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Publication, Part of

Report 1: Care Processes and Treatment Targets 2020-21, Full Report

Audit, Survey, Other reports and statistics

Current Chapter

Report 1: Care Processes and Treatment Targets 2020-21, Full Report


The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales. It measures the effectiveness of diabetes healthcare against The National Institute for Health and Care Excellence (NICE) Clinical Guidelines and Quality Standards.

The NDA supports improvement in the quality of diabetes care by enabling participating NHS services and organisations to:

  • Assess local practice against NICE guidelines.
  • Compare their care, and care outcomes, with similar services and organisations.
  • Identify gaps or shortfalls that are priorities for improvement.
  • Identify and share best practice.
  • Provide a comprehensive national picture of diabetes care and outcomes in England and Wales.

This is the annual national report on care process completion and treatment target attainment. A 2020-21 data release was published in December 2021.

This report describes the national picture regarding completion of NICE recommended annual care processes, and achievement of NICE recommended treatment targets, in people with diabetes living in England and Wales during 2020-21.

Regional and local data should be accessed via the accompanying dashboard.

Key Recommendation 1

Diabetes care providers and local systems should restore routine diabetes review (9 annual care processes) and work to reduce geographic variation. The data dashboard for 2020-21 and the quarterly data releases can be used for benchmarking and tracking progress.

Key Recommendation 2

Diabetes care providers and local systems should work with people who have type 2 and other types of diabetes to help them achieve individualised targets for blood glucose and blood pressure control. For people with type 1 diabetes they should build on the 2020-21 improvement in glucose control as per recommendations in the NDA Type 1 Report and improve achievement of blood pressure control.

Key Recommendation 3

General practices should identify the small number of people with type 2 or other diabetes and severe frailty, who are treated with sulphonlyureas and/or insulin, and have evidence for low average glucose levels (HbA1c ≤ 53 mmol/mol) and consider de-intensification of glucose-lowering treatment.

Key Facts

Key Finding 1: COVID-19 and Care Process Completion

During the COVID-19 pandemic care process completion declined everywhere but there was greater geographical variation than usual. The greatest impacts were on foot examination, weight measurement, and retinal screening. Urine albumin checks remain lowest.

Key Finding 2: COVID-19 and Treatment Target attainment

During the COVID-19 pandemic glucose control improved in people with type 1 diabetes but deteriorated in those with type 2 and other types of diabetes; blood pressure deteriorated in all; and use of statins was relatively unchanged.

Key Finding 3: Diabetes and frailty

2.0% of people with type 1 diabetes and 5.3% with type 2 or other types of diabetes have severe frailty. 65,970 people with type 2 diabetes have both severe frailty and HbA1c ≤ 53 mmol/mol. 18,690 people with diabetes with severe frailty and HbA1c ≤ 53mmol/mol are on insulin or sulphonylurea or both. These people may be at particular risk of harm due to hypoglycaemia.

Last edited: 28 September 2022 2:54 pm