Publication, Part of National Diabetes Audit
National Diabetes Audit 2021-22, Report 1: Care Processes and Treatment Targets, Detailed Analysis Report
Audit, Survey, Other reports and statistics
Change to mapping used for integrated care board (ICB) analysis
An issue was found with the mapping used to define integrated card boards (ICB) in this report resulting in larger than expected cohorts for each ICB. This has been corrected in this report and has resulted in slight changes to the results of analyses broken down by ICB.
21 December 2023 00:00 AM
Care processes and treatment targets: National summary, 2021-22
Care processes and treatment targets are a core component of the National Diabetes Audit (NDA). The National Institute for Health and Care Excellence (NICE) provides guidance and recommendations (1,2) on these and they are thus utilised as a representative marker for the quality of a person's diabetes care. Everyone with diabetes is eligible to receive care processes, with some age exceptions. In the NDA, those who have had the relevant care process (HbA1c blood test, for example) are then eligible to be in the treatment target measure (HbA1c ≤ 58 mmol/mol, for example). For detailed descriptions of the care processes and treatment targets, please see Additional information of this report.
Notes:
Care processes: Type 1 diabetes by country, 2017-18 to 2021-22
Notes:
1. For the 9 care processes 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. See Definitions in Additional information for details of all care processes.
2. The data for retinal screening is only available from 2019-20 for England.
3. Data tables for these charts are provided in the Appendix.
- In people with type 1 diabetes in England, the completion of all 8 key care processes has improved in 2021-22 compared to the previous year (the first pandemic year) but still remains below pre-pandemic levels. For example, the HbA1c care process completion dropped from 83.6% in 2019-20 to 75.8% in 2020-21 and is at 78.9% in 2021-22, still below pre-pandemic levels.
- The care processes with the greatest drop from 2019-20 to 2020-21 were blood pressure, digital retinal screening and foot risk surveillance. Foot risk surveillance dropped from 72.5% in 2019-20 to 51.0% in 2020-21 and is at 58.5% in 2021-22.
- Across the 5 years, urine albumin/creatinine ratio was the lowest performer. In 2021-22, only 49.8% of people with type 1 diabetes received this care process in England.
Notes:
1. 9 care processes includes retinal screening, the data for which is currently not received for Wales meaning that Wales can only achieve completion of the 8 NICE recommended care processes in the NDA data. See Definitions in Additional information for details of all care processes.
2. Data tables for these charts are provided in the Appendix.
- In people with type 1 diabetes in Wales, the completion of all 8 key care processes has improved in 2021-22 compared to the previous year (the first pandemic year) but remains below pre-pandemic levels. For example, HbA1c care process completion rates were 71.4% in 2019-20, 61.3% in 2020-21 and 64.8% in 2021-22, still below pre-pandemic levels.
- The care processes with the greatest drop from 2019-20 to 2020-21 were blood pressure, BMI and foot risk surveillance. Foot risk surveillance dropped from 47.7% in 2019-20 to 25.7% in 2020-21 and is at 33.3% in 2021-22.
- Across the 5 years, urine albumin/creatinine ratio was the lowest performer. In 2021-22, only 29.0% of people with type 1 diabetes received this care process in Wales.
Care processes: Type 2 diabetes by country, 2017-18 to 2021-22
Notes:
1. See Definitions in Additional information for the definition of type 2 and other diabetes.
2. For the 9 care processes 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. See Definitions in Additional information for details of all care processes.
3. The data for retinal screening is only available from 2019-20 for England.
4. Data tables for these charts are provided in the Appendix.
- In people with type 2 and other diabetes in England, the completion of all 8 key care processes has improved in 2021-22 compared to the previous year (the first pandemic year) but remains below pre-pandemic levels. For example, the HbA1c care process completion dropped from 93.5% in 2019-20 to 86.2% in 2020-21 and is at 90.4% in 2021-22, still below pre-pandemic levels.
- The care processes with the greatest drop from 2019-20 to 2020-21 were digital retinal screening, foot risk surveillance and urine albumin/creatinine ratio. Retinal screening dropped from 80.4% in 2019-20 to 49.5% in 2020-21 and is at 68.0% in 2021-22; and foot risk surveillance dropped from 83.9% in 2019-20 to 59.4% in 2020-21 and is at 70.2% in 2021-22.
Notes:
1. See Definitions in Additional information for the definition of type 2 and other diabetes.
2. 9 care processes includes retinal screening, the data for which is currently not received for Wales meaning that Wales can only achieve completion of the 8 NICE recommended care processes in the NDA data. See Definitions in Additional information for details of all care processes.
3. Data tables for these charts are provided in the Appendix.
- In people with type 2 and other diabetes in Wales, the completion of all 8 key care processes has improved in 2021-22 compared to the previous year (the first pandemic year) but remains below pre-pandemic levels. For example, the HbA1c care process completion dropped from 91.3% in 2019-20 to 80.7% in 2020-21 and is at 85.3% in 2021-22, still below pre-pandemic levels.
- Across the 5 years, urine albumin/creatinine ratio care process completion remains low. In 2021-22, only 47.8% of people with type 2 and other diabetes in Wales received this care process. However, the lowest percentage of people with type 2 and other diabetes in Wales found receiving a care process was for the foot risk surveillance care process in 2020-21 at 38.9%.
Treatment targets: Type 1 diabetes by country, 2017-18 to 2021-22
Notes:
1. See Definitions in Additional information for details of treatment targets.
2. Data tables for these charts are provided in the Appendix.
Notes:
1. See Definitions in Additional information for details of treatment targets.
2. Data tables for these charts are provided in the Appendix.
- Achievement of all 3 treatment targets has improved in England and Wales. 22.4% of people with type 1 diabetes in England and 15.9% of people with type 1 diabetes in Wales achieved all 3 treatment targets in 2021-22 compared to 21.5% in England and 15.5% in Wales in 2020-21.
- HbA1c treatment target achievement is improving, whereas a downward trend can be seen in blood pressure treatment target achievement. 31.6% of people with type 1 diabetes in England achieved the HbA1c treatment target in 2019-20. This rose to 34.8% in 2020-21 and then again to 36.3% in 2021-22.
Treatment targets: Type 2 and other diabetes by country, 2017-18 to 2021-22
Notes:
1. See Definitions in Additional information for the definition of type 2 and other diabetes.
2. See Definitions in Additional information for details of treatment targets.
3. Data tables for these charts are provided in the Appendix.
Notes:
1. See Definitions in Additional information for the definition of type 2 and other diabetes.
2. See Definitions in Additional information for details of treatment targets.
3. Data tables for these charts are provided in the Appendix.
- There is a downward trend in both blood pressure and HbA1c treatment target achievement, and these do not yet show signs of recovery when compared to the first pandemic year, 2020-21. 65.6% of people with type 2 and other diabetes in England achieved the HbA1c treatment target in 2019-20. This decreased to 63.4% in 2020-21 and then to 63.1% in 2021-22. In Wales, 61.1% of people with type 2 and other diabetes achieved the HbA1c treatment target in 2019-20. This decreased to 58.8% in 2020-21 and 58.9% in 2021-22.
0 care processes received: Type 1 diabetes by country and age, 2017-18 to 2021-22
Notes:
1. See Definitions in Additional information for details of all care processes.
0 care processes received: Type 2 and other diabetes by country and age, 2017-18 to 2021-22
Notes:
1. See Definitions in Additional information for the definitions of type 2 and other diabetes and care processes.
- The percentage of people with diabetes receiving no care processes throughout the audit period has increased across all age groups from 2017-18 to 2020-21, followed by a slight drop in 2021-22 for most age groups. Of particular concern is the sharp rise during the pandemic year 2020-21 which has not returned to the pre-pandemic 2019-20 levels.
- This increase is most marked in the 17-24 year age group in Wales. 8.8% of people with type 1 diabetes in Wales received no care processes in the 17-24 age group in 2017-18, compared to 29.9% in 2020-21 and 25.4% in 2021-22. 7.7% of people with type 2 and other diabetes in this age group in Wales received no care processes in 2017-18, compared to 17.6% in 2020-21 and 14.5% in 2021-22.
- For those aged 25-29 years in Wales the rise has been significant but not as large as the youngest age group. 6.0% of people with type 1 diabetes aged 25-29 in Wales received no care processes in 2017-18 compared to 14.2% in 2021-22 and in people with type 2 and other diabetes, 4.6% in 2017-18 and 9.0% in 2021-22 received no care processes.
- In England, a similar trend is seen. 4.1% of people with type 1 diabetes aged 17-24 in England received no care processes in 2017-18 compared to 10.2% in 2020-21 and 9.8% in 2021-22. In people with type 2 and other diabetes in the same age group, 4.5% in 2017-18, 11.3% in 2020-21 and 10.1% in 2021-22 received no care processes.
- In people aged 25-29 in England, the percentage of people with type 1 diabetes receiving no care processes increased from 2.7% in 2017-18 to 6.1% in 2021-22 and the percentage of people with type 2 and other diabetes receiving no care processes increased from 2.3% in 2017-18 to 4.9% in 2021-22.
Geographic variation in receipt of care processes, 2021-22
Notes:
1. See Definitions in Additional information for details of the 8 care processes.
2. Integrated care boards (ICBs) replaced clinical commissioning groups (CCGs) in the NHS in England from 1 July 2022. See ICB look up in Additional information for ICB names. This reference information for ICBs is also available to search via the Organisation Data Service (ODS) data portal.
3. See Definitions in Additional information for the definition of type 2 and other diabetes.
- Across the different ICBs, there was a 3.5-fold variation in the percentage of people with type 1 diabetes in receipt of all 8 care processes, and a 2.5-fold variation in people with type 2 and other diabetes.
- In 2021-22 when looking across ICBs, the percentage of people receiving all 8 care processes ranged from 16.3% to 56.3% of people with type 1 diabetes and 26.1% to 63.0% in people with type 2 and other diabetes.
Geographic variation in treatment target achievement, 2021-22
Notes:
1. See Definitions in Additional information for the details of all 3 treatment targets.
2. Integrated care boards (ICBs) replaced clinical commissioning groups (CCGs) in the NHS in England from 1 July 2022. See ICB look up in Additional information for ICB names. This reference information for ICBs is also available to search via the Organisation Data Service (ODS) data portal.
3. See Definitions in Additional information for the definition of type 2 and other diabetes.
- The mean percentage of people achieving all 3 treatment targets was 22.5% in people with type 1 diabetes and 35.1% in people with type 2 and other diabetes, with variation across ICBs ranging from 17.8% to 29.1% amongst people with type 1 diabetes and 30.6% to 39.5% in those with type 2 and other diabetes.
Last edited: 12 April 2024 3:37 pm