZ158          |                |
| 56             | 72.6           |
| PZ159          |                |
| 127            | 69.4           |
| PZ162          |                |
| 99             | 73.6           |
| PZ163          |                |
| 128            | 71.1           |
| PZ164          |                |
| 101            | 73.1           |
| PZ167          |                |
| 124            | 72.1           |
| PZ168          |                |
| 35             | 66.5           |
| PZ169          |                |
| 90             | 74.0           |
| PZ170          |                |
| 99             | 78.7           |
| PZ171          |                |
| 146            | 67.2           |
| PZ172          |                |
| 170            | 73.0           |
| PZ173          |                |
| 75             | 74.4           |
| PZ174          |                |
| 100            | 72.6           |
| PZ175          |                |
| 115            | 64.7           |
| PZ176          |                |
| 139            | 69.9           |
| PZ177          |                |
| 87             | 69.7           |
| PZ178          |                |
| 19             | 77.9           |
| PZ179          |                |
| 104            | 71.5           |
| PZ180          |                |
| 128            | 67.9           |
| PZ181          |                |
| 189            | 74.8           |
| PZ182          |                |
| 92             | 81.2           |
| PZ183          |                |
| 175            | 75.3           |
| PZ184          |                |
| 41             | 68.7           |
| PZ185          |                |
| 42             | 68.9           |
| PZ186          |                |
| 173            | 73.3           |
| PZ187          |                |
| 77             | 67.6           |
| PZ188          |                |
| 165            | 77.4           |
| PZ189          |                |
| 69             | 70.7           |
| PZ190          |                |
| 47             | 76.0           |
| PZ191          |                |
| 105            | 83.3           |
| PZ193          |                |
| 36             | 68.6           |
| PZ195          |                |
| 62             | 87.7           |
| PZ196          |                |
| 11             | 53.9           |
| PZ199          |                |
| 104            | 74.3           |
| PZ200          |                |
| 74             | 81.5           |
| PZ202          |                |
| 74             | 74.7           |
| PZ203          |                |
| 304            | 64.1           |
| PZ213          |                |
| 133            | 71.6           |
| PZ215          |                |
| 123            | 80.5           |
| PZ216          |                |
| 84             | 67.9           |

Proportion (%) 
Mean 
with HbA1c >80 
HbA1c 
mmol/mol 
| Unadjusted     | Adjusted       |
|----------------|----------------|
|                |                |
| PDU code       |                |
| Proportion (%) |                |
|                |                |
| PDU            |                |
| size           |                |
| Mean           | with HbA1c >80 |
| HbA1c          | mmol/mol       |
| PZ218          |                |
| 135            | 71.0           |
| PZ219          |                |
| 197            | 68.2           |
| PZ220          |                |
| 104            | 79.1           |
| PZ221          |                |
| 123            | 77.2           |
| PZ222          |                |
| 154            | 73.6           |
| PZ223          |                |
| 96             | 67.3           |
| PZ225          |                |
| 112            | 75.5           |
| PZ226          |                |
| 69             | 77.7           |
| PZ228          |                |
| 65             | 62.1           |
| PZ230          |                |
| 40             | 73.2           |
| PZ231          |                |
| 126            | 71.5           |
| PZ232          |                |
| 143            | 76.1           |
| PZ234          |                |
| 152            | 72.3           |
| PZ238          |                |
| 189            | 70.3           |
| PZ240          |                |
| 103            | 74.1           |
| PZ242          |                |
| 239            | 70.3           |

Proportion (%) 
Mean 
with HbA1c >80 
HbA1c 
mmol/mol 

Royal College of Paediatrics and Child Health 5-11 Theobalds Road, London, WC1X 8SH The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).