Care For People With Diabetes in the UK Is Improving, Says Report From The IC

The care of people with diabetes is improving, with more people having the key tests and measurements they need to help keep their diabetes under control, says a report from The Information Centre for health and social care (The IC).

The National Diabetes Audit (NDA), carried out by The IC on behalf of the Healthcare Commission, is an ongoing audit designed to monitor care and help ensure consistent quality across the country.

The 2005-2006 audit shows there is still room for improvement, with only 30 percent of people are having all of the recommended, key tests and measurements carried out, although the level of achievement is increasing year on year.

The report shows that the young and the elderly are the least likely to get the care they need. While the implications differ for each age group, this can have serious consequences for the control of their diabetes, their general well-being and ultimately for adverse outcomes.

The report shows that over the last three years more and more people with diabetes are having key tests and measurements, such as blood pressure and cholesterol checks.  Some 80 percent of people are routinely having their blood glucose level (HbA1C) checked; this is a seven percent increase from the previous year. 

The greatest improvement identified since the 2004-2005 audit is in the number of people with diabetes receiving a foot examination.  This has increased by 10 percent - from 53.33 percent to 63.76 percent. There has also been a 10 percent increase in the numbers of people with diabetes receiving albumin testing, 48.20 percent compared to 38.00 percent. These key tests and measurements helps prevent the risk of patients developing the complications of diabetes, such as heart attack, stroke, poor circulation, kidney problems, amputations and sight loss.

The NDA is considered the biggest annual clinical audit in the world and is based on the records of around 656,000 people with diabetes gathered from primary care, secondary care and specialist paediatric units - a third more than the previous year 2004-2005.

The audit showed that significant improvements to care took place in 2005-2006. In particular:

• more people with diabetes are achieving the NICE recommended guidelines for treatment targets such as maintaining a healthy blood glucose level and blood pressure control.   However, this is variable across the age bands.  Better control helps prevent the risk of developing the complications of diabetes, such as heart attack and stroke
• the report also shows that the rate of heart attack and stroke in people with diabetes has reduced across the three years of the audit
• 73 percent of people with diabetes achieved the NICE guideline of lower than 5mmol/litre for cholesterol.

However, just over a third of people still have blood glucose levels above what is recommended.  If this is sustained over a long period of time, people are at increased risk of developing diabetic complications, such as blindness, cardiac failure, renal failure and retinopathy.

In pediatrics, the audit is based on records of almost 13,000 patients - a 65 percent increase on the previous year -  50 percent of all children and young people, aged under 24, with diabetes in England and Wales.

Although NICE guidelines do not state that cholesterol should be tested for all ages, the results from the data submitted to the NDA shows overall 79 percent of all children and young people achieve the NICE cholesterol guideline of<5.0mmol/litre.

The pediatric data shows 30 percent of children and young people have blood glucose levels above 9.5 percent - a level which, according to NICE, poses a real risk to health and should attract extra resources for care.

While this was slightly down on the previous year - 0.6 percent - it remains a cause for concern and an area that needs improvement.

Healthcare Commission head of external outputs, Dr Jonathan Boyce comments: "It is good to see the number of people with diabetes receiving key measurement tests such as cholesterol levels and blood pressure is increasing and that in certain groups, the positive outcomes of those tests is also increasing.

"However, health services must not become complacent - the number of people receiving key tests still needs to rise. "

Other key findings from the reports include:

• more GP practices than ever are submitting patient data to the NDA. This means that the NHS is becoming more able to respond to the needs of people with diabetes in their local community. This is encouraging and hopefully the introduction of the Automated Data extract will allow more GP to participate in the audit

• on average, 8.71 per cent of children and young people under the age of 16 experienced at least once episode of diabetic ketoacidosis in the audit period. This is a slight increase on the 2004-2005 audit result of 8.2 per cent. Again, more girls than boys experience ketoacidosis.   This is a serious and potentially life threatening condition.

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