Since the first National Diabetes audit in 2004, the annual data collection has increased in size and breadth and has become one of the pillars of assessing the quality of care of patients with Diabetes in England and Wales, both in primary and secondary care. Over the years, it has grown to encompass a number of work streams including the inpatient, pregnancy, foot, insulin pump and transition from children to adult audits. It is designed to ensure that all patients diagnosed with diabetes are recorded on a register (sub divided into Type 1 and Type 2) and to measure the percentage of people receiving the nine NICE care processes, the percentage of people reaching NICE defined targets, the rate of acute and long term complications. Its purpose is to assess local practice against NICE guidance, identify shortfalls in practice that are priorities for improvement and compare an areas servicewith local peers. The data for the 2015/ 2016 audit allows analysis down to CCG and practice level, comparing results to the previous year’s iteration. Several facts have emerged from this year’s audit. Encouragingly, participation has increased to 82.4% from 57.3% in 2014/15. The progressive rise in patients offered structured education continues to increase despite inconsistent recording of attendance. There continues to be a large variation among CCGs and local health boards, specialist and GP services for T1 and T2 diabetes, a situation not explained by case mix and with patients aged <65 performing worst. A drop in BMI and urinary albumin/ creatinine ratio measurements from earlier audits have not recovered. Encouragingly people with learning difficulties have similar care processes and target results compared to people without learning difficulties.
Clearly reducing the significant variability in care that exists should be the one of the main action points but other recommendations include attempts to improve the access to and recording of structured education attendance and in particular addressing the age related quality issues that have emerged. Allowing patients access to their practice results would also go some way in empowering them to address individual care issues.
Dr. Mark Freeman