More people with diabetes are receiving the care recommended to monitor their condition, but the number receiving effective treatment as a result has stalled and the number with certain complications has increased, according to the latest National Diabetes Audit.

The audit, commissioned by the Healthcare Quality Improvement Partnership and managed by The NHS Information Centre, is the largest of its kind in the world and includes records for over 1.7 million people with diabetes in England and Wales. Of which, over 39,000 records are for children and young people with diabetes. Records were submitted from 5920 practices, 110 paediatric units and 44 secondary care units in England. A further 152 practices and 14 paediatric units in Wales provided data.

Of those included in the 2008/09 audit, over 90 per cent are in contact with their healthcare teams at least once a year, shown by a high recording rate for blood pressure, weight and blood sugar care processes. These are three of the nine key processes of diabetes care recommended by the National Institute for Health and Clinical Excellence (NICE).

The percentage of people receiving all nine processes has risen to 32.2 per cent for people with Type 1 diabetes and 50.8 per cent for Type 2 diabetes. Although still far below the NICE recommendation, the figure has risen substantially from the recorded 11.9 per cent for Type 1 diabetes and 10.6 per cent for Type 2 diabetes six years ago.

However the audit shows the high level of contacts with healthcare teams are not always being converted into effective care. For example, blood sugar and blood pressure treatment targets aimed at reducing complications are not being met and end stage kidney disease (people with diabetes needing dialysis or kidney transplant) has almost doubled within six years.

Half of people with diabetes overall do not meet their blood pressure target and more than a third have levels of poor blood sugar control, which carries a very high risk of developing complications such as blindness, heart attacks, kidney failure and amputation.

This issue is especially prevalent in younger people. A third of people with diabetes did not have a urine test, which can identify early signs of diabetic kidney disease and support interventions to reduce the risk of progression to the stages of kidney disease where dialysis or a kidney transplant might be needed.

Younger people are also significantly less likely to receive all nine care processes. Of people aged 16 to 39, just over 20 per cent with Type 1 diabetes and just over 35 per cent with Type 2 diabetes received every process. This compares to just over 34 per cent of people with Type 1 diabetes and just over 51 per cent of people with Type 2 diabetes in the 40 to 84 age group.

The audit also found that:

• The prevalence of diabetes has increased by 25 per cent over the past six years, from 3.3 to 4.1 per cent.
• In six years obesity in people with Type 2 diabetes has increased by 10 per cent overall to reach over 50 per cent. The rising level of obesity may be a barrier to improving the control of blood pressure and blood sugar levels in people with Type 2 diabetes, as obesity decreases insulin sensitivity and inhibits the effectiveness of all diabetes treatments. Obesity also increases blood pressure independently of diabetes.
• Type 2 diabetes is 40 per cent more common in people who are the most socio-economically deprived in the country, compared to those who are the least. Deprivation is not a factor with Type 1 diabetes.

Gavin Terry, Policy Manager at Diabetes UK said: “There is little good news from this latest audit. Well over two thirds of people with Type 1 diabetes and half of people with Type 2 diabetes in England and Wales are missing out on checks that in real terms translate into saving a person's sight, preventing limb amputation and extending life expectancy through the prevention of kidney failure, stroke and heart disease. More worrying is that these figures are worse for young people.”

Consultant diabetologist and clinical lead for the audit Dr Bob Young said, “It is encouraging to see the continued commitment of those involved with diabetes care in participating in this audit – which now includes records for 75 per cent of people with diabetes. Analysis of those 1.7 million records is vital to understanding and treating diabetes and this year's report shows that, while some improvements have been made, there is still much work to be done to best address a condition which is affecting more and more people every year.”

The executive summary of the audit, including a PCT dashboard with detailed analysis of the audit results, can be accessed at www.ic.nhs.uk/nda

The full report for the 2008/09 National Paediatric Unit Audit can also be accessed at www.ic.nhs.uk/nda

Data for the 2009/10 NDA is already being collected. PCTS, hospital trusts, GP practices and specialist paediatric units can participate by visiting www.ic.nhs.uk/nda/takepart

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 more than 300 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 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions, including diabetes.
4. According to Quality and Outcomes Framework (The QOF), 2.2 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 was achieved by 63 per cent of the diabetics 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. Children and young people are classed as up to and including 24 years of age
8. For non-media enquires about The NDA or diabetes information and services at The NHS Information Centre, contact diabetes@ic.nhs.uk
9. For media enquires please call 0845 257 6990 or contact:

• Sarah Dahlgren on 0113 254 7272, sarah.dahlgren@ic.nhs.uk
• Kristina Fox on 07908 818962, Kristina.fox@ic.nhs.uk