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Young diabetes patients receive fewer vital checks than older patients

ยท Under 40s "receive the worst routine care and treatment"

02 October 2014

*Regional data is published with this report 

New figures show that diabetes patients aged under 40 receive fewer vital checks and less often hit treatment targets than older age groups.

The National Diabetes Audit 2012-2013 presents findings for the care of over two million people8 in England and Wales with diabetes. It found that of approximately 130,000 patients under the age of 40, only 29.1 per cent with Type 1 diabetes and 46.3 per cent with Type 2 diabetes received eight of the nine NICE recommended care processes9.

These annual checks assess the effectiveness of diabetes treatment, as well as cardiovascular risk factors such as blood pressure (BP), serum cholesterol, body mass index (BMI) and smoking and the emergence of early complications including eye screening9, foot surveillance and kidney surveillance.

Patients aged 65 to 79 had the highest rate of receiving eight care processes, at 59.9 per cent for those with Type 1 diabetes and 66.7 per cent for those with Type 2 diabetes.

The audit also records the three NICE recommended treatment targets that should be monitored and met for patients with diabetes. These are glucose control, blood pressure and serum cholesterol. It found:

  • In the under 40s age group, 14.7 percent of patients with Type 1 diabetes met all three treatment targets
  • In the under 40s age group, 24.3 per cent of patients with Type 2 diabetes met all three treatment targets
  • Patients aged 80 and over had the highest treatment target achievement rate, with 25.5 per cent with Type 1 diabetes and 45.1 per cent with type 2 diabetes meeting all three treatment targets.

Regionally10, there was also variation in patients receiving checks. The number of patients receiving eight care processes ranged from 30.4 per cent to 78.0 per cent across Clinical commissioning groups (CCGs) and local health boards (LHBs), with the median rate being 62.6 per cent. The number of patients receiving all three treatment targets ranged from 27.8 per cent to 48.0 per cent across CCGs and LHBs, with the median rate being 35.9 per cent.

Dr Bob Young, Clinical Lead for the audit, said: "This year's report has shown that there is age inequality for the care and treatment received by patients with diabetes. Younger people are receiving substantially worse routine care and treatment than older patients and yet will live longer with their diabetes. They are therefore most at risk of developing complications that will affect their health and could lead to mortality.

"We recommend that commissioners, diabetes leads and GP and specialist providers of diabetes care review their results and consider improvements to their systems for delivering effective care to younger people with Type 1 and Type 2 diabetes."

The audit is the largest of its kind in the world. It is managed by the Health and Social Care Information Centre (HSCIC) in partnership with Diabetes UK and is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme4.

You can view the full report at: http://www.hscic.gov.uk/pubs/natdiabetesaudit

ENDS


Notes to editors

1. The National Diabetes Audit (NDA) programme, is commissioned by The Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme (NCA). The NDA is managed by the Health and Social Care Information Centre (HSCIC) in partnership with Diabetes UK and is supported by Public Health England (PHE).

Development and delivery of the NDA is guided by a multi-professional national group of Diabetologists, GPs, consultants, public health physicians, and service user representatives. The NDA is chaired by Dr Bob Young Consultant Diabetologist & CMIO, Clinical Lead NDA (National Diabetes Audit) & NCVIN (National Cardiovascular Intelligence Network).

2. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.

3. Diabetes UK is the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes. For more information visit www.diabetes.org.uk. In the UK, there are 3.8 million people with diabetes, including an estimated 630,000 people that have Type 2 diabetes but do not know it.

4. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover 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 audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. http://www.hqip.org.uk/

5. According to the Quality and Outcomes Framework (QOF) - 2012-13, 2.7 million people in England aged 17 and above have diabetes (all types included). Diabetes comprises a group of disorders with many different causes, all of which are characterised by a raised blood glucose level. This is the result of a lack of the hormone insulin and/or an inability to respond to insulin. Insulin in the blood, produced by the pancreas, is the hormone which ensures that glucose (sugar) obtained from food can be used by the body. There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes. In people with Type 1 diabetes, the pancreas is no longer able to produce insulin because the insulin-producing cells (beta-cells) have been destroyed by the body's immune system. Without insulin to move glucose from the bloodstream to the body's cells, glucose builds up in the blood and is passed out of the body in the urine. In people with Type 2 diabetes, the beta-cells are not able to produce enough insulin for the body's needs. The majority of people with Type 2 diabetes also have some degree of insulin resistance, where the cells in the body are not able to respond to the insulin that is produced.

6. The results in the report are calculated using NDA methodology and should not be compared directly with other reports where different methodologies may have been used. In addition, the NDA methodology for 2012-2013 has been revised. Further details on the changes can be found here: http://www.hscic.gov.uk/pubs/methchanges

7. Numbers above 100 have been rounded to the nearest 10.

8. Participation in the audit was as follows (exact figures):

  • 2,058,321 people with diabetes in England and Wales; appreciably less than 2011-2012 (2,473,239) or 2010-2011 (2,235,810).
  • 70.6 per cent of practices in England and Wales (87.9 per cent in 2011-2012; 80.9 per cent in 2010-2011).

The drop in participation in the NDA this year was expected due to the restructuring of the NHS starting in April 2013. This has left both challenges and opportunities for clinical audit but undoubtedly the organisational transition had disrupted many well established people and systems. The NDA also acknowledges the changes in the governance landscape along with the added pressures of significant numbers of GP practices moving clinical systems all which add to the complexities of primary care data extraction for national clinical audit.

9. The nine NICE recommended care processes are:

  • effectiveness of diabetes treatment (HbA1c)
  • blood pressure (BP)
  • serum cholesterol
  • body mass index (BMI)
  • smoking
  • eye screening*
  • foot surveillance
  • urine albumin
  • serum creatinine

More information can be found here: http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12165

*The NDA does not report on eye screening. The NHS Diabetic Eye Screening Programme (NHS DESP) records every digital eye screening and its records should be used as the preferred measure for this annual care process. Results for individual CCGs and individual specialist care units will be published separately alongside the national report.

10. For non-media enquires about the NDA please contact enquiries@hscic.gov.uk.

11. For media enquiries please contact media@hscic.gov.uk or 0300 30 33 888.

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