Publication, Part of National Diabetes Audit: Young People with Type 2 Diabetes
National Diabetes Audit 2021-22, Young People with Type 2 Diabetes - Detailed Analysis Report
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Care processes and treatment targets
This section looks at the care process completion and treatment target achievement rates of young people with type 2 diabetes compared to older people with type 2 diabetes in 2021-22.
Care processes
Care processes - National Institute for Health and Care Excellence (NICE; annual)
All people with diabetes should receive all of the NICE recommended care processes and attend a structured education programme shortly after diagnosis. Because of differences in data collection and reporting between the NDA and the NPDA, the age ranges where care processes are treated as ‘should have occurred’ were consolidated and are shown against each care process below.
| Table 3: 9 Annual care processes for people with type 2 diabetes | |
| Responsibility of Diabetes Care providers | |
| 1. HbA1c [All ages] | 5. Urine Albumin/Creatinine Ratio [All ages] |
| (blood test for glucose control) | (urine test for risk of kidney disease) |
| 2. Blood Pressure [All ages] | 6. Foot Risk Surveillance [Aged 12+] |
| (measurement for cardiovascular risk) | (examination for foot ulcer risk) |
| 3. Serum Cholesterol [All ages] | 7. Body Mass Index [All Ages] |
| (blood test for cardiovascular risk) | (measurement for cardiovascular risk) |
| 4. Serum Creatinine [Aged 19+] | 8. Smoking History [Aged 19+] |
| (blood test for kidney function) | (question for cardiovascular risk) |
| Responsibility of NHS Diabetes Eye Screening (NHS England) | |
| 9. Digital Retinal Screening [Aged 12+] | |
| (photographic eye test for early detection of eye disease) | |
- People aged 19 to 39 years old with type 2 diabetes were less likely to receive all 8 care processes (1,2) (26.5% of 19-25 year olds and 34.7% of 26-39 year olds) compared to older adults with type 2 diabetes (44.0% and 51.6% of 40-59 and 60-79 year olds respectively).
Notes:
1. Care processes assessed based on age:
- Under 12s: HbA1c, BMI, cholesterol, blood pressure and albumin
- 12-18 years: HbA1c, BMI, cholesterol, blood pressure, albumin and foot exam
- 19 years and over: HbA1c, BMI, cholesterol, blood pressure, albumin, foot check, smoking status and creatinine
For example, a person aged 10 would be assessed for the HbA1c, BMI, cholesterol, blood pressure and albumin care processes, but not the foot exam, smoking status and creatinine care processes. Therefore if they received the HbA1c, BMI, cholesterol, blood pressure and albumin care processes then in this analysis they are recorded as having received 'all 8 care processes'.
2. Diabetes Eye Screening data (used for the eye exam/retinopathy care process) was not collected for Wales. Therefore analysis is restricted to 8 of the 9 care processes for England and Wales.
3. For more details on each of the care processes see Additional information.
4. Totals may not sum due to disclosure control. See Additional information for more details.
- For people in England with type 2 diabetes, 19.0% of 19-25 year olds and 24.8% of 26-39 year olds received all 9 care processes (1,2), compared to 34.0% and 42.2% of 40-59 and 60-79 year olds respectively.
Notes:
1. Care processes assessed based on age:
- Under 12s: HbA1c, BMI, cholesterol, blood pressure and albumin
- 12-18 years: HbA1c, BMI, cholesterol, blood pressure, albumin, eye exam/retinopathy and foot exam
- 19 years and over: HbA1c, BMI, cholesterol, blood pressure, albumin, eye exam/retinopathy, foot check, smoking status and creatinine
For example, a person aged 10 would be assessed for the HbA1c, BMI, cholesterol, blood pressure and albumin care processes, but not the eye exam/retinopathy, foot exam, smoking status and creatinine care processes. Therefore if they received the HbA1c, BMI, cholesterol, blood pressure and albumin care processes then in this analysis they are recorded as having received 'all 9 care processes'.
2. Diabetes Eye Screening data (used for the eye exam/retinopathy care process) was not collected for Wales. Therefore analysis on the completion of all 9 care processes is restricted to England only.
3. For more details on each of the care processes see Additional information.
4. Totals may not sum due to disclosure control. See Additional information for more details.
Treatment targets
HbA1c
- Over half of people with type 2 diabetes achieved the HbA1c treatment target across all age groups. The lowest proportion of people to achieve the HbA1c treatment target was in those aged 16-18 years old (50.2%), whereas the highest proportion was in those aged 12-15 years old (65.3%).
- The proportion of people with type 2 diabetes achieving the HbA1c treatment target steadily increased with age from 16 years old, from 50.2% of those aged 16-18 years old to 65.1% of those aged 60-79 years old.
Notes:
1. For more details on the HbA1c treatment target see Additional information.
2. Totals may not sum due to disclosure control. See Additional information for more details.
Blood pressure
- The proportion of people with type 2 diabetes achieving the blood pressure treatment target steadily decreased with age from 67.8% of 12-15 year olds to 58.4% of 26-39 year olds; after which the proportion achieving the treatment target increased with age up to 70.1% of 60-79 year olds.
Notes:
1. Blood pressure treatment target not applicable to people under 12 years old.
2. For more details on the blood pressure treatment target see Additional information.
3. Totals may not sum due to disclosure control. See Additional information for more details.
Statins
- Fewer than one-third (28.6%) of people with type 2 diabetes aged 19-25 years old achieved the secondary prevention statin treatment target (1,3,4).
Notes:
1. Achievement rates only include people eligible for statins in calculation. Eligibility depends on age and history of cardiovascular disease (CVD). For more details on the statin treatment target see Additional information.
2. Statins treatment target not applicable to those under 12 years old. Age bands '12-15' and '16-18' excluded from analysis due to small denominators. See Disclosure control section in Additional information for more details.
3. It was not possible to identify whether a person in the National Paediatric Diabetes Audit (NPDA) only had experienced a cardiovascular event. Therefore, these people were not included in the calculation.
4. This analysis relates to all people in the cohort who are eligible for statins and not just people with a history of CVD.
5. Totals may not sum due to disclosure control. See Additional information for more details.
HbA1c levels - Contributing factors
- A greater proportion of people with type 2 diabetes aged 15 or under had a HbA1c level of 48 mmol/mol or lower (33.3% of under 12 year olds and 40.6% of 12-15 year olds) when compared to their older counterparts (21.7% of 40-59 year olds and 28.2% of 60-79 year olds).
- The highest proportion of people with type 2 diabetes to have a HbA1c level over 86 mmol/mol was found in those aged 16-18 years where a fifth had a high HbA1c level (20.3%). This declined with age with 5.5% of those aged 60-79 years having a HbA1c level over 86 mmol/mol.
Notes:
1. 'HbA1c unknown' includes people who have not had a HbA1c reading taken (i.e. not completed the HbA1c care process) and people where there is a date for their HbA1c measurement, but no value recorded.
2. Totals may not sum due to disclosure control. See Additional information for more details.
Cohort size: 117,480
C statistic: 0.62
- Female sex (odds ratio (OR) is 1.44 when compared to male)
- Being from ethnic groups other than white (e.g. OR for Asian ethnic group is 1.23 and OR for black ethnic group is 1.17 when compared to white ethnic group)
- Shorter diabetes duration (OR for 2-9 years is 0.60 when compared to duration of less than 2 years)
- Being from a more deprived area (most deprived OR is 0.80 when compared to least deprived)
- Longer diabetes duration (OR for 10 years and over is 0.31 when compared to duration of less than 2 years)
- Living with obesity (OR is 0.88 when compared to healthy weight body mass index (BMI) category)
Notes:
1. Young people are defined as those up to the age of 40 years.
2. The model has a weak predictive ability with a c statistic around 0.6, meaning the patient characteristics in the model do not greatly contribute to whether a person has an HbA1c ≤ 58 mmol/mol. Therefore findings from this model should be treated with caution.
3. For information on how to interpret the forest plot in figure 13 and explanations on odds ratios, logistic regression, and the c statistic see Additional information.
Cohort size: 117,480
C statistic: 0.61
- Black ethnic groups (OR is 1.23 when compared to white ethnic group)
- Being from a more deprived area (most deprived OR is 1.33 when compared to least deprived)
- Longer diabetes duration (OR for 10 years and over is 2.36 when compared to duration of less than 2 years)
- Being in a lower BMI category (OR for underweight category is 1.50 when compared to healthy weight category)
- Female sex (OR is 0.66 when compared to male)
- Asian or other ethnic group (OR for Asian ethnic group is 0.75 and OR for other ethnic group is 0.81 when compared to white ethnic group)
- Being in the overweight BMI category or living with obesity (OR for overweight category is 0.84 and OR for living with obesity is 0.84 when compared to healthy weight category)
Notes:
1. Young people are defined as those up to the age of 40 years.
2. The model has a weak predictive ability with a c statistic around 0.6, meaning the patient characteristics in the model do not greatly contribute to whether a person has an HbA1c > 86 mmol/mol. Therefore findings from this model should be treated with caution.
3. For information on how to interpret the forest plot in figure 14 and explanations on odds ratios, logistic regression, and the c statistic see Additional information.
Last edited: 11 October 2024 8:55 am