Skip to main content

Publication, Part of

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

Audit, Survey, Other reports and statistics

Appendix

Registrations

Table 3: Diabetes registrations and prevalence for all diabetes by source, England and Wales, 2020-21

Audit Year Total number of registrations1 Percentage of the population2 Registrations from primary care Registrations from specialist care where there is no corresponding GP record
2020-21 3,648,240 7.10% 3,611,365 36,875

 

The prevalence of diabetes has generally increased year on year since 2010-11 in England and Wales from less than 5% to more than 7%.

The NDA experienced lower participation rates in 2013-14 and 2014-15, which may have affected the reported prevalence for those years.

The National Cardiovascular Intelligence Network (NCVIN) publishes a diabetes prevalence model for local authorities and CCGs. It uses Health Survey for England data to estimate the total number of diagnosed and undiagnosed people with diabetes aged 16 and over in England and can be found here: https://www.gov.uk/government/publications/diabetes-prevalence-estimates-for-local-populations

Footnotes:

  1. Total registrations include all people submitted by GP practices and specialist care and will therefore be different to the GP practice level figures provided in the NDA interactive reports. GP practice level figures, as well as national care process and treatment target figures throughout the report, are based only on people submitted by GP practices.
  2. Population is the participating GP practice list size

Care Processes: type 1 by country, 2015-21

Table 4: Percentage of people with type 1 diabetes receiving NICE recommended care processes

England (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c 84.5 84.9 85.4 86.3 83.6 75.8
Blood Pressure 89.4 90.6 91.1 91.5 90.5 73.7
Serum Cholesterol 80 80.8 81.1 81.8 78.5 67.9
Serum Creatinine 82.1 83.3 83.5 83.9 80.9 73.8
Urine Albumin/ Creatinine Ratio 51 51 52.3 49.3 53.5 42.5
Foot Risk Surveillance 73.7 70.1 75.1 75.8 72.5 51
Body Mass Index 75.8 75.8 82.7 84.5 83.7 67.5
Smoking History 79 79.8 90.4 90.8 89.8 84
Digital Retinal Screening - - - - 79.4 61.3
Eight Care Processes1 37.3 34.4 42.9 40.8 42.3 27.4
Nine Care Processes1 - - - - 37.4 19.9
 

 

Wales (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c 73.3 74.7 74.7 73.8 71.4 61.3
Blood Pressure 85.2 84.8 83.5 82.4 80.3 58.7
Serum Cholesterol 67 66.4 65.2 64.1 60.7 50.8
Serum Creatinine 73.5 74 73.8 73.3 71.3 62.5
Urine Albumin/ Creatinine Ratio 39.5 36.2 35.1 33.8 31.9 24.7
Foot Risk Surveillance 62.3 60.6 56.9 52.8 47.7 25.7
Body Mass Index 67.5 67.2 66.7 66.5 65.8 47.1
Smoking History 71.7 70 82.8 80.5 78.2 67.3
Digital Retinal Screening - - - - - -
Eight Care Processes1 25.7 23.8 24.7 23.3 21.4 11.8
Nine Care Processes1 - - - - - -

 

Footnotes:

  1. 9 care processes includes retinal screening data, which we currently do not receive for Wales, meaning that Wales can only currently achieve completion of the NICE recommended 8 care processes in the NDA data

Care Processes: type 2 and other by country, 2015-21

Table 5: Percentage of people with type 2 and other diabetes receiving NICE recommended care processes

England (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c 95.1 95.3 95.3 95.3 93.5 86.2
Blood Pressure 95.8 96.4 96.3 96.2 95.4 82.6
Serum Cholesterol 93.1 93.1 92.9 92.8 91 79.3
Serum Creatinine 94.8 95.1 95.1 94.4 92.3 85.7
Urine Albumin/ Creatinine Ratio 66.8 65.6 66.2 61.1 68.6 52.7
Foot Risk Surveillance 87.1 79.4 86.8 86.7 83.9 59.4
Body Mass Index 82.8 83.3 88 88.8 88.3 72.8
Smoking History 85.4 85.7 95.5 95.8 95.4 89.5
Digital Retinal Screening - - - - 80.4 49.5
Eight Care Processes1 53.9 47.7 58.8 54.3 58.5 36.9
Nine Care Processes1 - - - - 52.2 21.2

 

Wales (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c 92.9 92.8 92.4 92.1 91.3 80.7
Blood Pressure 94.9 94.4 93.3 92.3 91.1 73.9
Serum Cholesterol 87.9 86.9 85.1 84.2 82.8 69.7
Serum Creatinine 93.3 93.1 92.9 92.7 92.1 82.3
Urine Albumin/ Creatinine Ratio 64.6 59.8 56.9 56.1 55 40.1
Foot Risk Surveillance 81.2 78.6 74.8 72.5 68.6 38.9
Body Mass Index 80.7 79.7 79 79.7 79.4 62.1
Smoking History 83.4 82.2 91.7 90.7 89.3 78.7
Digital Retinal Screening - - - - - -
Eight Care Processes1 50.7 47 45.9 44.7 42.6 21.4
Nine Care Processes1 - - - - - -

Footnotes:

  1. 9 care processes includes retinal screening data, which we currently do not receive for Wales, meaning that Wales can only currently achieve completion of the NICE recommended 8 care processes in the NDA data

Treatment Targets: type 1 by country, 2015-21

Table 6: Percentage of people with type 1 diabetes achieving their treatment targets

England (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c ≤ 58 mmol/mol 29.6 30.4 29.9 31.1 31.6 34.8
Blood pressure ≤ 140/80 75.7 76 74.8 74.8 73.9 71
Statins for Combined Prevention of CVD - - 68.9 68.3 69.4 69.5
Meeting all 3 treatment targets - - 18.9 19.6 20 21.5

 

Wales (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c ≤ 58 mmol/mol 23.9 26.8 26 27.5 26.3 29.4
Blood pressure ≤ 140/80 74.7 73.3 71.6 68.7 65.9 63.8
Statins for Combined Prevention of CVD - - 67.3 66.6 66.5 65
Meeting all three treatment targets - - 15.2 15.1 14.2 15.5

Treatment Targets: type 2 and other by country, 2015-21

Table 7: Percentage of people with type 2 and other diabetes achieving their treatment targets

England(percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c ≤ 58 mmol/mol 65.9 67 65.8 66.5 65.6 63.4
Blood pressure ≤ 140/80 73.7 74.4 73.8 74.5 73.6 66.7
Statins for Combined Prevention of CVD - - 76.1 74.9 76.1 75.7
Meeting all 3 treatment targets - - 40.2 40.5 40.1 35.7

 

Wales (percent)
  2015-16 2016-17 2017-18 2018-19 2019-20 2020-21
HbA1c ≤ 58 mmol/mol 63 64.7 63 62.7 61.1 58.8
Blood pressure ≤ 140/80 72.4 71.1 68.4 66.8 64.6 58.8
Statins for Combined Prevention of CVD - - 73.5 72.6 72 71.3
Meeting all 3 treatment targets - - 35 33.6 31.5 28.2

Care processes

All people with diabetes aged 12 years and over should receive all of the 9 NICE recommended care processes and attend a structured education programme shortly after diagnosis.

Nine Annual Care Processes for all people with diabetes aged 12 and over
  • 1.  HbA1c (blood test for glucose control)
  • 2.  Blood pressure (measurement for cardiovascular risk)
  • 3.  Serum cholesterol (blood test for cardiovascular risk)
  • 4.  Serum creatinine (blood test for kidney function)
  • 5.  Urine albumin/creatinine ratio (urine test for risk of kidney disease)
  • 6.  Foot risk surveillance (examination for foot ulcer risk)
  • 7.  Body mass index (measurement for cardiovascular risk)
  • 8.  Smoking history (question for cardiovascular risk)
  • 9.  Digital retinal screening (photographic eye test for early detection of eye disease) - responsibility of NHS England's diabetic eye screening programme

Treatment Targets

NICE recommends treatment targets for HbA1c (glucose control), blood pressure and cardiovascular disease risk reduction.

NICE treatment target specifications were updated in 2015-16 and now differ between type 1 and type 2 diabetes (https://www.nice.org.uk/guidance/ng17; https://www.nice.org.uk/guidance/ng28)

NICE recommended treatment targets for people with diabetes
  • Target HbA1c reduces the risk of all diabetic complications (eyes, kidney, nerves) and cardiovascular disease risk
  • Target blood pressure reduces cardiovascular disease risk and reduces the progression of diabetic eye and kidney disease
  • Statins reduce serum cholesterol and cardiovascular disease risk

Last edited: 15 April 2024 3:33 pm