Increase in patients meeting blood pressure targets, NDA finds
Published: 27 Jan 2016
National Diabetes Audit also highlights wide regional variation in care and treatment
New figures show an increase in the number of diabetes patients meeting target blood pressure levels.
The National Diabetes Audit (NDA) 2014-2015 presents findings for the care of 1.9 million people in England and Wales with diabetes. The latest audit reports that 76.4 per cent of Type 1 and 74.2 per cent of Type 2 diabetes patients achieved the target blood pressure levels of less than or equal to 140/80 in 2014-15. In 2009-10, 68.5 per cent of Type 1 and 60.8 per cent of Type 2 patients met these target levels.
Blood pressure is one of the three NICE recommended treatment targets.9 In 2010-11 and 2011-12, the NDA audits highlighted the risk of cardiovascular complications associated with diabetes and recommended improvements in blood pressure control to reduce these risks.
The audit also records eight NICE recommended care processes, of which blood pressure is one.10 In 2014-15, 89.0 per cent of patients with Type 1 and 96.1 per cent with Type 2 diabetes received a blood pressure check. These latest figures reverse the downward trend over the last five years, which saw the number of checks being recorded drop to their lowest figures in 2013-14 (87.0 per cent of Type 1 and 94.9 per cent of Type 2 diabetes patients).
Younger people aged under 40 were less likely to receive eight care processes, which is similar to patterns seen in previous years. In 2014-15, this represented 43.3 per cent of Type 1 and 3.2 per cent of Type 2 diabetes patients. For people aged under 65, all three treatment targets were achieved by 17.5 per cent of Type 1 and 32.5 per cent of Type 2 diabetes patients.
Across both care processes and treatment targets, there were similar trends when comparing latest figures by region.
Regional variation showed that the number of patients receiving eight care processes ranged from 24.8 per cent to 80.6 per cent across clinical commissioning groups (CCGs) and local health boards (LHBs), with the median being 58.7 per cent. The number of patients achieving all three treatment targets ranged from 32.7 per cent to 51.7 per cent across CCGs and LHBs, with the median being 40.1 per cent.
The National Diabetes Audit1 is managed by the Health and Social Care Information Centre (HSCIC)2 in partnership with Diabetes UK3 and is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme.
Dr Bob Young, Clinical Lead for the audit, said: “It is encouraging to see that there has been a notable improvement in the blood pressure of diabetes patients. This will help to reduce heart disease, strokes and severe diabetic eye and kidney disease.
“To further improve on these latest results, we would encourage patients to attend invitations for annual care process checks and work with care providers to achieve recommended treatment targets. Equally, we would ask GPs and specialist services to sustain focus on improving blood pressure and blood glucose control.
“There continues to be wide regional variation in the care and treatment of diabetes patients. We recommend that clinical commissioning groups and local health boards support care providers to participate in the audit and provide forums for sharing best practice to improve underachievement.
The full report can also be viewed on the NHS Digital website
Background
1.The National Diabetes Audit (NDA) programme, is commissioned by The Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme (NCA). The NDA is managed by the Health and Social Care Information Centre (HSCIC) in partnership with Diabetes UK and is supported by Public Health England (PHE).
Development and delivery of the NDA is guided by a multi-professional national group of Diabetologists, GPs, consultants, public health physicians, and service user representatives. The NDA is chaired by Dr Bob Young Consultant Diabetologist & CMIO, Clinical Lead NDA (National Diabetes Audit) & NCVIN (National Cardiovascular Intelligence Network).
Data has been collected as part of the NDA since 2003-04.
2. The Health and Social Care Information Centre (HSCIC) was established on April 1, 2013, as an Executive Non-Departmental Public Body (ENDPB). It is England’s trusted data source, delivering high-quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 260 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.
3. Diabetes UK is the leading UK charity that cares for, connects with and campaigns on behalf of all people affected by and at risk of diabetes. For more information visit www.diabetes.org.uk. In the UK, 3.5 million people are diagnosed with diabetes. In addition, there are an estimated 549,000 people who have Type 2 diabetes but don’t know they have it because they haven’t been diagnosed. An estimated 11.9 million people are at increased risk of developing Type 2 diabetes and if current trends continue, an estimated 5 million people will have diabetes by 2025.
4. The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the National Clinical Audit Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. www.hqip.org.uk
5. According to the Quality and Outcomes Framework (QOF) – 2013-14, 2.8 million people in England aged 17 and above have diabetes (all types included). Diabetes comprises a group of disorders with many different causes, all of which are characterised by a raised blood glucose level. This is the result of a lack of the hormone insulin and/or an inability to respond to insulin. Insulin in the blood, produced by the pancreas, is the hormone which ensures that glucose (sugar) obtained from food can be used by the body. There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes. In people with Type 1 diabetes, the pancreas is no longer able to produce insulin because the insulin-producing cells (beta-cells) have been destroyed by the body’s immune system. Without insulin to move glucose from the bloodstream to the body’s cells, glucose builds up in the blood and is passed out of the body in the urine. In people with Type 2 diabetes, the beta-cells are not able to produce enough insulin for the body’s needs. The majority of people with Type 2 diabetes also have some degree of insulin resistance, where the cells in the body are not able to respond to the insulin that is produced.
6. The results in the report are calculated using NDA methodology and should not be compared directly with other reports where different methodologies may have been used. Details of the NDA methodology are published alongside the report. The NDA methodology was revised in 2012-2013, further details on the changes can be found here
Numbers above 1 million have been rounded to the nearest 100,000. Percentages have been rounded to one decimal place.
8. Participation in the audit was as follows (exact figures):
- 1,894,887 people with diabetes in England and Wales.
- 57.3 per cent of practices in England and Wales.
Participation of GP practices is variable across the country. This may be due to the varied support offered by Clinical Commissioning Groups (CCG’s) to GP Practices with registration and submission procedures, in light of new Information Governance ‘opt in’ requirements.
9. The three NICE recommended treatment targets are glucose control, blood pressure and serum cholesterol.
10. The nine NICE recommended care processes are:
- effectiveness of diabetes treatment (HbA1c)
- blood pressure (BP)
- serum cholesterol
- body mass index (BMI)
- smoking
- eye screening*
- foot surveillance
- urine albumin
- serum creatinine
More information can be found here: www.nice.org.uk/guidance/index
*The NDA does not report on eye screening. The NHS Diabetic Eye Screening Programme (NHS DESP) records every digital eye screening and its records should be used as the preferred measure for this annual care process. Results for individual CCGs and individual specialist care units will be published separately alongside the national report.