National Diabetes Audit 2021-22, Type 1 Diabetes - Detailed Analysis Report

The Integrated Diabetes Specialist Services Structures Survey (ISSSS) collects information from specialist services on the services they provide, and is split by service type. There were responses from 130 type 1 diabetes services; some responses were at trust level, others at hospital level.

113 of these services said that they provided access to diabetes technology to all people with type 1 diabetes who needed it in the local area, in accordance with the NHS Long Term Plan. The vast majority (111 services) said their staff were trained to support people using diabetes technologies.

Out of the 111 services with staff trained to support provision, 104 services said their staff had adequate time to complete the training on supporting diabetes technology, and 80 services said their staff are appraised annually regarding the training and given a chance to update it.

The HES OP data for attendance at a diabetes service clinic was linked to the cohort of adults with type 1 diabetes, for England only. This data, along with the NDA specialist services data, enabled us to identify people in the cohort who had been seen by a specialist service during the 2021-22 audit period. In all, 69.1% of adults with type 1 diabetes in England had been seen in specialist services. For the remaining 30.9% of the cohort, there was no evidence in either data source of attendance at specialist services, despite the individuals being recorded as having type 1 diabetes in their GP record, and being prescribed insulin during the audit period.

The map in figure 18 shows that there is a degree of variation across ICBs in the percentage of adults who attended specialist services. Little more than 1 in 3 (35.3%) people in NHS Mid and South Essex ICB attended, compared to more than 4 out of 5 (81.2%) in NHS Bath and North Somerset, Swindon and Wiltshire ICB

When broken down by characteristics, the percentages of adults with type 1 diabetes who had attended specialist services showed some variation. The characteristics illustrated in figures 19, 20 and 21 were age, deprivation, ethnicity group, diabetes duration, smoking status and body mass index (BMI) group. The largest variation was seen across age groups. Figure 19 shows that attendance at specialist services showed a steady decline across the age groups, with attendance highest in the youngest age group (19-24 year olds) at 80.3% and lowest in the 80 plus age group at 50.9%

Care process completion was higher for adults who had attended specialist services - this was true across all 8 care processes. 38.7% of adults with type 1 diabetes in England who had attended specialist services completed all 8 care processes in 2021-22, compared to 35.3% of those who had not attended specialist services.