One in Four At Risk

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Published: 23 September 2005

One in Four At Risk

A quarter of all people who may have diabetes have not been identified, leaving them at increased risk of developing serious complications.

This is a key finding of a clinical audit carried out by the Health and Social Care Information Centre on behalf of the Healthcare Commission.

The audit compared the numbers of people diagnosed and registered with diabetes against the diabetes population prevalence model developed by the Yorkshire and Humber Public Health Observatory.

The audit asked four key questions:

Is everyone with diabetes diagnosed and recorded on a practice diabetes register?
For people with diabetes what is the annual rate of specific complications?
What proportions of people with diabetes receive the key processes of diabetes care?
What proportions of people with diabetes achieve treatment targets?

The first year of this audit, which covers the period 2003/04, has produced invaluable information on the level and extent of diabetes care in England, which can be used by all registered contributors, including primary care trusts, GP surgeries, hospital trusts and specialist paediatric units to help them:
identify & care for people with diabetes, and
to support quality improvement.

In Europe's largest national audit of diabetes care, information about more than 250,000 people in England has been collected.

Twenty percent of PCTs, over 1,700 individual GP practices, 47 hospital trusts and 58 specialist paediatric units have already registered during the early phases of the audit, with many more expected to join over the coming year.

The early findings suggest that:
almost half of women with diabetes may be undiagnosed;
less than 50% of diagnosed people are receiving eye examinations putting them at risk of avoidable blindness; and
only 56% of people with diabetes are managing their glucose levels within the guidelines set by NICE (an HbA1c less than 7.5%).

The report highlights the need for further work to determine whether there is a systematic under-identification of women aged 40 and above.

It also recommends that problems with recording of ethnicity are addressed as there is a known increased risk of diabetes for particular ethnic groups.

Positively the audit suggests that where patients are recorded as having diabetes some of the basic components of care such as monitoring glucose levels, cholesterol and blood pressure are carried out on at least an annual basis for most patients.

Anna Walker, Chief Executive of the Healthcare Commission, said:
"This work shows us the value of national audit and we are anticipating that all PCTs will participate in the audit next year.

We expect to see changes as a result of this work and we will be using participation in the audit as part of our annual performance ratings for primary care trusts.

It is very important that patients and the public are informed of and understand the benefits of treatment and follow-up care for diabetes, as well as the risks of long term complications that will result without diagnosis and treatment.

In addition to this audit the Healthcare Commission will be surveying 150,000 people with diabetes in spring 2006.

The results will be used to review how well health services are supporting people with diabetes and provide recommendations to improve overall diabetes care in England "

Douglas Smallwood, Chief Executive at Diabetes UK said:
"Many people with diabetes are seeing their healthcare team, which is an essential part of good diabetes management.

However, the audit shows that almost a quarter of people who have diabetes don't know it or are not recorded as having diabetes with their GP.

The longer people are left undiagnosed or are not managing their diabetes, the greater the risk of long term complications such as heart and kidney disease, blindness and amputations.

The importance of this audit is that gaps are now identified and action can be taken by healthcare professionals to improve services. We encourage all areas to participate in this to drive up standards."

Further information
Key findings about the quality of care for people with diabetes in England (1.3MB)

Factsheet: What is diabetes?

Factsheet: Risk factors and symptoms of Type 2 diabetes

Health and Social Care Information Centre

Healthcare Commission

Diabetes UK

Related articles
Improving Long-term NHS Care

Diabetes Education

Diabetes Annual Report