The NHS may be facing a diabetes time bomb involving the future care of hundreds-of-thousands of younger patients, the biggest ever audit of diabetes in England and Wales has found.

Nearly 300,000 children and younger adults with diabetes have high risk, and 144,000 dangerously high risk, blood sugar levels that will lead to high levels of severe and disabling complications like kidney failure, limb amputation and stroke, according to the National Diabetes Audit 2010.

Children and younger adults (aged 0 to 54) are also less likely than older adults (aged 55 to 69) and the elderly (aged 70 and over) to receive all the basic care checks required to monitor their condition; leading to concerns that a large cohort of a whole generation with diabetes will require substantial hospital care in a matter of years.

The audit also shows that obesity is more prevalent among children and younger adults with diabetes than older adults and the elderly. Among younger adults with Type 2 diabetes, nine out of 10 are overweight or obese; the highest prevalence within any age group.

Commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by The NHS Information Centre, the audit is the largest of its kind in the world. It includes data from more than 80 per cent of the estimated 2.34 million people aged 17 and over with diagnosed diabetes in England. This is a 16 per cent records increase on the previous year and reflects increased participation by GPs and hospitals in all 151 Primary Care Trust areas. The audit also includes data from all seven Local Health Boards in Wales, where participation has almost trebled in three years.

The audit shows:

• High risk blood sugar levels are more common in younger people and in the socially deprived. However, overall over 800,000 people with diagnosed diabetes have high risk levels and are at risk of complications.
• Fewer younger adults compared to other age groups (42 per cent of 24 to 54-year-olds compared to 54 per cent of adults aged 55 and over) receive all nine recommended basic care processes annually, such as blood pressure, blood sugar and foot checks. Overall, the percentage of patients receiving every process is improving each year, but two thirds of Type 1 patients and almost half of Type 2 patients still do not receive all nine.

The audit also found that the prevalence of diabetes, especially Type 2 diabetes, is rising each year; in particular in deprived communities. It also identified substantial regional variation in both the prevalence and treatment of complications – such as kidney failure and dialysis.

For some trusts, this may be due to high volumes of cases of varying complexity, but the audit recommends that the bottom quartile of commissioners and providers urgently investigate the causes of high complications and/or low treatment provision.

Audit lead clinician Dr Bob Young, consultant diabetologist and clinical lead for the National Diabetes Information Service, said: “These results ring alarm bells. They show that younger people make up a quarter of all those with diabetes yet have the highest risks of potentially preventable complications. If these risks could be reduced much future disability and shortened life expectancy could be prevented.”

Dr Rowan Hillson, National Clinical Director for Diabetes said: "I am very concerned that the National Diabetes Audit shows that we still have a long way to go in delivering basic standards of diabetes care for everyone. In particular, young and middle-aged people with diabetes are not getting the regular checks they need to manage their condition for better outcomes. This is something we must improve if the NHS is going to meet the future challenge it faces from diabetes. These checks are vital to reduce serious but avoidable complications. All health care professionals should follow NICE's clear recommendations. There is no excuse for not doing the basics well."

From June 29 the audit can be accessed at www.ic.nhs.uk/nda

ENDS

Notes to editors

1. The NHS Information Centre (The NHS IC) is England's authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS IC also produces more than 120 statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.

2. The NHS IC is the largest single provider of clinical audits to the NHS and carries out a range of audits, mainly funded by the Healthcare Quality Improvement Partnership, into cancer, heart disease and diabetes.

3. 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 hosts the contract to manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP). Their purpose is to engage clinicians across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement in the quality of treatment and care. The programme comprises more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions.

4. According to Quality and Outcomes Framework (The QOF), 2.34 million people in England have Diabetes. 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.

5. The nine key processes of care for diabetes are recommended by the National Institute for Health and Clinical Excellence (NICE) and are; HbA1c, BMI, blood pressure, albumin, creatinine, cholesterol, eye examinations, foot examinations and smoking.

6. The target for blood sugar is that less than 7.5 per cent of blood cells should have glucose attached (this is known as HbA1c). This was achieved by 63 per cent of the people with diabetes in the audit.

There are two targets for blood pressure depending on whether the person is in a high risk group or low risk group. High risk is where eye, kidney or vascular disease is present, while low risk is where eye, kidney or vascular disease is absent.

The high risk group blood pressure target is 130/80; achieved by 38 per cent of the high risk group The low risk group blood pressure target is 140/80 achieved by 61 per cent of the low risk group Overall 50 per cent of people with diabetes achieved their recommended blood pressure target.

7. For non-media enquires about The NDA or diabetes information and services at The NHS Information Centre, contact diabetes@ic.nhs.uk

8. For media enquires and interview requests please call 0845 257 6990 or contact: mediaenquiries@ic.nhs.uk