Publication, Part of National Diabetes Audit, Type 1 Diabetes
National Diabetes Audit, 2020-21, Type 1 Diabetes
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16 June 2022 09:30 AM
Care processes
How many adults received the care processes that are recommended to manage their type 1 diabetes?
All people with diabetes aged 12 years and over should receive all of the 9 NICE recommended care processes and attend a structured education programme shortly after diagnosis*.
| Table 5: 9 annual care processes for people with type 1 diabetes | |
| Responsibility of Diabetes Care providers | |
| 1. HbA1c | 5. Urine Albumin/Creatinine Ratio |
| (blood test for glucose control) | (urine test for risk of kidney disease) |
| 2. Blood Pressure | 6. Foot Risk Surveillance |
| (measurement for cardiovascular risk) | (examination for foot ulcer risk) |
| 3. Serum Cholesterol | 7. Body Mass Index |
| (blood test for cardiovascular risk) | (measurement for cardiovascular risk) |
| 4. Serum Creatinine** | 8. Smoking History |
| (blood test for kidney function) | (question for cardiovascular risk) |
| Responsibility of NHS Diabetes Eye Screening (NHS England)*** | |
| 9. Digital Retinal Screening | |
| (photographic eye test for early detection of eye disease) | |
For NDA 2020-21, Diabetes Eye Screening (DES) data has been collected directly from DES providers. However, due to temporary service closures during the pandemic, the data is incomplete. Therefore this report does not report on retinal screening.
* NICE Clinical Guidelines – NG17: Type 1 diabetes in adults: diagnosis and management http://www.nice.org.uk/guidance/ng17
** There is a potential issue with the SNOMED codes used to identify if a person has had their creatinine diabetes care process check. 2 creatinine plasma codes were removed from the NDA creatinine code set during the universal SNOMED code refresh. This has affected creatinine care process completion percentage, and potentially the all 8/9 NICE care processes completion percentage, for organisations/areas that still use these codes. To resolve the issue, the NDA business rules are currently being amended to add these code into future NDA data extractions
*** Responsibility of Public Health England up to September 2021
Care processes - CCGs/LHBs
Figure 6: The range of CCG/LHB care process completion*,** for adults with type 1 diabetes, England and Wales, 2019-20 and 2020-21
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This an image of a box and whisker plot showing the variation in completion of the 8 care processes and "All 8 care processes". It shows the median, interquartile range and range of the completion percentages across all CCG/LHBs.
* The 9th NICE care process, digital retinal screening, is not included; therefore this figure comprises the first 8 care processes only.
** There is a potential issue with the SNOMED codes used to identify if a person has had their creatinine diabetes care process check. 2 creatinine plasma codes were removed from the NDA creatinine code set during the universal SNOMED code refresh. This has affected creatinine care process completion percentage, and potentially the all 8/9 care process completion percentage, for organisations/areas that still use these codes. To resolve the issue, the NDA business rules are currently being amended to add these code into future NDA data extractions.
- Rates of care process completion were lower in 2020-21 than in 2019-20 with a median completion rate of 80% or less for all care processes except smoking in 2020-21
- Care processes requiring face to face contact, such as foot surveillance, were reduced the most
- The ranges of rates of care process completion across CCG/LHBs were wider in 2020-21 than in 2019-20
- Nevertheless, despite the pandemic, rates of over 90% of care process completion were achieved by some CCG/LHBs for some of the care processes
HbA1c care process – CCG/LHB variation in recording HbA1c values
As a result of low care process completion and incomplete HbA1c values, in cases where the HbA1c check had taken place, the number of values recorded in 2020-21 was considerably lower than in 2019-20.
A logistic regression model was used to produce expected numbers of HbA1c values recorded for each CCG/LHB. The model c-statistic was 0.79 (strong).
- Of 113 CCG/LHBs, 30 were more than 2 standard deviations (SD) outside the expected number of adults with a value recorded for the HbA1c care process.
- 16 CCG/LHBs were above expectation.
- 14 CCG/LHBs were below expectation.
* For explanations of odds ratios, logistic regression and forest plot interpretation please see Additional Information: ‘Definitions – Statistical terms’.
- Sex
- Age group
- Duration of diabetes
- Ethnicity
- Deprivation quintile
- BMI group
- Smoking status
- Insulin regimen
- Continuous Glucose Monitoring (CGM) status
- Frailty status
HbA1c – contributing factors (HbA1c recorded)
Figure 8 shows a forest plot of odds ratios which illustrate the individual person characteristics associated with an HbA1c value being recorded in the 2020-21 audit year. These odds ratios were derived from a logistic regression model*.
Figure 8: Individual person characteristics in adults with type 1 diabetes and likelihood of HbA1c being recorded, England and Wales, 2020-21
* For explanations of odds ratios, logistic regression and forest plot interpretation please see Additional Information: ‘Definitions – Statistical terms’.
Last edited: 3 October 2024 8:13 am