National Diabetes Audit (NDA)

The NDA currently covers four ‘core care’ components of the National Service Framework (NSF) for Diabetes

1. Registrations:
Is everyone with diabetes diagnosed and recorded on a practice diabetes register?

2. Care Processes:
What percentage of people registered with diabetes received the nine key processes of diabetes care (Measure: Weight, Blood Pressure, HbA1c, Urine Albumin Creatinine Ratio (UACR), Serum Creatinine, Serum Cholesterol; Assess: Eyes, Feet, Smoking)?

3. Treatment Targets:
What percentage of people registered with diabetes achieved NICE defined treatment targets for glucose control, blood pressure and blood cholesterol?

4. Complications:
For people with registered diabetes what are the rates of acute and long term complications (disease outcomes)

Summaries of the NDAs for the years 2004, 2005, … , 2010 are available from:

http://www.ic.nhs.uk/nda

The audits make grim reading. In all four ‘core care’ components there are serious problems.

1. Registrations:
Large % of diabetics are not diagnosed and recorded on a practice diabetes register.

2. Care Processes:
Large % of registered diabetics do not receive the nine key processes of diabetes care.

3. Treatment Targets:
Large % of registered diabetics do not achieve the NICE defined treatment targets.

4. Complications
Large % of registered diabetics have acute and long term complications.

To avoid getting overwhelmed with the wealth of data we will consider only the NICE clinical guidelines that the HbA1c level should be less than 7.5% (in itself considered by many to be too high!)

Over the years 2004 -2010 the % of registered diabetics failing to achieve HbA1c of less than 7.5% has remained at approximately 40% (with small year to year variations).

There seems to be only one conclusion – The NHS strategy for diabetes is not working. Given the increasing prevalence of diabetes the implications for both for the diabetics suffering and the public purse are deeply worrying.

John