National Diabetes Audit 2021-22, Report 1: Care Processes and Treatment Targets, Overview

This is a GP appointment where the annual NICE recommended care processes are undertaken.

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 two main types of diabetes: type 1 diabetes (no insulin); type 2 diabetes (insufficient insulin).

• ‘Type 1’ includes where a person is recorded as having type 1 diabetes in the National Diabetes Audit (NDA).
• ‘Type 2 and other’ includes where a person is recorded as having type 2 diabetes, Maturity-onset Diabetes of the Young (MODY), other or non-specified diabetes in the NDA.

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.

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 is calculated from weight and height and used to classify body weight as underweight, healthy, overweight and obese.

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

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

Diabetic retinopathy is a microvascular disease specific to the people with diabetes. Everyone with diabetes from the age of 12 is eligible for diabetic eye screening to detect the development of diabetic retinopathy. 

In England there is to be a move to alternate year retinal screening for those known not to have retinopathy for the past 2 screening occasions. This was implemented to some extent early during the pandemic in order to deal with the reduced screening capacity.

This blood test measures a type of fat that can damage blood vessels.

This is a blood test used to measure kidney function.

This records whether the person is a smoker. Smoking increases the diabetic risk for heart attacks and stroke.

UACR is a ratio between two measured substances urine albumin and urine creatinine. Unlike a urine dipstick test for albumin, UACR is unaffected by variation in urine concentration.

High levels are a risk for heart attacks and strokes; high blood pressure also drives progression of eye and kidney disease.

The treatment target within the NDA for people with diabetes is defined as blood pressure ≤ 140/80.

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

The treatment target within the NDA for people with diabetes is defined as HbA1c ≤ 58 mmol/mol.

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

• Primary prevention of cardiovascular disease (CVD): Those aged between 40 and 80 years old, with no history of admission to hospital for cardiovascular disease.
• Secondary prevention of CVD: Those of any age, with a confirmed history of admission to hospital for cardiovascular disease.
• Combined prevention of CVD: The prescription of statins for people with diabetes that fall into either of the primary or secondary prevention groups.

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

For those aged 12 and under, meeting all 3 treatment targets is defined as having HbA1c ≤ 58 mmol/mol only as other treatment targets are not recommended in the NICE guidelines for this age group.