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Diabetes care monitoring improves

More people with diabetes are receiving the care recommended to monitor their condition, but the number receiving effective treatment as a result has stalled and the number with certain complications has increased, according to the latest National Diabetes Audit.

The audit, commissioned by the Healthcare Quality Improvement Partnership and managed by The NHS Information Centre, is the largest of its kind in the world and includes records for over 1.7 million people with diabetes in England and Wales.

Of these, over 39,000 records are for children and young people with diabetes. Records were submitted from 5,920 practices, 110 paediatric units and 44 secondary care units in England. A further 152 practices and 14 paediatric units in Wales provided data.

Of those included in the 2008/09 audit, over 90% are in contact with their healthcare teams at least once a year, shown by a high recording rate for blood pressure, weight and blood sugar care processes. These are three of the nine key processes of diabetes care recommended by the National Institute for Health and Clinical Excellence (NICE).

The percentage of people receiving all nine processes has risen to 32.2% for people with type 1 diabetes and 50.8% for type 2 diabetes. Although still far below the NICE recommendation, the figure has risen substantially from the recorded 11.9% for type 1 diabetes and 10.6% for type 2 diabetes six years ago.

However, the audit shows the high level of contacts with healthcare teams are not always being converted into effective care. For example, blood sugar and blood pressure treatment targets aimed at reducing complications are not being met and end stage kidney disease (people with diabetes needing dialysis or kidney transplant) has almost doubled within six years.

Half of people with diabetes overall do not meet their blood pressure target and more than a third have levels of poor blood sugar control, which carries a very high risk of developing complications such as blindness, heart attacks, kidney failure and amputation. This issue is especially prevalent in younger people.

A third of people with diabetes did not have a urine test, which can identify early signs of diabetic kidney disease and support interventions to reduce the risk of progression to the stages of kidney disease where dialysis or a kidney transplant might be needed.

Younger people are also significantly less likely to receive all nine care processes. Of people aged 16 to 39, just over 20% with type 1 diabetes and just over 35% with type 2 diabetes received every process. This compares to just over 34% of people with type 1 diabetes and just over 51% of people with type 2 diabetes in the 40-84 age group.

The audit also found that:

  • The prevalence of diabetes has increased by 25% over the past six years, from 3.3 to 4.1%.
  • In six years obesity in people with type 2 diabetes has increased by 10% overall to reach over 50%. The rising level of obesity may be a barrier to improving the control of blood pressure and blood sugar levels in people with type 2 diabetes, as obesity decreases insulin sensitivity and inhibits the effectiveness of all diabetes treatments. Obesity also increases blood pressure independently of diabetes.
  • Type 2 diabetes is 40% more common in people who are the most socio-economically deprived in the country, compared to those who are the least. Deprivation is not a factor with type 1 diabetes.

Gavin Terry, Policy Manager at Diabetes UK, said: "There is little good news from this latest audit. Well over two thirds of people with type 1 diabetes and half of people with type 2 diabetes in England and Wales are missing out on checks that in real terms translate into saving a person's sight, preventing limb amputation and extending life expectancy through the prevention of kidney failure, stroke and heart disease. More worrying is that these figures are worse for young people."

Consultant diabetologist and clinical lead for the audit, Dr Bob Young, said, "It is encouraging to see the continued commitment of those involved with diabetes care in participating in this audit - which now includes records for 75% of people with diabetes.

"Analysis of those 1.7 million records is vital to understanding and treating diabetes and this year's report shows that, while some improvements have been made, there is still much work to be done to best address a condition which is affecting more and more people every year."

National Diabetes Audit

Your comments (terms and conditions apply):

"It is easier to become a diabetic link nurse in the community or a nursing home or in hospital than to become a diabetic specialist nurse. I know because I am one. My clients are situated in the community, and in nursing homes. They are achieving stability and slowing the 'progression' of their condition, with the support of their GPs" - E Kennedy, N Ireland