(13 October 2014)
The HSCIC published the first part of the 2012-13 National Diabetes Audit (Care processes and Treatment Targets. The second part (focusing on complications including mortality) will be published in early 2015.
Overall the report finds that there is a familiar picture with low completion of the care processes, very low achievement of the NICE targets and poor access to and uptake of education.
The report shows that this is particularly true for younger people across both T1 and T2 and those with T1 in general. What is interesting is that the report goes on to compare these results with those from the DCCT, EDIC and UKPDS studies, showing that there is still some way to go in treating young people with T1 to target with the complications and burdens also being highest in this group:
“After an average follow up of six and a half years trial people allocated to conventional treatment (managing blood glucose levels to prevent symptoms) had a mean HbA1c of 76 mmol/mol (9.1 per cent) whilst those in the intensive treatment (aiming for a HbA1c in the normal range) group had a mean HbA1c of 56 mmol/mol (7.3 per cent4). A broadly comparable cohort of people with Type 1 diabetes from the 2012–2013 NDA cohort had a mean HbA1c of 72 mmol/mol (8.7 per cent).”
The report acknowledges the need for “new approaches to care” if improvements are to be achieved, while DUK (which is a delivery partner alongside HSCIC) has called the report a “a wakeup call to the NHS” to get the help and support they need to prevent serious complications later in life.
On the care processes
Annual completion rates for all care processes in 2012-1 was 59.9 per cent, compared to 60.5 per cent in 2011–2012 and 60.6 per cent in 2010–2011.
Those under 40 are less likely to achieve the care processes for both Type 1 and Type 2 diabetes
There is huge geographical variation ranging from between 55.4% vs. 67.2%
On treatment targets
Still only 35.9% of people are reaching all three of the NICE recommended glucose, blood pressure and cholesterol levels with a geographical variation of just 3.8% between the highest and lowest achieving CCGs.
There is variation in age groups for those achieving all three NICE targets as people get older
Only 27.3% of people with T1 achieved the NICE recommended HbA1c level compared to 64.8 % of people with T2
Only 3.9% and 16.7% respectively of newly diagnosed T1 and T2 and only 2.4% and 6.0% overall have been offered some sort of structured education.
Attendance is also low with only 1.1% T1 and 1.6% T2 overall attending education.