Skip to main content

Publication, Part of

National Diabetes Audit, 2020-21, Type 1 Diabetes

Current Chapter

National Diabetes Audit, 2020-21, Type 1 Diabetes

Future publication format

Please note that future publications will be web-based only. This is to improve the accessibility of our publications

16 June 2022 09:30 AM


The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales. It measures the effectiveness of diabetes healthcare against National Institute for Health and Care Excellence (NICE) Clinical Guidelines and NICE Quality Standards*,**. This is the second report on adults with type 1 diabetes. It details the findings and recommendations relating to diabetes care process completion, treatment target achievement and structured education for people with type 1 diabetes. The 2020-21 audit covers the period 01 January 2020 to 31 March 2021. Case ascertainment from General Practitioner (GP) records is >99% so geographical comparisons are comprehensive. But low rates of data submissions from specialist services, possibly hampered due to COVID-19, make provider reports patchy.

-* NICE Clinical Guidelines – NG17: Type 1 diabetes in adults: diagnosis and management

** NICE – Diabetes in Adults Quality Standard


Recommendation 1

Recommendation 1

Given that specialist services play a key role in leading the provision of type 1 diabetes care, it is imperative that all specialist services submit data to the audit. Details for the 2021-22 submission can be found at - deadline 30th June 2022

Recommendation 2

Recommendation 2

Specialist services should work with local systems to ensure that everyone with type 1 diabetes, irrespective of age, sex, ethnicity or social circumstances has the opportunity to benefit from structured education, non-invasive glucose monitoring and insulin pump treatment as per guidelines from the National Institute for Health and Care Excellence (NICE). The NDA specialist service type 1 diabetes Quality Improvement Collaborative is launching in Autumn 2022. Every specialist service will be invited to participate. This will be an invaluable opportunity for networking and shared learning

Recommendation 3

Recommendation 3

Given the high variability of care process completion and treatment target achievement, specialist services and local systems should try to find ways to understand the reasons for these differences with the aim of improving the level of outcomes overall and reducing their variability. The regional ‘deep dives’, as undertaken by NHS England, are a mechanism for drawing attention to variability and promoting shared learning and change

NDA type 1 diabetes advisory group expert by experience* perspective

"We cannot underestimate the challenges of providing care for people with type 1 diabetes during the COVID-19 pandemic but we are concerned to see the reduction in the essential healthcare checks we should be receiving every year. We hope that routine care for people with type 1 diabetes can return to and improve on pre-pandemic levels as soon as possible”

“It is heartening to see improvements in the proportion of people having a HbA1c within the recommended targets. The benefits of structured education, Flash and CGM and insulin pumps for people with type 1 diabetes are clear to see but there is too much inequality of access. Services need to work to reduce variation - whether that’s due to if someone is living in poverty, their ethnicity or where they live. Commissioners, services and people with diabetes need to work together to understand the reasons for the variation and learn from other areas with higher levels of treatment target achievement” 

* A person with lived experience of type 1 diabetes

Key Facts

Care processes

Due to the pandemic restrictions, care process completion reduced markedly in 2020-21 – for example glycated haemoglobin (HbA1c) checks reduced from 88% to 80% and Body Mass Index (BMI) measurements from 86% to 67%.

By contrast, overall HbA1c treatment target achievement improved in 2020-21; for example, the median rate of achieving HbA1c ≤58mmol/mol (7.5%) has increased from 28% in 2019-20 to 31% in 2020-21.

Insulin pump technology

Use of non-invasive glucose monitoring and insulin pump technology was associated with lower HbA1c. These technologies were being used more by adults of white ethnicity and adults in areas of low deprivation than by adults of other ethnicities and in more deprived areas. Findings were similar for recorded completion of structured education.


All care processes and treatment outcomes vary by location. For example, both comprehensive Clinical Commissioning Group/ Local Health Board (CCG/LHB) data and partial specialist service data show ranges of 20-45% in achievement of HbA1c≤58mmol/mol (7.5%) by location.


The National Diabetes Audit Type 1 dashboard presents data on demographics and care processes of adults with type 1 diabetes at CCG/LHB, Integrated Care System (ICS), NHS Region and national levels. Some information is presented at hospital provider level.

In order to access the dashboard and its functionality, we recommend the following internet browsers:

Microsoft Edge

Chrome desktop latest version

Safari Mac latest version

Firefox desktop latest version

Last edited: 14 July 2023 4:21 pm