Publication, Part of National Diabetes Audit, Type 1 Diabetes

National Diabetes Audit, 2020-21, Type 1 Diabetes

Publication Date:: 16 Jun 2022
Geographic Coverage:: England, Wales
Geographical Granularity:: Regions, Clinical Commissioning Groups, Integrated Care Boards
Date Range:: 01 Jan 2020 to 31 Mar 2021

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16 June 2022 09:30 AM

Treatment targets

How many adults with type 1 diabetes met their recommended treatment targets?

HbA1c achievement – Time series

Table 3: Adults with type 1 diabetes*, by HbA1c result (mmol/mol)**, England and Wales, 2017-18 to 2020-21.

Audit period	Total	HbA1c ≤ 48		48 < HbA1c ≤ 53		53 < HbA1c ≤ 58		58 < HbA1c ≤ 70***		70* < HbA1c ≤ 86**		HbA1c > 86		HbA1c Unknown
	Number	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent
	Number	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent	Number	Per cent
2020-21	175,395	17,170	9.8	16,990	9.7	22,490	12.8	49,130	28.0	43,480	24.8	25,260	14.4	875	0.5
2019-20	192,320	15,630	8.1	16,175	8.4	22,940	11.9	58,395	30.4	48,140	25.0	30,495	15.9	545	0.3
2018-19	194,715	16,160	8.3	16,195	8.3	23,110	11.9	59,265	30.4	48,655	25.0	30,735	15.8	600	0.3
2017-18	193,235	15,710	8.1	16,030	8.3	22,730	11.8	59,025	30.5	48,375	25.0	30,745	15.9	615	0.3

* In 2020-21, severely frail adults are excluded

** Only includes adults who had a recorded HbA1c check within the audit period.

*** 58<HbA1c<=69 and 69<HbA1c<=86 in 2020-21

In 2020-21:

There was no change in the distribution of HbA1c treatment target achievement in those with a recorded value between 2017-18 and 2019-20, but there has been a change between 2019-20 and 2020-21

• In 2020-21 there were 6.9% fewer adults with a recorded HbA1c value

• But there has been a significant improvement in achievement of treatment targets which does not appear to be due to a biased cohort (see appendix for further comparison of achievement for adults with HbA1c records in 2019-20 and 2020-21)

Download the data for this chart Figure 9: Distribution of HbA1c achievement, England and Wales, 2017-18 to 2020-21

9.8% achieved the NICE HbA1c target of 48 mmol/mol or lower*.
Almost 1 in 5 had an HbA1c result of 53 mmol/ml or lower (19.5%), and 32.3% achieved the HbA1c treatment target of 58 mmol/mol or lower.
14.4% had a very high risk HbA1c result of above 86 mmol/mol in 2020-21, compared to 15.9% in 2019-20

* NICE Guideline 17.1.6: https://www.nice.org.uk/guidance/ng17/chapter/Recommendations

HbA1c treatment target – CCG/LHB variation in proportion meeting treatment target (HbA1c ≤ 58 mmol/mol, 7.5%)

A logistic regression model was used to produce expected numbers of adults meeting the HbA1c ≤ 58 mmol/mol treatment target in each CCG/LHB.

The model c-statistic was 0.64 (weak)

Figure 10: Funnel plot of CCG/LHB standardised ratios of adults achieving HbA1c ≤ 58mmol/mol, England and Wales, 2020-21

Download the data for this chart Figure 10: Funnel plot of CCG/LHB standardised ratios of adults achieving HbA1c ≤ 58mmol/mol, England and Wales, 2020-21

Of 113 CCG/LHBs, 50 were more than 2 SD beyond the expected number of adults achieving the treatment target
19 CCG/LHBs were above expectation
31 CCG/LHBs were below expectation

Sex
Age group
Duration of diabetes
Ethnicity
Deprivation quintile
BMI group
Smoking status
Insulin regimen
CGM status
Frailty status

HbA1c – contributing factors (HbA1c ≤ 58mmol/mol)

Figure 11 shows a forest plot of odds ratios which illustrate the individual person characteristics associated with adults meeting the HbA1c ≤ 58mmol/mol treatment target. These odds ratios were derived from a logistic regression model*.

Figure 11: Individual person characteristics in adults with type 1 diabetes and likelihood of meeting the HbA1c ≤ 58 mmol/mol treatment target , England and Wales, 2020-21

Individual person characteristics in adults with type 1 diabetes and likelihood of meeting the HbA1c ≤ 58 mmol/mol treatment target

Non-modifiable factors associated with reduced likelihood of an HbA1c ≤ 58mmol/mol (7.5%):

•Diabetes duration between 10 and 19 years

•Being female

•Being of Black or Asian ethnicity

•Living in a more deprived area than the least deprived

•Being age 19-24

•Not being moderately or severely frail

Modifiable factors associated with likelihood of an HbA1c ≤ 58mmol/mol (7.5%):

•Healthy weight (BMI 18.5-24.9)

•Overweight, obesity and underweight are all associated with lower rates of HbA1c ≤ 58

•Being on an insulin pump or fixed mix insulin

•Not smoking

•Using CGM

* For explanations of odds ratios, logistic regression and forest plot interpretation please see Additional Information: ‘Definitions – Statistical terms’.

HbA1c treatment target – CCG/LHB variation in proportion meeting treatment target (HbA1c ≤ 86 mmol/mol, 10%)

A logistic regression model was used to produce expected numbers of adults meeting the HbA1c<= 86 mmol/mol treatment target in each CCG/LHB.

The model c-statistic was 0.73 (moderate).

Figure 12: Funnel plot of CCG/LHB standardised ratios of adults achieving HbA1c ≤ 86mmol/mol, England and Wales, 2020-21

Download the data for this chart Figure 12: Funnel plot of CCG/LHB standardised ratios of adults achieving HbA1c ≤ 86mmol/mol, England and Wales, 2020-21

Of 113 CCG/LHBs, only 3 were more than 2 SD beyond the expected number of adults achieving the treatment target, and none were outside of 3 SD.
1 CCG/LHB was above expectation.
2 CCG/LHBs were below expectation

Sex
Age group
Duration of diabetes
Ethnicity
Deprivation quintile
BMI group
Smoking status
Insulin regimen
CGM status
Frailty status

HbA1c – contributing factors (HbA1c ≤ 86mmol/mol)

Figure 13 shows a forest plot of odds ratios which illustrate the individual person characteristics associated with an HbA1c value up to 86 mmol/mol. These odds ratios were derived from a logistic regression model*.

Figure 13: Individual person characteristics in adults with type 1 diabetes and likelihood of HbA1c up to 86mmol/mol, England and Wales, 2020-21

Individual person characteristics in adults with type 1 diabetes and likelihood of HbA1c up to 86mmol/mol,

Non-modifiable factors associated with likelihood of a high HbA1c (i.e. not achieving HbA1c<=86 mmol/mol):

•Younger age (up to 49 years)

•Shorter duration of diabetes (up to 19 years)

•Female sex

•Black or mixed ethnicity

•Living in a more deprived area than the least deprived

•Being moderately or severely frail.

Modifiable factors associated with achieving HbA1c<=86 mmol/mol:

•Being on an insulin pump

•Having a BMI higher than 25 kg/m2

•Not smoking

•Using CGM

* For explanations of odds ratios, logistic regression and forest plot interpretation please see Additional Information: ‘Definitions – Statistical terms’.

Treatment target – CCG/LHB

Figure 14: The range of CCG/LHB treatment target achievement*,** for adults with type 1 diabetes, England and Wales, 2019-20 and 2020-21***

The range of CCG/LHB treatment target achievement*,** for adults with type 1 diabetes, England and Wales, 2019-20 and 2020-21

This an image of a box and whisker plot showing the variation in achievement of the three treatment targets and "All 3 treatment targets". It shows the median, interquartile range and range of the achievement percentages across all CCG/LHBs.

* Achievement rates of statins for Primary, Secondary and Combined Prevention only include people eligible for statins in calculation.

** Defined as having HbA1c ≤58mmol/mol, blood pressure ≤140/80 and for people falling in the combined prevention CVD group: receiving statins.

*** 2020-21 achievement only calculated for adults who were not severely frail

The rates of treatment target achievement did not all change in the same direction between 2019-20 and 2020-21

•Percentage achievement of the HbA1c target was up

•Percentage achievements of Statins for combined CVD prevention and blood pressure targets were down

The median rate of achieving HbA1c ≤ 58mmol/mol (7.5%) increased from 27.6% in 2019-20 to 30.8% in 2020-21

Last edited: 3 October 2024 8:13 am