Failures in diabetes care identified

Sixty per cent of the 1.42 million people with diabetes in England included in the last National Diabetes Audit did not receive all the care recommended for their condition. The fifth national audit, carried out by The NHS Information Centre in 2007/08 and funded and commissioned by the Healthcare Quality Improvement Partnership (HQIP), also showed people with diabetes are more likely to have complications if they live in certain parts of the country or have a more socially deprived background. People with Type 1 diabetes or maturity onset diabetes of the young (MODY) were also found to be less likely than those with Type 2 diabetes to receive any of the nine care processes recommended by the National Institute for Health and Clinical Excellence (NICE). The audit found that in England:

• Just over 90% of people with Type 2 diabetes received a BMI, blood pressure or blood sugar (HbA1c) check, compared to just over 80% of people with Type 1 diabetes and just over 70% of people with MODY diabetes.
•80% of people with Type 2 diabetes received a foot examination, compared to 60% of people with Type 1 diabetes and less than 40% of people with MODY diabetes.
• More than 90% of people with Type 2 diabetes received a cholesterol check, compared to just over 70% of people with Type 1 diabetes and less than 50% of people with MODY diabetes.

However, the increase in those who did receive all nine care processes – 40% in 2007/08 – is significant compared to five years ago, when 6.5% of patients received all nine care processes. The nine processes of care for diabetes are recommended by the National Institute for Health and Clinical Excellence (NICE) and are; HbA1c, BMI, blood pressure, albumin, creatinine, cholesterol, eye examinations, foot examinations and smoking. The fifth annual audit also showed the complication rate, relating to nine specific complications sometimes had by diabetes patients, varies widely by region. England’s 10 Strategic Health Authorities (SHAs) were ranked according to prevalence for each of the nine complications, ranging from cardiac failure and stroke to amputations and angina. All but one SHA ranked in the lowest performing quarter for at least one complication, while seven ranked in the top performing quarter for at least one complication.
The audit also found wide variation in meeting care targets across England’s 152 primary care Trusts (PCTs). For example, glucose control and blood pressure targets are achieved for 50% more people with diabetes in some PCTs compared to others. Apart from eye disease, all complications were found to be more common with increasing social deprivation, with a two fold increase in complications between the least and most socially deprived patients. The prevalence of stroke, for example, was 0.47% in people with diabetes with the least socially deprived backgrounds, compared to 0.74% for the most socially deprived. The NHS Information Centre’s clinical lead for diabetes, Dr Bob Young, said: “Diabetes affects an estimated 2.1 million people in England, not to mention the lives of friends and family of those who suffer from the condition. It also places significant pressure on the resources of the NHS. The audit results shows positive steps have been taken by care providers – with the percentage of people receiving all the care that is recommended for them up from just over 6% to 40% in just five years. “However, that means that more than half of diabetics still do not get all of the care that is recommended they receive. There is stark contrast in the level of care depending on what type of diabetes a person has, where they live in the country, and how socially deprived they happen to be.”