National Diabetes Audit Type 1 diabetes data reporting - hybrid closed loop implementation

NICE have published their final guidance on hybrid closed loop (HCL) systems for managing blood glucose levels in type 1 diabetes (TA943).

NHS England have developed 5-year HCL implementation strategy. Data from the National Diabetes Audit (NDA) and the National Paediatric Diabetes Audit (NPDA) will be used to distribute funding, measure uptake, monitor equitable access and evaluate effectiveness of HCL.

All adult and young adult diabetes specialist services delivering care to people with Type 1 diabetes in England must submit data for hybrid closed loop (HCL) systems by the following deadlines for quarterly submissions.

Data can be uploaded throughout the quarter at any time prior to the deadline for submission, but support to resolve issues with submissions can only be assured if raised by the deadline to submit queries.

Services must still submit the full NDA collection as normal each year by the deadline of 23 May 2025.

Data must be entered directly into the Clinical Audit Platform (CAP). New users must register to use the platform (opens in Word).

There are 2 approaches to submitting data into CAP. You can:

1. Enter individual patient records. Find guidance on how to submit individual patient records into CAP.
2. Bulk upload csv files. Find guidance on how to bulk upload files into CAP.

Fields not relating to the HCL submission can be left blank or other NDA data can be submitted alongside the HCL required fields. 

Although the deadline for the usual NDA collection is 23 May 2025, NDA data can be uploaded anytime throughout the year, and will be captured in the year-end report.

Individual person level data will be used to calculate ICB reimbursement funding.

Each quarter all adult and young adult diabetes specialist services in England should submit data for all existing and new type 1 diabetes patients that have had appointments in that quarter, regardless of their use of glucose technology or type of insulin regime.

This should include any observations made at appointments, or from other data sources, on the use of continuous glucose monitoring systems (rtCGM), open loop insulin pumps, and HCL/closed loop system supplied by specialist services (non-GP prescribed) including confirmation where not using.

If patient has multiple observations from the same quarter, please submit all observations.

You can include observations from previous quarters that have not yet been submitted. However, please note that late data submissions may have an impact on reimbursement to the ICB.

For CAP bulk upload data submissions, where there are multiple rows for a patient (for example, multiple observations in a month), please ensure:

• the last row of data in the csv file is the latest information
• the ‘Patient’ and ‘Pregnancy and pregnancy planning’ (if applicable) fields listed above are complete in the last row 

The following data items are required in the quarterly submission:

• NHS number
• Date of birth
• Diabetes type
• GP practice code

• Is the patient pregnant? (Yes/No)
• If yes, estimated delivery date

• Is the patient planning pregnancy? (Yes/No) Note: The definition of planning pregnancy is attendance at a pre-pregnancy care service.
• If yes, pregnancy planning observation date

• Is the patient on an open loop insulin pump? (Yes - NHS funded/Yes - non-NHS funded/No)
• If yes, observation date (open loop insulin pump)
• If yes, date started using open loop pump

• Is the patient the patient using a continuous glucose monitoring systems (rtCGMS)? (Yes - NHS funded/Yes - non-NHS funded/No)
• If yes, rtCGMS observation Date
• If yes, date started using rtCGMS

• Is the patient using a closed loop system (CLS)? (Yes - NHS funded/Yes - non-NHS funded/No - offered but declined)
• If yes, CLS observation date
• If yes, date started using CLS
• If yes, was the patient on an insulin pump prior to 1 April 2024? (Yes/No)

• Person observation (HbA1c level) (for HCL/closed loop system users only)
• Observation date (HbA1c level) (for HCL/closed loop system users only)

CAP bulk upload data submission

Where there are multiple rows for a patient (for example, multiple observations in a month), please ensure:

• the last row of data in the csv file is the latest information
• the ‘Patient’ and ‘Pregnancy and pregnancy planning’ (if applicable) fields listed above are complete in the last row 

GP codes

We are aware of issues with the GP code list in the Clinical Audit Platform. Please leave the GP code field blank if it is not valid in the CAP system (you will get a data warning on submission).

Dates

The observation date is the date something is observed to have happened. Observation dates can be when an appointment happens, or the date on which other data is used to confirm data for a field - for example, to record someone is still using a pump the date it was confirmed they are still receiving consumables for pump from the trust.

This can be an observation of ongoing usage (for example, if still using open loop pump, record ‘yes’ and ‘DD/MM/YYYY’ as the date this was observed) or as a change using the date the change was made. The observation can be from in any care setting/appointment type.

Where 'Date started' is unknown, please leave blank (this field is not mandatory except for closed loop system). Where the year is known but not the month, submit 01/YYYY. 

HCL/closed loop system questions

Where HCL/closed loop system is fully NHS-funded or fully non-NHS funded: Complete the closed loop system questions only. You should leave the rtCGMS and insulin pump questions blank.

Where there is a mix of NHS/non-NHS funded items in a HCL/closed loop system:

1. If the insulin pump is NHS-funded but the rtCGMS is not: Answer 'Yes - NHS-funded'. You should also complete the rtCGMS and open loop insulin pump questions, making sure all have the same observation date.
2. If the insulin pump is non-NHS funded but the rtCGMS is: Answer 'Yes - non-NHS funded'. You should also complete the rtCGMS and open loop insulin pump questions, making sure all have the same observation date.

Where a patient is not using a HCL/closed loop system but has not been offered a HCL/closed loop system, the question: 'Is the patient using a closed loop system?' can be left blank. If they have been offered HCL but declined, this can be answered 'No – offered but declined' with the observation being the date the patient declined HCL/closed loop system.

Incorrect NHS number or date of birth

You can amend all patient details in the CAP except date of birth. If a patient’s data of birth or NHS number needs to be corrected, please contact the National Service Desk by emailing [email protected] or calling 0300 303 5035. Do not include any patient information or NHS number in your initial email.

Data collected will be used to set indicative budgets and calculate reimbursement funding for ICBs.

If you have queries about funding, please contact [email protected].

For further information about the audit, and help with technical queries, please contact the National Service Desk (NSD) by emailing [email protected] or calling 0300 303 5035. Note that lines are open Monday to Friday 9am to 5pm.

For data submission queries write 'CAP submission query' in the subject header.