Diabetes patients ‘missing targets’
Wednesday 30th October 2013, 11:30AM GMT.
More than 1.2 million people with diabetes do not have good blood pressure control while hundreds of thousands are missing blood sugar targets, according to NHS data.
The National Diabetes Audit, which covers 88% of GP practices and almost 2.5 million people with diabetes in England and Wales, found just 19% of patients met the three ideal targets on blood sugar, blood pressure and cholesterol.
The targets – set by the National Institute for Health and Care Excellence (Nice) and intended to be used by GPs and nurses – are aimed at keeping people as healthy as possible and preventing life-threatening complications of the disease.
Today’s data, which is managed by the Health and Social Care Information Centre (HSCIC), found just 27% of people with Type 1 diabetes met the ideal blood sugar level alongside 66% of those with Type 2.
The ideal blood glucose level is recorded as a HbA1c of less than 58mmol/mol.
On blood pressure, 52% of people with Type 1 but only 38% of those with Type 2 – which is linked to obesity – met the ideal target.
This means more than 1.2 million patients (of the 2.3 million patients whose blood pressure was recorded) had not met the blood pressure target of less than 140/80.
Diabetes is a major risk factor for heart disease. Blood pressure that is not controlled properly increases the risk of heart attacks, heart failure and stroke.
The audit also found that only 30% of people with Type 1 diabetes and 41% of those with Type 2 met the recommended cholesterol level of less than 4mmol/l.
However, 71% of those with Type 1 and 78% of those with Type 2 had cholesterol that was less than 5mmol/l – an NHS target which rewards GPs financially if they meet it.
Some three million people in the UK have diabetes, of whom about 90% have Type 2, which is linked to unhealthy lifestyles.
An extra 850,000 people have Type 2 diabetes but do not know it.
According to the charity Diabetes UK, 24,000 people with diabetes in England and Wales die early each year because of the condition.
Today’s report found that of eight basic checks all patients with diabetes should receive on the NHS, just 43% of those with Type 1 and 63% of those with Type 2 received them.
Some 74% of people received eye screening in England, which the report said was too low and “a major concern as diabetic retinopathy remains the commonest cause of blindness in England”.
The audit – the largest of its kind in the world – said there was wide variation around the country in achieving the checks.
Dr Bob Young, clinical lead for the audit, said: “Today’s audit shows how much scope there is for reducing heart disease and stroke in people with diabetes by achieving the blood pressure treatment target more often.”
Barbara Young, chief executive of Diabetes UK, said: “It is concerning that there is still a considerable variation in the percentage of people getting the checks they need to help them manage their condition, with less than 20% getting eight care processes in the worst performing areas while in the best-performing areas over 75% are getting these checks.
“If the NHS in one area can achieve this then why can’t it do so in others?
“Also, we are concerned that so few people with Type 1 and Type 2 diabetes are recorded as attending education courses that can help them manage their own diabetes, which can be key in giving people the tools they need to have the best possible chance of a long and healthy life.
“We are also continuing to see a worrying trend where people with Type 1 diabetes, in particular, are less likely to get the checks or to have their condition under control than people with Type 2, and this needs to be tackled by designing systems of care that meet the needs of this often overlooked group.”
She added: ” While there is some good news in the increase in the proportion of people who are managing their condition, this is increasing much too slowly and, alarmingly, the proportion of people with diabetes who meet the recommended level for blood glucose levels has gone down.
“This is hugely worrying, as having high blood glucose levels over a long period of time increases a person’s risk of health complications that have a devastating impact on people’s quality of life and are extremely expensive to treat.”
An NHS England spokesman said: “In the recently published Global Burden of Disease Study, the UK was shown to have the lowest rates of early death due to diabetes of the 19 wealthy countries included in the analysis.
“However, as the latest NDA (National Diabetes Audit) published today shows, we know there is still a great deal that can be achieved to further reduce morbidity and mortality associated with diabetes through improved care delivery.
“Successful partnerships between those with diabetes and those that deliver care are crucial if we are to continue to improve clinical outcomes and improve the experience of care for those with diabetes.
“The findings of this report are an important message to clinical commissioning groups as they commission diabetes services in England.”