NPDA 2022-23 Annual Report
Source: data.gov.uk (2025-02-12)

National Paediatric Diabetes Audit 2022 - 2023. The excel file contains unit, regional and national level data obtained from the National Paediatric Diabetes Audit 2022-2023.

Specifically, it includes information on patient characteristics, completion of health checks and outcomes achieved (as recommended by the National Institute for Clinical Excellence) for infants, children and young people with type 1 diabetes, under the age of 25, who attended paediatric diabetes units in England and Wales between 1 April 2022 and the 31 March 2023.

Data are included for the seven key health checks:
• Glycated Haemoglobin A1c (HbA1c)
• Body Mass Index (BMI)
• Thyroid
• Blood pressure
• Urinary albumin
• Foot examination
• Eye screening.

Data on other health checks include:
• Psychological assessment
• Offering of immunisation against influenza
• Advice about managing diabetes (‘sick-day rules’)
• Using (or trained to use) blood ketone testing strips and a meter
• Cholesterol
• Additional dietetic support

Data are included for health checks at diagnosis
• Screening for autoimmune disease (coeliac and thyroid disease) 
• Provision of Level 3 carbohydrate-counting education

Data on outcomes of care include:
• HbA1c target measurements
• Small vessel (microvascular) disease
• Large vessel (macrovascular) disease
• Autoimmune disease (coeliac and thyroid disease)

The data were first published in 2024 alongside the National Paediatric Diabetes Audit Report 2022-2023 Data suppressed due to small numbers (<5).

For further information and details on the audit please refer to:
• National Paediatric Diabetes Audit Annual Reports: https://www.rcpch.ac.uk/resources/npda-annual-reports
• NPDA results online: http://npda-results.rcpch.ac.uk/default.aspx
• The RCPCH website: https://www.rcpch.ac.uk/npda

Audits 
RCPCH
NPDA
National Paediatric 
Diabetes Audit
National Paediatric Diabetes 
Audit (NPDA) Report on Care 
and Outcomes 2022/23
Royal College of 
Paediatrics and Child Health
RCPCH

NPDA
National Paediatric
Diabetes Audit
Contents
Introduction				
3
Key messages				
4
National recommendations				
5
2022/23 Results Summary				
6
01. How many children and young people were receiving care
6 
from paediatric diabetes services in England and Wales?
02. What percentages of children and young people received
7 
all six recommended health checks?
03. What percentage of all recommended health checks were
8 
delivered by PDUs in 2022/23?
04. What percentages of children and young people with Type 1
9 
diabetes received recommended checks at diagnosis?
05. Has there been improvement in national HbA1c?
9
06. What percentages of children and young people with diabetes
10 
were at risk of macrovascular and microvascular complications?
07. What percentages of children and young people with Type 1
11 
were using diabetes-related technologies?
08. What was the average HbA1c for children and young people
11 
with Type 1 diabetes using different diabetes-related technologies?
09. What percentages of children and young people with Type 1
12 
diabetes had diabetes-related hospital admissions?
10. How many children and young people with diabetes were assessed
12 
as requiring additional psychological support following assessment?
Spotlight on inequalities				
13
Quality improvement resources				
14
Front cover art  
competition winner:
Olly M-F. Age 10.
© 2024 Healthcare Quality Improvement 
Partnership (HQIP)
Cite as: National Paediatric Diabetes Audit 
Annual Report 2022-23: Care Processes and 
Outcomes. RCPCH: London, 2024.
The Royal College of Paediatrics and Child Health 
is a registered charity in England and Wales 
(1057744) and in Scotland (SCO38299)
2

HQIP is led by a consortium of the Academy 
of Medical Royal Colleges, and the Royal 
College of Nursing. Its aim is to promote quality 
improvement in patient outcomes, and in 
particular, to increase the impact that clinical 
audit, outcome review programmes and 
registries have on healthcare quality in England 
and Wales. 
HQIP holds the contract to commission, 
manage, and develop the National Clinical 
Audit and Patient Outcomes Programme 
(NCAPOP), comprising around 40 projects 
covering care provided to people with a wide 
range of medical, surgical and mental health 
conditions. The programme is funded by NHS 
England, the Welsh Government and, with 
some individual projects, other devolved  
administrations and crown dependencies  
www.hqip.org.uk/national-programmes. 
The NPDA has been reporting for 20 years. 
Data is submitted by healthcare professionals 
in Paediatric Diabetes Units (PDUs) in England 
and Wales about the care received by the 
children and young people with diabetes using 
their service. 
The effectiveness of diabetes care is measured 
against NICE guidelines (NG18, NICE 2015) and 
includes treatment targets, health checks, 
patient education, psychological wellbeing, and 
assessment of diabetes-related complications 
including acute hospital admissions, all of 
which are vital for monitoring and improving 
the long-term health and wellbeing of children 
and young people with diabetes. In 2022/23, 
100% of PDUs participated in the NPDA.
Extended analysis:
Expanded analysis of 2022/23 data,  
PDU level reports and posters, a glossary 
of terms used in this report, a line-of-sight 
table describing the evidence base for the 
recommendations made in this report, and 
links to Excel files of data at PDU, regional 
network and integrated care system levels 
are available within the annual reports 
page:
https://www.rcpch.ac.uk/resources/npda-
annual-reports
PDU level, regional network, NHSE region, 
local health board and ICS level data is 
available at: 
npda-results.rcpch.ac.uk
Further information:
Further information on the background, 
aims, and scope of the NPDA is available at: 
https://www.rcpch.ac.uk/work-we-do/
clinical-audits/npda/about
The National Paediatric Diabetes Audit (NPDA) is managed by the Royal College of Paediatrics 
and Child Health (RCPCH) and commissioned by the Healthcare Quality Improvement Partnership 
(HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). 
Introduction
3
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

Key messages 
The prevalence of children and young 
people cared for in PDUs in England 
and Wales has increased from 
33,251 in 2021/22 to 34,371 in 
2022/23, despite a fall in the 
incidence of new cases.
The overall median HbA1c for 
England and Wales has fallen 
from 60.5mmol/mol in 2021/22 
to 60.0mmol/mol, but excessive 
PDU variability in this outcome 
measure still persists.
Use of diabetes related technology has 
increased in 2022/23 with around half 
of children and young people with Type 
1 diabetes using insulin pumps (45.3%, 
compared to 40.3% in 2021/22) and half 
(48.6%, compared to 30.0% in 2021/22) using 
a real time continuous glucose monitor 
(rtCGM). 
Use of hybrid close loop 
systems doubled since the 
previous audit year, with 14.7% 
now using this technology 
compared to 7.5% in 2021/22.
Around a quarter (23.3%) of all 
new cases of Type 1 diabetes 
had diabetic ketoacidosis 
(DKA) at diagnosis compared 
to 25.6% in 2021/22.
The percentages of children and young 
people with Type 1 and Type 2 diabetes 
receiving all six key annual healthcare 
checks has increased but there remains 
much variability between 
PDUs, and completion 
rates for those with Type 
2 remain lower than for 
those with Type 1.
Percentages of young people with early 
signs of micro and macrovascular 
complications for both Type 
1 and Type 2 diabetes show 
very little change in 2022/23 
compared to the previous 
audit year. 
Lower HbA1c was associated 
with use of a hybrid closed 
loop system or rtCGM.
Despite improvements in outcomes and use 
of technologies across different ethnicities 
and areas of deprivation, inequalities 
remain evident. 
In terms of rtCGM use, the inequality gap 
by deprivation has reduced however the 
difference in use between Black 
and White children with Type 
1 diabetes has widened from 
8.6% in 2021/22 to 14% in 
2022/23.
0.1
HbA1c
BMI
Blood Pressure
Thyroid Test
Foot Check
Albuminuria
HbA1c – test
HbA1c – test
HbA1c – test
HbA1c – test
4
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

National recommendations
1
Commissioners of care should make sure that multidisciplinary diabetes teams are adequately staffed 
to manage the growing numbers of children and young people with Type 1 and Type 2 diabetes since 
2020. These teams should be trained to encourage the best use of new diabetes-related technologies.
Action by: Integrated Care Boards across England and Local Health Boards across Wales.
4
Awareness of the symptoms of onset of Type 1 Diabetes should be raised to reduce presentation  
with diabetic ketoacidosis (DKA). This could include targeting healthcare professionals, school  
teachers and parents and reinvigoration of public awareness campaigns such as the Diabetes UK 4Ts.
Action by: The Office for Health Improvement and Disparities, NHS England, Public Health Wales and 
NHS Wales supported by the National Children and Young People's (CYP) Diabetes Network, and diabetes 
charities such as Diabetes UK and JDRF.
2
Children and young people with Type 1 and Type 2 diabetes should have equitable access to diabetes 
care, regardless of social deprivation, ethnicity, or geography. Action is required to increase the 
proportion of those with Type 2 diabetes receiving recommended key annual health checks and to 
improve equity of access to diabetes treatment technology for Type 1 diabetes.  
Action by: Integrated Care Boards across England; Local Health Boards across Wales, and the RCPCH, to 
provide a better understanding of ethnic and social deprivation variability.
5
Studies should be funded to derive evidence for interventions supporting pre-diabetic children 
and young people to avoid progression to Type 2 diabetes.
Action by: Funding bodies such as the National Institute for Health and Care Research and Diabetes UK. 
3
Young people with diabetic retinopathy recorded in their previous annual screen should be invited  
for annual re-screening. Paediatric diabetes teams should be aware of which patients in their service 
have retinopathy and encourage them and their family to attend screening appointments when  
offered so that diabetes management advice can be appropriately tailored.
Action by: NHS Diabetic Eye Screening Programme in England (DESP), Diabetic Eye Screening Wales 
(DESW), Clinical teams within paediatric diabetes units in NHS Trusts and Local Health Boards across 
England and Wales.
6
Studies should be funded to understand the progression from childhood signs of micro- and 
macro- vascular disease to the development of future diabetes complications, and to inform 
preventative interventions.
Action by: Funding bodies such as the National Institute for Health and Care Research, Diabetes UK 
and JDRF. 
5
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

1,250
1,300
1,350
1,400
1,450
1,500
1,550
1,600
1,650
1,700
1,750
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2015/16
2016/17
2017/18
2018/19
2019/20*
2020/21
2021/22
2022/23
Number in Wales
Number of children and young people 
receiving care from a Paediatric 
Diabetes Unit
*166 out of 173 PDUs submitted information to the 2019/20 audit, artificially lowering
numbers reported.
England
England and Wales
Wales
There were 34,371 children and young people receiving care from PDUs in 2022/23: 32,673 (95.1%) 
in England and 1,698 (5.0%) in Wales. There has been a steady increase in this prevalence since the 
COVID-19 pandemic in 2020/21 in England and Wales from 29,242 in 2019/20 to 34,371 in 2022/23.
The incidence of Type 1 diabetes (0-15 years) decreased from 32.7 new cases per 100,000 in 2021/22 to  
31.1 in 2022/23, with 3,610 new cases diagnosed and managed in PDUs in this audit year. Despite this 
reduction, the incidence rate remains higher than rates observed prior to the COVID-19 pandemic.  
Table 1: Numbers of children and diabetes being managed within PDUs in England and Wales, 2022/23 
*Includes cystic fibrosis diabetes, maturity-onset diabetes of the young (MODY) and “unknown/unspecified” types of 
diabetes.
2022/23 Results Summary
How many children and young people were 
receiving care from paediatric diabetes services
in England and Wales?
SECTION 01
0.1
Country
Total number of children and 
young people with diabetes
Type 1 diabetes
Type 2 diabetes
Other rare 
forms
England
32,673
30,647 (93.8%)
1,206 (3.7%)
820 (2.5%)*
Wales
1,698
1,629 (96.0%)
39 (2.3%)
30 (1.8%)*
England and Wales
34,371
32,276 (94.0%)
1,245 (3.6%)
850 (2.5%)*
Figure 1: Total numbers of children and young people receiving care from PDUs in England and Wales, 2015/16 to 2022/23.
6
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
2022/23
Boys
24.8
28.0
24.8
25.9
26.0
25.8
27.0
33.9
34.1
32.3
Girls
20.8
24.4
20.8
24.4
24.2
23.3
24.3
27.7
31.3
29.8
All
22.8
26.5
22.8
25.4
25.1
24.6
25.6
30.9
32.7
31.1
0
5
10
15
20
25
30
35
Incidence per 100,000
general population
0-15 years old
Sex and audit year
Figure 2: Incidence of Type 1 diabetes per 100,000 general population 0-15 years old in England and Wales, from 2013/14 to 2022/23
There were 1,245 children and young people in England and Wales being cared for in PDUs with Type 2 
diabetes in 2022/23. Of these, there were 268 new cases – similar to the 281 new cases recorded in 
2021/22. 
There were increases in the completion rates for all individual ‘key’ health checks in 2022/23 compared to 
the previous audit year.
63.4% of those with Type 1 diabetes aged 12 and above received all six ‘key’ annual health checks 
(HbA1c, BMI, blood pressure, thyroid function test, albuminuria screening, and foot checks), compared to 
59.7% in 2021/22. 
36.0% of those with Type 2 diabetes aged 12 and above received all six ‘key’ health checks (HbA1c, BMI, 
blood pressure, cholesterol, albuminuria screening, and foot checks), compared to 33.0% in 2021/22. 
Eye screening for retinopathy was removed from annual ‘key health check’ reporting in the NPDA as 
it was reduced to biennial frequency from 2020/21 in many NHS Trusts and Health Boards (unless an 
abnormal result was observed in a previous screen), due to changes in national retinopathy screening 
guidance. However, it remains an essential component of paediatric diabetes care. 
In 2022/23, 75.7% of those aged 12 years and above who had an abnormal eye screen in 2021/22 and who 
were also captured in the 2022/23 dataset had an eye screen in 2022/23, up from 59.5% of those who had 
an abnormal eye screen result in 2020/21 and were recaptured in 2021/22.
A similar proportion (75.9%) of those aged 12 years and above who had a normal eye screen in 2021/22 
and who were also captured in the 2022/23 dataset also received an eye screen in 2022/23.
What percentages of children and young people 
received all six recommended health checks?  
SECTION 02
HbA1c
BMI
Blood Pressure
Thyroid Test
Foot Check
Albuminuria
7
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Health check completion rate
PDUs
Figure 3: Percentage of children and young people with Type 1 diabetes receiving individual health checks, 2015/16 to 2022/23.
Figure 4: Column chart of health check completion rates for children and young people with Type 1 diabetes per PDU in England 
and Wales, 2022/23
In 2022/23 the overall completion rate (the total number of the six ‘key’ annual health checks completed 
divided by the total that should have been provided based on the age of those included in the analysis) 
for ‘key’ annual health checks received by children and young people with Type 1 diabetes was 90.8%, 
although completion rates varied between PDUs (Figure 4). 
What percentage of all recommended health 
checks were delivered by PDUs?
SECTION 03
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
2022/23
% of children and young people 
who completed a year of care
HbA1c
Blood pressure*
BMI
Urinary albumin*
Foot Exam*
Thyroid
* health checks 
completed for children 
and young people aged 
12 or older.
8
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

85.2% received level three carbohydrate counting education within a fortnight of diagnosis, 
compared to 85.9% in 2021/22.
91.6% received screening for thyroid disease within three months of diagnosis, compared to 
91.2% in 2021/22.
88.3% received screening for coeliac disease within three months of diagnosis, compared to 
87.0% in 2021/22.
The national overall median HbA1c for children and young people with all types of diabetes in England 
and Wales was 60.0 mmol/mol (60.0 mmol/mol for England and 60.0 mmol/mol for Wales), down from 
60.5 mmol/mol in 2021/22.
The national median HbA1c for children and young people with Type 1 diabetes in England and Wales 
was 60.5 mmol/mol (60.5 mmol/mol for England and 61.0 mmol/mol for Wales, Figure 5) down from 61.0 
mmol/mol in 2021/22. The median HbA1c at PDU level ranged from 53.0 mmol/mol to 70.3 mmol/mol. 
The national median HbA1c for Type 2 diabetes was 49.3 mmol/mol, down from 50.0 mmol/mol in 
2021/22.
What percentages of children and young people with Type 
1 diabetes received  recommended checks at diagnosis?
SECTION 04
Has there been an improvement in national HbA1c?
SECTION 05
HbA1c – test
HbA1c – test
2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23
England
71.6
70.5
69.0
69.0
66.5
65.0
64.0
64.0
62.0
62.0
61.0
61.0
60.5
Wales
70.5
70.0
70.0
69.0
68.3
65.0
64.0
65.0
62.0
62.0
62.0
62.0
61.0
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
Median HbA1c (mmol/mol) children 
and young people with Type 1 diabetes
England
Wales
England
Wales
Figure 5: Median HbA1c for children and young people with Type 1 diabetes in England and Wales, 2010/11 to 2022/23.
9
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

50
55
60
65
70
75
80
0
100
200
300
400
500
600
Mean adjusted HbA1c (mmol/mol)
Number of children and young people with Type 1 diabetes
PDUs in England
PDUs in Wales
2 SD
3 SD
Mean (England and Wales)
Figure 6: Funnel plot of mean case mix adjusted HbA1c by PDU for children and young people with Type 1 diabetes
What percentages of children and young people 
with diabetes were at risk of macrovascular and 
microvascular complications? 
SECTION 06
Figure 6 shows considerable variation 
in mean HbA1c for Type 1 diabetes at 
PDU level after case mix adjustment.
There has been little change in percentages of children and young people with diabetes showing early 
warning signs of complications between 2021/22 and 2022/23, or the years preceding.
TYPE 1 DIABETES
TYPE 2 DIABETES
29.6% (aged 12 and above) had a diastolic or systolic 
blood pressure in the hypertensive range (>98th centile 
after correction for age and gender), compared to 
29.9% in 2021/22.
46.5% (all ages) had a diastolic or systolic blood 
pressure in the hypertensive range (>98th centile after 
correction for age and gender), compared to 46.1% in 
2021/22.
19.6% (aged 12 and above) had a total blood cholesterol 
of 5mmol/l or higher, compared to 19.0% in 2021/22.
(Cholesterol is no longer included in the health checks specified 
for Type 1 diabetes by NICE, however the NPDA continues to report 
the outcomes of the cholesterol tests undertaken and submitted 
as some PDUs consider it to merit continuing scrutiny). 
29.6% (all ages) had a total blood cholesterol of 
5mmol/l or higher, compared to 27.9% in 2021/22.
41.7% (all ages) were overweight or obese (BMI>85th 
centile after correction for age and gender), compared 
to 42.3% in 2021/22.
93.5% (all ages) were overweight or obese (BMI >85th 
centile after correction for age and gender), compared 
to 92.8% in 2021/22.
10.9% (aged 12 and above) had an abnormal 
retinopathy screen, compared to 11.4% in 2021/22.
6.3% (aged 12 and above) had an abnormal retinopathy 
screen, compared to 8.4% in 2021/22.
10.4% (aged 12 years and above) had micro- or 
macroalbuminuria, compared to 11.5% in 2021/22.
21.4% (all ages) had micro- or macroalbuminuria, 
compared to 20.6% in 2021/22.
Table 2: Percentages of children and young people with Type 1 and Type 2 diabetes with evidence of risk factors for micro- and 
macrovascular complications, 2022/23
10
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

2021/22
2022/23
50
55
60
65
70
Injections
Injections
+ Flash
Injections
+ CGM
Pump
Pump +
Flash
Pump +
CGM
Closed-
loop
system
Number of children 2021/22
4,985
7,593
2,463
1,390
3,719
3,540
2,232
Mean HbA1c (mmol/mol) 2021/22
68.6
66.1
62.0
64.7
62.3
58.8
56.8
Number of children 2022/23
2,904
6,848
4,532
673
2,985
4,789
4,690
Mean HbA1c (mmol/mol) 2022/23
70.7
67.0
64.0
66.6
62.7
58.9
57.3
Mean HbA1c 
(mmol/mol)
What percentages of children and young people with 
Type 1 were using diabetes-related technologies?
SECTION 07
What was the average HbA1c for children 
and young people with Type 1 diabetes 
using different diabetes-related technologies?
SECTION 08
HbA1c – test
HbA1c – test
Across England and Wales:
45.3% were using an insulin pump, compared to 40.3% in 2021/22. 
14.7% were using a closed loop system, compared to 7.5% in 2021/22.
48.6% were using a real time continuous glucose monitor (rtCGM); either combined with insulin 
injections or a pump), compared to 30.0% in 2021/22.
37.2% were using a flash glucose monitor or a modified flash monitor, compared to 43.7% in 2021/22.
Figure 7 shows that the mean HbA1c of children and young people using each technology combination  
increased between 2021/22 and 2022/23. However, the total number using technology combinations 
associated with lower mean HbA1c also increased (including insulin pumps in conjunction with CGMs or 
closed-loop systems). This has contributed to lower average national HbA1c (see Figure 5).
Table 3: Percentages of children and young people with Type 1 diabetes using diabetes-related technologies 2022/23. 
*Denominator = the number of children and young people with Type 1 diabetes with a valid recorded treatment regimen. 
**Proportion of all children and young people with Type 1 diabetes.
Country
Insulin pump*
Closed-loop 
system**
rtCGM*
Flash glucose monitor or 
modified flash monitor*
England
45.2% 
 (13,348/29,548)
14.7%  
(4,510/30,647)
48.2% 
(13,163/27,293)
37.4% 
(10,195/27,293)
Wales
47.8%  
(760/1,591)
14.0%  
(228/1,629)
55.7% 
(828/1,487)
33.9% 
(504/1,487)
England and Wales
45.3%  
(14,108/31,139)
14.7%  
(4,738/32,276) 
48.6% 
(13,991/28,780)
37.2% 
(10,699/28,780)
Figure 7: Mean HbA1c for children and young people with Type 1 diabetes using different combinations of treatment regimen and 
glucose monitoring in 2021/22 - 2022/23 (error bars represent 95% confidence intervals).
11
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

DKA
Hypoglycae
mia
Ketosis
without
acidosis
Stabilization
2021/22
2.4%
0.9%
0.9%
1.9%
2022/23
2.2%
0.9%
0.6%
2.0%
Number of children 2021/22
(Denominator: 30,595)
734
271
266
575
Number of children 2022/23
(Denominator: 31,037)
673
271
180
636
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
% of those with Type 1 diabetes 
admitted at least once
What percentages of children and 
young people with Type 1 diabetes had 
diabetes-related hospital admissions?
SECTION 09
How many children and young people with 
diabetes were assessed as requiring additional 
psychological support following assessment?
SECTION 10
Figure 8: Percentages and numbers of children and young people with Type 1 diabetes admitted at least once for a diabetes-
related cause not associated with diagnosis, 2021/22 and 2022/23.
23.3% of children and young people newly diagnosed with Type 1 diabetes presented with DKA at 
diagnosis in 2022/23 compared to 25.6% in 2021/22. 
N.B. of the 172 PDUs participating in the 2022/23 audit, 165 submitted data on hospital admissions. 
Results above are based on the 31,037 children and young people with Type 1 diabetes receiving care at 
these PDUs. The percentage with DKA at diagnosis is lower than those reported in the NPDA Hospital 
Admissions report published in 2022, which combined PDU submitted data with HES and PEDW data. 
This result should therefore be interpreted with caution.
32.0% of those with Type 1 diabetes and known outcome of psychological assessment (n=21,827) were 
assessed as requiring additional psychological support outside of multidisciplinary team meetings 
compared to 39.0% in 2021/22.
41.4% of those with Type 2 diabetes and known outcome of psychological assessment (n=654) were 
assessed as requiring additional psychological support outside of multidisciplinary team meetings 
compared to 48.3% in 2021/22.
DKA
Hypoglycaemia
Stabilisation
Ketosis without 
acidosis
12
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

NPDA results have shown persistent inequalities in HbA1c outcomes and use of diabetes-related 
technologies associated with ethnicity, deprivation, age, and sex. Presented here are three  
examples- extended analysis is presented separately and can be viewed and downloaded  
from the NPDA annual reports page.
Spotlight on inequalities
Figure 9: Mean HbA1c by deprivation quintile for children and young people with Type 1 diabetes, 2013 - 2023.
Figure 10: Use of rtCGM by ethnic category and deprivation quintile amongst children and young people with Type 1 diabetes: 
2019/20- 2022/23 
2019/20
2020/21
2021/22
2022/23
England &
Mixed
White
Other
Asian
Black
Most
Second
most
Third
least
Second
least
Least
Ethnicity
Deprivation
18.5%
20.2%
16.0%
15.1%
11.7%
14.0%
17.3%
19.3%
22.3%
25.2%
29.3%
28.4%
28.1%
25.3%
21.9%
23.8%
24.9%
27.8%
29.8%
34.7%
31.3%
30.8%
26.9%
25.4%
22.2%
23.9%
25.7%
31.1%
32.7%
37.7%
47.0%
50.2%
42.7%
42.8%
36.2%
43.3%
45.3%
49.0%
52.1%
54.4%
0%
10%
20%
30%
40%
50%
60%
% children and young people with
Type 1 diabetes using rtCGM
England & Wales average (2022/23)
2013/1
4
2014/1
5
2015/1
6
2016/1
7
2017/1
8
2018/1
9
2019/
20
2020/
21
2021/2
2
2022/
23
Most deprived
74.7
73.7
71.6
70.7
70.9
68.2
68.3
67.8
67.6
66.8
Second most deprived
74.0
72.3
69.6
68.7
68.7
66.2
66.1
65.2
65.1
65.0
Third least deprived
72.2
70.6
68.1
67.0
67.5
65.0
65.1
64.4
63.3
63.0
Second least deprived
70.4
69.0
66.7
65.6
65.9
63.4
62.7
62.3
61.8
61.8
Least deprived
69.0
67.2
64.8
64.0
64.2
61.9
62.0
60.7
60.1
59.9
55
60
65
70
75
80
Mean HbA1c (mmol/mol)
2013/14
2014/15
2015/16
2016/17
2017/18
2018/19
2019/20
2020/21
2021/22
2022/23
13
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

White
Mixed
Other
Asian
Black
Most
Second
most
Third
least
Second
least
Least
Ethnicity
Deprivation
39.8%
34.9%
35.0%
29.7%
26.7%
31.7%
35.8%
37.5%
42.4%
44.3%
40.2%
37.8%
34.6%
31.1%
27.4%
32.5%
36.3%
38.4%
42.4%
44.0%
42.2%
38.0%
37.7%
33.0%
29.0%
34.0%
38.8%
41.1%
44.1%
45.1%
47.5%
39.5%
43.4%
39.5%
33.0%
38.8%
43.5%
46.0%
49.8%
50.7%
average (2022/23)
45.3%
45.3%
45.3%
45.3%
45.3%
45.3%
45.3%
45.3%
45.3%
45.3%
45.3%
0%
10%
20%
30%
40%
50%
60%
% children and young people with
Type 1 diabetes using insulin pumps
England & Wales average (2022/23)
Figure 11: Use of insulin pump therapy by ethnic category and deprivation quintile amongst children and young people with Type 1 
diabetes: 2019/20- 2022/23 
2019/20
2020/21
2021/22
2022/23
England &
The RCPCH Diabetes Quality Improvement Website provides multidisciplinary teams with the tools 
to identify, design and analyse their own interventions specific to the needs of the children and young 
people and their families that they care for.
A slide deck is available on the NPDA reports page for teams to customise with their own results, with 
prompts for team discussions around results, and links to relevant QI resources. 
Quality Improvement resources
14
National Paediatric Diabetes Audit (NPDA) Report on Care and Outcomes 2022/23

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and Child Health 
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and in Scotland (SC038299). 
Royal College of 
Paediatrics and Child Health
RCPCH
National Paediatric Diabetes Audit (NPDA)  
Report on Care and Outcomes 2022/23 
Healthcare Quality  
Improvement Partnership (HQIP) 
Dawson House, 5 Jewry Street,  
London EC3N 2EX
©2024 Healthcare Quality Improvement Partnership.  
Published by RCPCH April 2024