Publication, Part of National Diabetes Audit: Adolescent and Young Adults with Type 1 Diabetes
Adolescent and Young Adult Type 1 Diabetes Audit (AYA), 2017-21
Future publication format
Please note that future publications will be web-based only. This is to improve the accessibility of our publications.
16 June 2022 09:30 AM
Change to inclusion of drug prescription and diabetic ketoacidosis (DKA) data for Wales
In the Interactive data visualisation published on 16 June 2022 Wales drug prescription data was not included in the diabetes diagnosis validation process. In v2.0 of the visualisation this data has been included resulting in a larger cohort used for the analysis, particularly for Wales. For further details on the diagnosis validation process see main report.
In addition, v2.0 no longer includes analysis on DKA hospital inpatient admissions for Wales. This is because it was only possible to obtain data NHS hospital admission data from hospitals in England and therefore any DKA hospital inpatient admission results for Wales would not have been representative of diabetes care in Wales.
18 July 2022 09:00 AM
Changes to NDA reporting
NHS England are currently reviewing the routine production of NDA State of the Nation reports. Please note that data will still be released via dashboards and standalone data files whilst this review is being conducted.
To help inform this review we would be grateful if users can provide feedback on their use of the State of the Nation reports using the feedback survey available in the ‘Related links' section of this page.
3 June 2024 00:00 AM
Appendix
Care Processes
Table 7: Care process completion rates*,**,*** in adolescents and young adults with type 1 diabetes, by age, England, 2017-21
| Age at audit start | HbA1c | UACR | Blood pressure | Cholesterol*** | BMI | Foot exam |
| 15 | 82.6 | 57.0 | 83.5 | 55.4 | 88.5 | 59.2 |
| 16 | 85.4 | 55.9 | 86.8 | 59.9 | 88.6 | 63.0 |
| 17 | 85.9 | 52.3 | 86.9 | 64.3 | 86.7 | 65.4 |
| 18 | 82.3 | 44.2 | 84.3 | 65.2 | 82.2 | 61.8 |
| 19 | 78.0 | 38.8 | 81.6 | 65.4 | 75.9 | 59.5 |
| 20 | 78.0 | 39.2 | 81.6 | 66.7 | 75.6 | 59.8 |
| 21 | 78.4 | 39.1 | 82.2 | 68.2 | 75.8 | 60.5 |
| 22 | 79.3 | 39.7 | 82.5 | 69.3 | 76.3 | 61.9 |
| 23 | 79.9 | 39.7 | 82.2 | 69.8 | 75.8 | 61.9 |
| 24 | 79.7 | 39.9 | 82.2 | 70.5 | 75.5 | 62.8 |
| 25 | 80.7 | 39.7 | 82.8 | 71.3 | 76.4 | 62.9 |
- For the majority of care processes, the highest completion rate occurred at ages 16 and 17 years and the lowest rates occurred at ages 19 and 20 years.
* Due to retinal screening data only being available from 2019-20 and due to serum creatinine and smoking checks not being included in the NPDA, this report is restricted to 6 of the 9 care processes for England.
** Under 12s: HbA1c, BMI and cholesterol care processes.
12-18 years: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening and foot exam care processes.
19 years and over: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening, foot exam, smoking status and creatinine care processes.
*** Cholesterol is not a mandated care process for adolescents and young adults.
- 7.9% of adolescents and young adults with type 1 diabetes did not have a HbA1c care process check when aged between 15 and 25 years**.
- HbA1c care process completion rates were highest in younger years and peaked when aged 17 years.
- HbA1c care process completion rates were lowest at 19 and 20 years.
* Under 12s: HbA1c, BMI and cholesterol care processes.
12-18 years: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening and foot exam care processes.
19 years and over: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening, foot exam, smoking status and creatinine care processes.
** Based on age at audit year start.
- UACR care process completion rates were highest at 15 and 16 years, decreased between the ages of 16 and 19 years, and remained steady in those aged 19 years old and older.
* Under 12s: HbA1c, BMI and cholesterol care processes.
12-18 years: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening and foot exam care processes.
19 years and over: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening, foot exam, smoking status and creatinine care processes.
- Blood pressure care process completion rates peaked for 16 and 17 year olds, before decreasing slightly and then remaining consistent for those aged 19 years and older.
* Under 12s: HbA1c, BMI and cholesterol care processes.
12-18 years: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening and foot exam care processes.
19 years and over: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening, foot exam, smoking status and creatinine care processes.
- Care process completion rates were steady between 2017-18 and 2019-20, but dropped greatly in 2020-21. This is likely due to the impact the coronavirus pandemic had on diabetes services.
* Due to retinal screening data only being available from 2019-20 and due to serum creatinine and smoking checks not being included in the NPDA, this report is restricted to 6 of the 9 care processes for England.
** Under 12s: HbA1c, BMI and cholesterol care processes.
12-18 years: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening and foot exam care processes.
19 years and over: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening, foot exam, smoking status and creatinine care processes.
*** Cholesterol is not a mandated care process for adolescents and young adults.
**** Aged 15 to 25 years old at audit year start.
Table 8: Care process completion rates*,**,*** in adolescents and young adults**** with type 1 diabetes, by audit year, England, 2017-21
| Audit year | HbA1c | UACR | Blood pressure | Cholesterol*** | BMI | Foot exam |
| 2017-18 | 85.8 | 47.6 | 89.3 | 72.4 | 84.0 | 69.7 |
| 2018-19 | 86.8 | 47.7 | 90.0 | 73.7 | 84.9 | 70.9 |
| 2019-20 | 83.3 | 48.5 | 88.5 | 69.2 | 83.7 | 67.5 |
| 2020-21 | 66.9 | 29.8 | 64.9 | 50.8 | 64.1 | 38.8 |
- Care process completion rates were steady between 2017-18 and 2019-20, but dropped greatly in 2020-21. This is likely due to the impact the coronavirus pandemic had on diabetes services.
* Due to retinal screening data only being available from 2019-20 and due to serum creatinine and smoking checks not being included in the NPDA, this report is restricted to 6 of the 9 care processes for England.
** Under 12s: HbA1c, BMI and cholesterol care processes.
12-18 years: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening and foot exam care processes.
19 years and over: HbA1c, BMI, cholesterol, blood pressure, urine albumin, retinal screening, foot exam, smoking status and creatinine care processes.
*** Cholesterol is not a mandated care process for adolescents and young adults.
**** Aged 15 to 25 years old at audit year start.
Treatment target: HbA1c
Table 9: HbA1c results (mmol/mol)* by age at HbA1c result, England, 2017-21
| Age at HbA1c result | Number of people | Mean HbA1c | Median HbA1c | Interquartile range | Range** | Standard deviation |
| 15 | 9,090 | 69.0 | 65.0 | 56.0 - 78.0 | 153.0 | 20.1 |
| 16 | 9,865 | 71.5 | 66.0 | 56.0 - 81.0 | 170.8 | 22.2 |
| 17 | 10,975 | 73.0 | 68.0 | 57.0 - 84.0 | 159.8 | 22.8 |
| 18 | 11,270 | 75.2 | 70.0 | 58.0 - 88.0 | 156.6 | 23.5 |
| 19 | 10,955 | 76.3 | 71.0 | 59.0 - 89.0 | 163.8 | 23.7 |
| 20 | 11,155 | 76.8 | 73.0 | 60.0 - 90.0 | 168.0 | 23.2 |
| 21 | 11,555 | 76.1 | 72.0 | 60.0 - 89.0 | 161.4 | 22.8 |
| 22 | 12,130 | 75.4 | 71.0 | 59.0 - 87.7 | 171.6 | 22.5 |
| 23 | 12,570 | 74.3 | 70.0 | 58.0 - 87.0 | 165.0 | 21.9 |
| 24 | 12,910 | 73.7 | 70.0 | 58.0 - 86.0 | 168.8 | 21.7 |
| 25 | 13,250 | 73.1 | 69.0 | 57.4 - 85.0 | 160.0 | 21.7 |
- The lowest average HbA1c level was found in adolescents and young adults with type 1 diabetes aged 15 years.
- The average HbA1c level then increased with age until its peak at 20 years.
* Based on latest HbA1c result at age in years.
** The range is the difference between the highest and the lowest HbA1c levels.
- Mean and median HbA1c were slightly lower in older adolescents and young adults with type 1 diabetes known to paediatrics services compared to those not known to paediatric services (at 20 years old: Median difference = 3.0 mmol/mol; Mean difference = 2.7 mmol/mol).
* Based on latest HbA1c result at age in years.
** ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
*** Data on people over 20 years old not reported due to small number of those known to paediatric services.
**** For a summary of the statistics see next 2 tables below.
Table 10: HbA1c results (mmol/mol)* adolescents and young adults with type 1 diabetes known to paediatric services** by age at HbA1c result***, England, 2017-21
| Age at HbA1c result | Number of people | Mean HbA1c | Median HbA1c | Interquartile range | Range**** | Standard deviation |
| 15 | 7,180 | 68.6 | 65.0 | 56.0 - 77.0 | 151.1 | 19.4 |
| 16 | 7,310 | 70.8 | 66.0 | 56.0 - 80.0 | 146.0 | 21.4 |
| 17 | 6,860 | 72.4 | 67.0 | 57.0 - 83.0 | 148.6 | 22.2 |
| 18 | 5,305 | 74.0 | 69.0 | 58.0 - 85.0 | 156.0 | 22.2 |
| 19 | 1,445 | 73.8 | 70.0 | 58.0 - 85.0 | 158.5 | 21.8 |
| 20 | 130 | 74.2 | 70.0 | 58.0 - 87.0 | 103.0 | 21.5 |
- The average HbA1c level of older adolescents and young adults with type 1 diabetes known to paediatrics services was slightly lower compared to those not known to paediatric services.
* Based on latest HbA1c result at age in years.
** ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
*** Data on people over 20 years old not reported due to small number of those known to paediatric services.
**** The range is the difference between the highest and the lowest HbA1c levels.
Table 11: HbA1c results (mmol/mol)* adolescents and young adults with type 1 diabetes not known to paediatric services** by age at HbA1c result, England, 2017-21
| Age at HbA1c result | Number of people | Mean HbA1c | Median HbA1c | Interquartile range | Range*** | Standard deviation |
| 15 | 1,910 | 70.6 | 66.0 | 56.0 - 80.0 | 150.5 | 22.7 |
| 16 | 2,555 | 73.3 | 67.2 | 56.3 - 85.0 | 170.8 | 24.2 |
| 17 | 4,115 | 74.0 | 68.0 | 57.0 - 86.0 | 158.0 | 23.9 |
| 18 | 5,960 | 76.3 | 71.0 | 59.0 - 90.0 | 153.6 | 24.5 |
| 19 | 9,505 | 76.7 | 72.0 | 59.0 - 90.0 | 163.8 | 23.9 |
| 20 | 11,030 | 76.9 | 73.0 | 60.0 - 90.0 | 168.0 | 23.2 |
| 21 | 11,545 | 76.1 | 72.0 | 60.0 - 89.0 | 161.4 | 22.8 |
| 22 | 12,125 | 75.4 | 71.0 | 59.0 - 87.7 | 171.6 | 22.5 |
| 23 | 12,565 | 74.3 | 70.0 | 58.0 - 87.0 | 165.0 | 21.9 |
| 24 | 12,910 | 73.7 | 70.0 | 58.0 - 86.0 | 168.8 | 21.7 |
| 25 | 13,250 | 73.1 | 69.0 | 57.4 - 85.0 | 160.0 | 21.7 |
- The average HbA1c level of older adolescents and young adults with type 1 diabetes known to paediatrics services was slightly lower compared to those not known to paediatric services.
* Based on latest HbA1c result at age in years.
** ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
*** The range is the difference between the highest and the lowest HbA1c levels.
- As adolescents and young adults with type 1 diabetes grew older they were less likely to be known to paediatric services.
* ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
** Based on latest HbA1c result at age in years.
- Those known to paediatric services were consistently more likely to achieve a HbA1c result less than or equal to 58 mmol/mol than those not known to such services. However, this difference is very slight in younger years.
* ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
** Based on latest HbA1c result at age in years.
*** Data on people over 20 years old not reported due to small number of those known to paediatric services.
- As adolescents and young adults with type 1 diabetes grew older they were less likely to be known to paediatric services.
* ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
** Based on latest HbA1c result at age in years.
- Those not known to paediatric services were consistently more likely to have a HbA1c result greater than 86 mmol/mol than those known to paediatric services.
* ‘Known to paediatric services’ defined by having a HbA1c date recorded in NPDA at age in years.
** Based on latest HbA1c result at age in years.
*** Data on people over 20 years old not reported due to small number of those known to paediatric services.
HbA1c at transfer from paediatric to adult services
- 4,985 adolescents and young adults with type 1 diabetes transferred from paediatric services to adult services*.
- 4,945 transferred between the ages of 15 and 20 years***.
- Over 90% of all adolescents and young adults who transferred had an HbA1c result recorded when age of transfer was between 15 and 20 years*** (92.6%).
- The average HbA1c level at age of transfer was similar for all ages of transfer between 15 and 20 years.
* Based on latest HbA1c result at age of transfer.
** Person who is in NPDA with a recorded leaving date and the reason for leaving paediatric services being transfer to adult services. A person transferred when they appeared in the NDA the audit year following transfer date.
*** Data on people over 20 years old at age of transfer not reported due to very low number of people who transferred when over the age of 20 years old.
**** For a summary of the statistics see next table below.
Table 12: HbA1c results (mmol/mol)* by age at completed transfer** from paediatric services to adult services***, England, 2017-21
| Age at HbA1c result | Number of people | Mean HbA1c | Median HbA1c | Interquartile range | Range**** | Standard deviation |
| 15 | 25 | 72.5 | 65.0 | 54.0 - 85.0 | 78.7 | 21.8 |
| 16 | 455 | 73.3 | 69.0 | 58.0 - 83.0 | 111.0 | 22.3 |
| 17 | 800 | 73.4 | 68.0 | 58.0 - 84.0 | 134.0 | 21.9 |
| 18 | 2,070 | 73.7 | 69.0 | 58.2 - 84.5 | 156.6 | 21.3 |
| 19 | 1,155 | 75.0 | 71.0 | 59.0 - 87.0 | 136.6 | 21.8 |
| 20 | 75 | 75.3 | 71.7 | 58.0 - 87.3 | 119.0 | 22.7 |
- The average HbA1c level at age of transfer slightly increased with age when the age of transfer was between 15 and 20 years.
* Based on latest HbA1c result at age of transfer.
** Person who is in NPDA with a recorded leaving date and the reason for leaving paediatric services being transfer to adult services. A person transferred when they appeared in the NDA the audit year following transfer date.
*** Data on people over 20 years old at age of transfer not reported due to very low number of people who transferred when over the age of 20 years old.
**** The range is the difference between the highest and the lowest HbA1c levels.
Insulin pump: HbA1c
Table 13: HbA1c results (mmol/mol)* of adolescents and young adults with type 1 diabetes on an insulin pump by age at audit year start, England, 2017-21
| Age at HbA1c result | Number of people | Mean HbA1c | Median HbA1c | Interquartile range | Range** | Standard deviation |
| 15 | 3,115 | 65.3 | 62.0 | 55.0 - 72.0 | 115.0 | 16.2 |
| 16 | 3,085 | 66.8 | 63.9 | 55.0 - 74.0 | 121.0 | 17.2 |
| 17 | 2,935 | 68.9 | 65.0 | 56.0 - 77.0 | 140.8 | 18.7 |
| 18 | 2,575 | 70.5 | 67.0 | 57.0 - 80.0 | 131.0 | 19.0 |
| 19 | 2,160 | 72.2 | 69.0 | 58.0 - 81.0 | 138.0 | 19.6 |
| 20 | 1,945 | 70.9 | 67.0 | 58.0 - 80.0 | 138.4 | 18.6 |
| 21 | 1,835 | 70.7 | 67.0 | 58.0 - 80.0 | 138.0 | 18.5 |
| 22 | 1,740 | 69.6 | 67.0 | 58.0 - 78.0 | 115.0 | 17.0 |
| 23 | 1,660 | 68.1 | 65.0 | 56.0 - 77.0 | 141.0 | 17.2 |
| 24 | 1,645 | 67.7 | 65.0 | 56.0 - 77.0 | 132.0 | 17.1 |
| 25 | 1,705 | 66.2 | 63.0 | 55.0 - 74.0 | 136.0 | 17.2 |
- Insulin pump treatment is associated with a lower median and mean HbA1c result.
* Based on latest HbA1c result in audit year.
** The range is the difference between the highest and the lowest HbA1c levels.
Table 14: HbA1c results (mmol/mol)* of adolescents and young adults with type 1 diabetes not on an insulin pump by age at audit year start, England, 2017-21
| Age at HbA1c result | Number of people | Mean HbA1c | Median HbA1c | Interquartile range | Range** | Standard deviation |
| 15 | 5,875 | 73.2 | 68.0 | 57.0 - 85.0 | 163.0 | 23.2 |
| 16 | 6,700 | 75.2 | 70.0 | 58.0 - 88.0 | 170.0 | 24.2 |
| 17 | 7,470 | 77.0 | 71.0 | 59.0 - 91.0 | 162.0 | 25.0 |
| 18 | 8,065 | 78.0 | 73.0 | 60.0 - 93.0 | 159.8 | 24.7 |
| 19 | 8,460 | 78.3 | 74.0 | 60.0 - 92.0 | 162.0 | 24.2 |
| 20 | 9,120 | 77.8 | 74.0 | 61.0 - 91.0 | 165.0 | 23.5 |
| 21 | 9,655 | 77.0 | 73.0 | 60.0 - 90.0 | 157.0 | 23.4 |
| 22 | 10,315 | 75.9 | 72.0 | 59.0 - 89.0 | 169.9 | 22.8 |
| 23 | 10,705 | 75.3 | 71.0 | 59.0 - 88.0 | 167.7 | 22.3 |
| 24 | 11,000 | 74.6 | 71.0 | 58.0 - 87.0 | 169.0 | 22.2 |
| 25 | 11,435 | 73.9 | 70.0 | 58.0 - 86.0 | 155.0 | 21.9 |
- Insulin pump treatment is associated with a lower median and mean HbA1c result.
* Based on latest HbA1c result in audit year.
** The range is the difference between the highest and the lowest HbA1c levels.
Last edited: 3 June 2024 10:34 am