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Publication, Part of

Non-Diabetic Hyperglycaemia, 2021-22, Diabetes Prevention Programme, Overview

Publication Date:
14 Dec 2023
Geographic Coverage:
England
Geographical Granularity:
Country, GP practices, Integrated Care Boards
Date Range:
01 Jan 2021 to 31 Mar 2022

Previous Chapter

Overview

Current Chapter

Key findings

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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

Page contents

Key findings

Key finding 1

New diagnoses of people with NDH reduced in 2020-21 compared to 2019-20 but they have now almost returned to pre-pandemic levels.

 

Between January 2021 and March 2022, 582,820 people were newly diagnosed with NDH. There were 592,785 new diagnoses of NDH between January 2019 and March 2020 prior to the pandemic. New diagnoses of NDH dipped to 440,260 during the pandemic between January 2020 and March 2021.

Nearly a third of referrals to the NHS DPP (256,650 out of 806,450) were for people with a valid laboratory blood test result but for whom the diagnostic code of NDH had not yet been recorded in their clinical record.

Figure 1: New diagnoses of non-diabetic hyperglycaemia (January 2017 to March 2022)
Download the data for this chart Figure 1: New diagnoses of non-diabetic hyperglycaemia (January 2017 to March 2022)
  • The CVDPREVENT audit has recently reported on this in detail.
  • 2021-22 NDH-DPP Detailed Analysis: Introduction

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%).

These tests are critical to identify progression to type 2 diabetes. Increases during 2021-22 in blood testing may relate to the new Quality and Outcomes Framework (QOF) indicator introduced in April 2020 (note that QOF was suspended in 2020-21 due to the pandemic). However, while an increase was seen in blood testing, slightly over half of people (52.8%) already diagnosed and recorded with NDH had a body mass index (BMI) check in 2021-22, lower than occurred pre-pandemic in 2019-20 (60.3%).

Figure 2: Glycaemic and BMI checks for people with pre-existing NDH (January 2017 to March 2022)
Download the data for this chart Figure 2: Glycaemic and BMI checks for people with pre-existing NDH (January 2017 to March 2022)

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 integrated care board (ICB) and by demographic characteristics. The biggest inequality being age (ranging from 58.7% to 81.3% receiving the blood test and 44.1% to 58.2% with a BMI check between age groups).

 

Between ICBs rates of blood tests ranged from 66% to 83% and for BMI checks from 40% to 65%.

For blood tests, across the whole of England:

  • men (73.8%) were less likely to have a blood test than women (77.2%) 
  • people of Black (69.0%) and Asian (74.3%) ethnicities were less likely to have a blood test than people of White ethnicity (77.1%)
  • people under 65 (ranging from 58.7% to 70.0%) were less likely to have a blood test than over 65s (ranging from 81.0% to 81.3%)
  • the most deprived group (74.1%) were less likely to have a blood test than the other four deprivation groups (ranging from 74.7% to 76.8%)

For BMI checks, across the whole of England:

  • men (51.8%) were less likely to have weight measurements than women (53.6%)
  • people of Black (50.5%) and Asian (50.1%) ethnicities were less likely to have weight measurements than people of White ethnicity (54.6%)
  • people under 65 (ranging from 44.1% to 48.4%) were less likely to have weight measurements than over 65s (ranging from 56.1% to 58.2%)
Figure 3a: Glycaemic tests for people with pre-existing NDH by demographic characteristics (2021-22)
Download the data for this chart Figure 3a: Glycaemic tests for people with pre-existing NDH by demographic characteristics (2021-22)
Figure 3b: BMI checks for people with pre-existing NDH by demographic characteristics (2021-22)
Download the data for this chart Figure 3b: BMI checks for people with pre-existing NDH by demographic characteristics (2021-22)
  • deprivation quintiles range from IMD1 (Most deprived) to IMD5 (Least deprived)
  • 2021-22 NDH-DPP Detailed Analysis: Care Processes

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

 

Progression rates to type 2 diabetes were:

  • higher for people from the most deprived group (21.3%) compared to the 4 other deprivation groups (ranging from 16.0% to 19.9%)
  • higher for people living with obesity (25.3%) compared to people with lower BMI values (ranging from 10.3% to 16.0%)
  • higher for those aged 40-64 (21.9%) compared to under 40s (21.0%) and over 65s (ranging from 12.2% to 16.0%)
  • higher for those with Black (19.7%) or Asian (23.6%) ethnicity compared with those with White ethnicity (17.9%)
Figure 4: 2021-22 diabetes rates of the cohort of people with NDH in 2017-18 by demographic characteristics
Download the data for this chart Figure 4: 2021-22 diabetes rates of the cohort of people with NDH in 2017-18 by demographic characteristics
  • data for patients who had died between 2017 and 2020 were excluded from the figure
  • deprivation quintiles range from IMD1 (most deprived) to IMD5 (least deprived)
  • 2021-22 NDH-DPP Detailed Analysis: Progression to diabetes

Key finding 5

Progression rates varied (between 15.1% and 21.2%) according to whether people had been referred to or participated in the NHS DPP.

People who had completed the DPP (attended at least 60% of sessions) had the lowest rate of progression to type 2 diabetes at 15.1%, while people who were referred but did not attend the programme had the highest rate of progression at 21.2%.  

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.

Figure 5: 2021-22 diabetes rates of the cohort of people with NDH in 2017-18 by DPP referral status
Download the data for this chart Figure 5: 2021-22 diabetes rates of the cohort of people with NDH in 2017-18 by DPP referral status
  • data for patients who had died between 2017 and 2020 were excluded from the figure
  • 2021-22 NDH-DPP Detailed Analysis: Progression to diabetes

Recommendations

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).

Last edited: 3 June 2024 10:19 am

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