Publication, Part of National Diabetes Audit: Non-Diabetic Hyperglycaemia, Diabetes Prevention Programme
Non-Diabetic Hyperglycaemia, 2021-22, Diabetes Prevention Programme, Detailed Analysis Report
Changes to NDA reporting
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3 June 2024 00:00 AM
Summary
The NHS Diabetes Prevention Programme (DPP) is a joint commitment from NHS England, Office for Health Improvement and Disparities (OHID, formerly Public Health England) and Diabetes UK to deliver, at scale, evidence based behavioural interventions that can prevent or delay the onset of type 2 diabetes in adults who have been identified as having non-diabetic hyperglycaemia (NDH).
This is the annual report for 2021-22 on people with non-diabetic hyperglycaemia and people seen by the DPP. This detailed report accompanies the 'State of the Nation' summary report for 2021-22.
The report primarily uses data from English GP practice systems for 2021-22; and also includes data generated by providers of the DPP relating to referrals up to March 2022. The GP data is only for people diagnosed and recorded with NDH.
Highlights
State of the Nation Report
This report contains more detailed analysis of the 2021-22 Non-Diabetic Hyperglycaemia audit.
The summary or 'State of the Nation' report can be found here:
Non-Diabetic Hyperglycaemia, 2021-22, Diabetes Prevention Programme, State of the Nation
New in 2021-22 - Diabetes progression rates and DPP engagement
Healthcare services continued to be under increased pressure during 2021-22, due to the ongoing COVID-19 pandemic. However, many GP practices have been able to restore levels of diagnosis of non-diabetic hyperglycaemia (NDH) and monitoring of people already diagnosed with NDH to levels reached during 2019-20; and referrals continue to be made to the Diabetes Prevention Programme (DPP).
In 2021-22, 47.5% of people who weren't newly diagnosed with non-diabetic hyperglycaemia had a glycaemic test and BMI measurement taken during the audit year. The rate of glycaemic testing increased above that reached in 2019-20, and the variation in testing between integrated care boards (ICBs) has reduced from a range of 36.4% to 15.2%.
The rate of BMI measurements in 2021-22 is still below that reached in 2019-20, and there has been little change in the variation of monitoring between ICBs. Rates of both glycaemic testing and BMI measurements remain lower in people under 40, male or of black ethnicity.
By the end of 2021-22...
- 582,820 people were newly diagnosed with NDH (-1.7% on new diagnoses in 2019-20)
- 75.6% of people with NDH (excluding newly diagnosed cases) had a glycaemic check during the audit period (+5.2% on glycaemic checks in 2019-20)
- 210,650 people from the 2017-18 audit collection (diagnosed with NDH before April 2018) had developed diabetes (this is up 58.7% from the 132,690 who had been diagnosed in the pre-covid audit collection of 2019-20)
- More than 2.7 million people in England are currently diagnosed with non-diabetic hyperglycaemia.
The audit continues to show that obesity is associated with greater risks of progression to type 2 diabetes. It also shows that completion of the Diabetes Prevention Programme is associated with a reduced rate of developing diabetes.
In the 2017-18 cohort that remained alive in 2020; 15.1% of people who had completed the NHS DPP developed diabetes by April 2022, compared to 19.8% of those who attended but did not complete DPP, 21.2% of those referred but did not attend DPP and 16.6% of those who were not referred to the NHS DPP. People with NDH may not be referred to the NHS DPP for various reasons, including not being considered clinically appropriate for referral by their GP practice or declining referral when offered.
Participation in the Diabetes Prevention Programme is key in making lifestyle changes that can delay the development of diabetes in people with high levels of blood glucose.
In 2017-18 1.3 million people were known to be diagnosed with non-diabetic hyperglycaemia...
...by 2021-22
- 68.7% still had non-diabetic hyperglycaemia;
- 16.3% had diabetes;
- 10.8% had died;
- 4.2% had an unknown outcome.
Key Findings and Recommendations
Key finding 1:
New diagnoses of people with NDH reduced in 2020-21 but they have now almost returned to pre-pandemic levels.
Key finding 2:
Around three-quarters of people (75.6%) who were already diagnosed and recorded with NDH received a blood test for glycaemia (usually a check of HbA1c) in 2021-22, higher than occurred pre-pandemic in 2019-20 (71.8%).
Key finding 3:
There were marked inequalities for those known to have NDH who received the NICE-recommended annual blood test and BMI checks, with variation by ICB and by demographic characteristics.
Key finding 4:
Of those diagnosed and recorded with NDH in the 2017-18 audit, 16.3% were recorded as living with type 2 diabetes in 2021-22.
Key finding 5:
Progression rates varied according to whether people had been referred to or participated in the NHS DPP.
Recommendation 1:
ICBs should support activities to identify people with NDH (such as the NHS Health Check).
As noted in Key finding 1, data from the NHS Diabetes Prevention Programme and the CVD Prevent dataset suggest that in up to a third of people with NDH-range blood test results, an NDH diagnosis code has not yet been recorded. This may impede invitation for monitoring. It is recommended that ICBs take action to help improve the consistency of diagnostic coding.
The CVDPREVENT audit has recently reported on this in detail.
Recommendation 2:
Using the NDA dashboards, ICBs should review patient data on glycaemic and BMI monitoring to target local quality improvement programmes which reduce variation and inequity.
Recommendation 3:
ICBs should ensure that eligible people with NDH are offered the NHS Diabetes Prevention Programme if clinically appropriate, with particular focus on supporting people with greater risk of progression to diabetes (i.e. those from the most deprived quintile, aged under 65, of Black or Asian ethnicity, and/or those living with obesity).
- The State of the Nation report has more information on the key findings and recommendations of the 2021-22 NDH report
NDH-DPP dashboard
The audit directs local organisations (including ICBs and GP practices) to the NDH-DPP dashboard. The latest iteration of this dashboard can be found on the dashboard hub.
Last edited: 3 June 2024 10:21 am