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National Diabetes Audit 2021-22, Report 1: Care Processes and Treatment Targets, Detailed Analysis Report

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National Diabetes Audit 2021-22, Report 1: Care Processes and Treatment Targets, Detailed Analysis Report

Change to mapping used for integrated care board (ICB) analysis

An issue was found with the mapping used to define integrated card boards (ICB) in this report resulting in larger than expected cohorts for each ICB. This has been corrected in this report and has resulted in slight changes to the results of analyses broken down by ICB.

21 December 2023 00:00 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 the National Institute for Health and Care Excellence (NICE) Clinical Guidelines and NICE Quality Standards. This NICE guidance is based on evidence that regular systematic review of people with diabetes and achievement of glucose, blood pressure and cardiovascular risk standards maintains health and reduces long term complications.

This is the detailed analysis report relating to diabetes care for people with diabetes for the 2021-22 audit, which covers the period 01 January 2021 to 31 March 2022. The State of the Nation overview based on the analyses provided in this detailed report can be found here. These reports provide in-depth and extended analysis of the data in the National Diabetes Audit Core Report 1: Care Processes and Treatment Targets 2021-22, Underlying data.

This NDA report focuses on NICE guidelines and Quality Standards for the routine care of people with type 1 and type 2 diabetes (1). Everyone with diabetes should be reviewed at least once a year. The review should include the following 8 care processes (2):

  • blood tests for HbA1c (glucose control)
  • creatinine (kidney function)
  • cholesterol (heart risk)
  • urine test for albumin (kidney risk)
  • blood pressure measurement
  • weight measurement (body mass index; BMI)
  • examination of the feet (foot ulcer risk)
  • review of smoking habit

The ninth care process is retinal screening, which is run by dedicated screening programmes (2).

At review, treatment should be adjusted where necessary to achieve the 3 NICE recommended treatment targets (2):

  • HbA1c level ≤ 58 mmol/mol
  • blood pressure level ≤ 140/80
  • those with high heart risk should be prescribed a statin

Data on routine diabetes care (care processes, treatment targets and structured education) are publicly available at national, regional, integrated care board (ICB), primary care network (PCN), general practice (GP) and specialist service level in the quarterly (3) and annual dashboards.


1. The National Diabetes Audit, Type 1 Diabetes and Young People with Type 2 Diabetes reports use additional diagnosis validation steps to determine diabetes diagnosis. Therefore, the cohort used for these reports differs from that used in this report. 

2. See Definitions in Additional information for details of the 8 care processes, ninth care process and treatment targets.

3. The quarterly dashboard presents primary care data for England only. Therefore, data is not available at specialist service level nor for Wales. 

What does the National Diabetes Audit provide?

The NDA supports delivery of high-quality diabetes care by enabling NHS services and organisations to:

  • assess local practice against NICE guidelines
  • compare their care processes, and care outcomes, with similar services and organisations
  • identify gaps or shortfalls that are priorities for improvement
  • track responses to change programmes
  • identify and share best practice
  • provide a comprehensive national picture of diabetes care and outcomes in England and in Wales

Report content overview

This is the 2021-22 annual national report on care process completion and treatment target attainment for people with diabetes. In England between 2017-18 and 2021-22 type 1 prevalence went up from 248,240 to 270,935 and type 2 and other diabetes prevalence increased from 2,952,695 to 3,336,980. In Wales between 2017-18 and 2021-22 type 1 prevalence went up from 15,210 to 16,090 and type 2 and other diabetes prevalence increased from 182,325 to 191,205 (see the section Incidence and prevalence for further information).

This year’s report highlights three 5-year trends:

  1. Impact of the pandemic on care delivery from 2017-18 to 2021-22: Changes that occurred during the pandemic are described and progress towards restoration of the pre-pandemic trends are reported.
  2. Health inequalities in routine diabetes care from 2017-18 to 2021-22: Includes variation in whether people received all relevant care processes and the personal characteristics (age, sex, duration of diabetes, deprivation and ethnicity) associated with this variation.
  3. Treatment target achievement in people with type 1 and type 2 and other diabetes from 2017-18 to 2021-22.

Geographical variation in achievement of the care processes in 2021-22 are presented in the section Care processes and treatment targets of this report. Analyses on people with frailty, learning disabilities and severe mental illness are available in the Health inequalities in diabetes section of this report.

Logistic regression modelling was used to quantify the relative impacts of the different personal characteristics in the Health inequalities in diabetes section of this report. An explanation of the methodology is provided in Additional information, and the results presented as forest plots are in the Appendix of this report.

National Diabetes Audit core annual dashboard

Through this dashboard, you can explore local analysis on care process and treatment target achievement, structured education referral and attendance, national and within-locale practice ranking and more.


Data from this report relates to the 2021-22 audit period. Latest data from the National Diabetes Core Audit is available online at National Diabetes Audit Dashboards.

Last edited: 12 April 2024 3:37 pm