National Diabetes Audit 2021-22, Type 1 Diabetes - Overview

This is a GP appointment where the annual National Institute for Health and Care Excellence (NICE) recommended care processes are undertaken.

Blood pressure is a measurement of the force driving the blood through the arteries. Blood pressure readings contain 2 figures, e.g.130/80. The first is known as the systolic pressure which is produced when the heart contracts. The second is the diastolic pressure which is when the heart relaxes to refill with blood.

BMI measurement – Body Mass Index is calculated from weight and height and used to classify body weight as low, normal, overweight and obese.

Serum creatinine – this is a blood test used to measure kidney function.

Urinary albumin – this urine test detects the earliest stages of kidney disease.

Cholesterol -  this blood test measures a type of fat that can damage blood vessels.

Foot check - this examination checks the blood supply and sensation (feeling) in the feet. Loss of either is a risk for foot disease.

Smoking status  - this records whether the person is a smoker. Smoking increases the risk of heart attacks and stroke on people with diabetes.

HbA1c – this is a blood test for average blood glucose levels during the previous 2 to 3 months.

For further information on care processes, please see the Methodology section of NDA Report 1: Care processes and treatment targets 2021-22

Diabetes is a condition where the amount of glucose in the blood is too high because the pancreas doesn’t produce enough insulin. Insulin is a hormone produced by the pancreas that allows glucose to be used as a body fuel and other nutrients to be used as building blocks. There are 2 main types of diabetes: type 1 diabetes (no insulin); type 2 diabetes (insufficient insulin).

Basal-bolus insulin treatment comprises background, slow acting (basal) insulin, self-injected once or twice daily, plus rapid acting (bolus) insulin at mealtimes

Fixed mix insulin combines rapid and longer acting insulin at a fixed ratio. It is usually self-injected twice daily.

Insulin pump or continuous insulin infusion therapy uses rapid acting insulin delivered subcutaneously under the control of a ‘Pump’. Background rates are programmed and mealtime boluses are added manually.

An integrated care system (ICS) is made up of 2 key bodies - an integrated care board (ICB) and an integrated care partnership (ICP). The ICB is responsible for the commissioning of NHS services - a function previously undertaken by clinical commissioning groups (CCGs). There are 42 ICBs in England.

There are 106 sub ICBs in England - most of these correspond to former CCGs.

This is a service (often hospital based but sometimes delivered in a community setting) which includes diabetes specialists working in multidisciplinary teams. These teams usually comprise physicians (diabetologists), diabetes specialist nurses and dieticians; it may also include clinical psychologists.

HbA1c - the closer this is to normal (less than 42mmol/mol) the lower is the risk of all long term complications of diabetes.

Blood pressure –  high levels are a risk for heart attacks and strokes; they also drive progression of eye and kidney disease.

Primary prevention of CVD – the prescription of statins for people with diabetes aged 40 to 80 years with no history of cardiovascular disease (CVD) to reduce the risk of CVD.

Secondary prevention of CVD – the prescription of statins for people with diabetes (any age) with a history of CVD to reduce the risk of CVD.

Combined prevention of CVD – the prescription of statins for people with diabetes that fall into either of the primary or secondary prevention groups.

Meeting all 3 treatment targets – having HbA1c ≤58mmol/mol, blood pressure ≤140/80 and for people falling in the combined prevention CVD group: receiving statins.

For further information on treatment targets, please see the Methodology section of NDA Report 1: Care processes and treatment targets 2021-22

The term wearable glucose monitor covers flash glucose monitors and continuous glucose monitors.

A flash glucose monitor is a small sensor that is worn just under the skin and known as flash for short. It records glucose (sugar) levels continuously throughout the day and night. The information collected can be obtained by scanning the device.

A continuous glucose monitor (CGM) also records glucose (sugar) levels continuously throughout the day and night, but the information collected is fed through to a display device. The user can also set alerts for high/medium/low levels.