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Summary of Results

Health Topic:   Endocrine, nutritional and metabolic
Guidance:   Type 2 diabetes (partially updated by CG87)
Description:   The summary of the published clinical guideline on Type 2 diabetes (partially updated by CG87). It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage
NICE implementation uptake report: insulin glargine Practice appears to be in line with guidance 2009 National
NICE implementation uptake report: glitazones Practice appears to be in line with guidance 2009 National

External literature

External literature Assessment Coverage

NHS Information Centre (2011) National Diabetes Paediatric Audit Report 2009-2010

Description: The audit received 19,558 records on children and young people (0-24 years of age), from 155 paediatric units. Results found that 89.3% of all children and young people with diabetes had a record of HbA1c measurement. Only 14.5 per cent of the HbA1c measurements achieved the NICE recommended HbA1c target of < 7.5 per cent (59 mmol/mol). But in children and young people over the age of 12, only 4.1% had all the NICE key processes of care recorded.

Doubts about or mixed impact in practice National

NHS Information Centre (2011) National Diabetes Audit 2009-2010

Description: Participation in the NDA was high amongst GP's, acute trusts and paediatric units in England and Wales. Results found that in 2009-2010, 52.9 per cent of people with Type 2 diabetes and 31.9 per cent of people with Type 1 diabetes received all nine, NICE recommended care processes. These results however mean that almost half of people with Type 2 and two thirds of people with Type 1 diabetes still do not achieve this standard of care.

Doubts about or mixed impact in practice National

The NHS Information Centre for Health and Social Care (2011) Prescribing for Diabetes in England 2009-10

Description: The data presented covers prescriptions issued in primary care in England and dispensed in the community in the United Kingdom. These figures were provided by NHS Prescription Services and were accessed using the electronic Prescribing Analysis and CosT tool (ePACT). Results found that there was a 70.1 per cent increase in items prescribed of the drug metformin from 8.6 million items in 2005/6 to 14.6 million items in 2010/11.

Not graded National

NHS Information Centre (2011) National Diabetes Audit Mortality Analysis 2007-2008

Description: This report links the National Diabetes Audit records to formal death notifications via the NHS Information Centre Medical Research Information Service. Data on 1.4 million people with diabetes was used and it was estimated that the number of deaths of people diagnosed with diabetes in England is 70 to 75 thousand per year. Risk of death for patients with Type 1 diabetes is 2.6 times higher than the general population, for patients with Type 2 diabetes the risk is 1.6 times higher.

Not graded National

DiabetesE innove (2012) DiabetesE Seventh National Report January 2012

Description: The findings presented in this report are based on data captured on 17th December 2011. In total 83% of PCTS and 181 specialist providers used DiabetesE to assess their services during 2011. There are a total of 344 questions in the PCT and specialist diabetes provider questionnaires covering all aspects of diabetes service commissioning and provision, including the NICE Quality Standard for Diabetes which is new for 2010/11. Results are presented against each Quality Statement.

Doubts about or mixed impact in practice National

NHS Information Centre (2012) National Diabetes Inpatient Audit (NaDIA)

Description: The National Diabetes Inpatient Audit (NaDIA) 2011 was carried out by diabetes teams in acute hospitals in England in October 2011. 188 audit sites took part, with bedside data from 11,866 inpatients and feedback on patient experience from 6,002. England results showed that only 22.4% of patients had a documented foot examination within 24 hours of admission, and that 49.2% of inpatients stated that they did not have a care plan but would have liked one. Separate results are presented for Wales.

Doubts about or mixed impact in practice National

Roberts, S.H. et al (2012) The impact and outputs from the Year of Care programme. Diabetic Medicine. Conference: Diabetes UK Professional Conference 2012 Glasgow United Kingdom. Conference Publication: (var.pagings). 29 (pp 115), 2012. Date of Publication: March 2012.

Description: This study evaluated a pilot framework for delivery of the Year of Care programme. Results showed that personalised care planning (CP) became routine for the majority of practices in the pilot communities: Tower Hamlets 97%, Kirklees 83% and in all 76% of people with type 2 diabetes had one or more CP consultations. One thousand professionals and 45 local trainers were trained, and people with Type 2 Diabetes reported improved experience of care and self-care.

Practice appears to be in line with guidance Local

Health and Social Care Information Centre (2012) National Diabetes Audit 2010-11 - Report 1: Care Processes and Treatment Targets

Description: This voluntary audit is based on data from GP and Specialist Records in England and Wales during 2010-11, covering 2.15 million people (87.6%) with diabetes in England, and 85,000 people with diabetes in Wales. The audit presents key findings on care processes and treatment target achievement rates in all age groups, all specified in NICE Clinical Guidelines and Quality Standards. Findings show that in England, 54.3% of patients received all nine care processes (up 2.9% from 2009/10).

Doubts about or mixed impact in practice National

Thomson-Moore, A. et al (2012) Audit of the continuous subcutaneous insulin infusion multidisciplinary service at the University Hospitals Bristol NHS Foundation Trust (UHB) Conference: Diabetes UK Professional Conference 2012 Glasgow United Kingdom. Conference Publication: (var.pagings). 29 (pp 73), 2012. Date of Publication: March 2012

Description: This retrospective analysis of patient records at University Hospitals Bristol NHS Foundation Trust audited the continuous insulin infusion (CSII) service against 2008 NICE guidance. Results found that of 81 eligible patients being actively supported on 25th August 2011, all had received self-management education, while 64/81 (79%) were achieving NICE specified treatment goals. Of the 17 not achieving treatment goals, nine started prior to publication of the 2008 guidance.

Practice appears to be in line with guidance Local

Diabetic Medicine. Conference Publication: (var.pagings). 29 (pp 176), 2012. Date of Publication: March 2012. (2012) A cross-sectional audit into insulin prescription and concordance with National Institute of Health and Clinical Excellence (NICE) guidance for Type 2 diabetics on long-acting analogue insulin.

Description: Findings are presented from an audit of 100 patients at Plymouth Hospital NHS Trust, carried out to measure adherence to NICE guidelines for Type 2 diabetes with regard to analogue insulin prescribing. Results show 17% were treated with natural protamine Hagedon (NPH) insulin in line with guidance. 37% were treated with insulin glargine and 46% with detemir. Of those treated with analogue insulin 19% had no documented reason for non-concordance.

Doubts about or mixed impact in practice Local

National Audit Office (2012) The management of adult diabetes services in the NHS

Description: This report examined whether the NHS in England is meeting the standards of care for diabetes set by the Department of Health in 2001 and reinforced by NICE. Analyses of the NHS Information Centre?s National Diabetes Audit 2009/10 found 16% of people with diabetes achieved all three treatment standards to control blood glucose, blood pressure, and cholesterol levels, 69% failed to achieve one or more of the three treatment standards and 15% were not tested at all.

Practice appears not to be in line with guidance National

Driskell, O.J. et al (2012) Inappropriate requesting of glycated hemoglobin (Hb A1c) is widespread: Assessment of prevalence, impact of national guidance, and practice-To-practice variability. Clinical Chemistry. 58 (5) (pp 906-915), 2012. Date of Publication: May 2012.

Description: This study examined the prevalence of under-and over requesting of Glycated Hemoglobin and the impact of NICE guidance on prevalence. 519,664 requests from 115,730 patients between January 2001 and March 2011 processed by the Clinical Biochemistry Department, University Hospital of North Staffordshire were examined. Only 49% of requests conformed to guidance; 21% were too soon and 30% were too late. Publication of NICE guidance had no significant impact on under-or over requesting rates.

Doubts about or mixed impact in practice Local

Royal College of Paediatrics and Child Health (2012) National Paediatric Diabetes Audit Report 2010-11

Description: This 8th annual report illustrates the quality of care for infants, children and young people with diabetes in England and Wales in 2010-11. The audit measures the percentage of people under 25 with diabetes who are receiving 8 key processes of care, including eye screening and foot examination. Data is included for 23,516 young people from 178 specialist units. Results show 951/16,444 (5.8%) people with diabetes aged 12-24 received all 8 care processes, up from 4.1% in 2009-10.

Practice appears not to be in line with guidance National

Health and Social Care Information Centre (2013) Prescribing for Diabetes in England: 2005/6 to 2011/12

Description: This publication reviews prescribing for diabetes for the period 2005/6-2011/12. The data covers prescriptions issued in primary care in England and dispensed in the community in the United Kingdom. These figures were provided by NHS Prescription Services and were accessed using the electronic Prescribing Analysis and CosT tool (ePACT). Results found that there was an 85.3% increase in items prescribed of the drug metformin from 8.6 million items in 2005/6 to 15.9 million items in 2011/2.

Practice appears to be in line with guidance National

Health and Social Care Information Centre (2013) National Diabetes Inpatient Audit (NaDIA) - 2012

Description: The NaDIA 2012 is the 4th audit of inpatient care conducted by diabetes teams in acute hospitals in England and Wales on one day between 17th and 21st Sept 2012. In total 216 audit sites took part, including bedside data from 13,409 inpatients with diabetes. Results showed 9.3% of patients had a foot complication on admission, of which 53.9% had input from a multi-disciplinary foot team within 24 hours. 38.7% reported that they had been involved in the design of their treatment or care plan.

Doubts about or mixed impact in practice National

Diabetes UK (2013) Access to test strips - A postcode lottery?

Description: Results are presented from an online survey conducted in March 2013 exploring the experiences of people with diabetes and their carers in relation to Self-Monitoring of Blood Glucose (SMBG) levels at home. Results found that 39% of respondents said that they had either been refused a prescription of blood glucose test strips or had their prescription restricted. 34% responded that the reason for restriction was due to cost saving measures.

Doubts about or mixed impact in practice National

Health and Social Care Information Centre (2013) National Diabetes Audit - 2011-2012: Report 1, Care processes and treatment targets

Description: This audit is based on data recorded on 2.47 million people with diabetes in England and Wales. The audit presents key findings on care processes and treatment target achievement rates. Completion of 8 basic care processes was 43.2% and 62.6% for those with Type 1 and Type 2 diabetes respectively (54.3% of patients received all 9 care processes in 2010/11). 2.2% of Type 1 and 12% of Type 2 people with a new diagnosis of diabetes were offered structured education.

Doubts about or mixed impact in practice National

Stone, M. A. et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guideline Adherence to Enhance Care (GUIDANCE) study. Diabetes Care 36 (9) 2628-2638.2013.

Description: This cross-sectional study aimed to determine levels of adherence in 8 European countries, including the UK to recommendations for the management of type 2 diabetes and to investigate factors associated with key intermediate outcomes. This was a cross-sectional study including retrospective data extraction from the medical records of people with type 2 diabetes recruited between March 2009 and December 2010. For the UK, results show 98.3% patients had their HbA1c checked.

Doubts about or mixed impact in practice National

Stone, M. A. A. et al (2013) Adherence to recommendations for the management of Type 2 diabetes: How does the UK compare with other European countries involved in the Guideline Adherence to Enhance Care (GUIDANCE) study? Diabetic Medicine. 2013 Conference (var.pagings) PAGES March-

Description: This study aimed to determine levels of adherence to intermediate outcome targets recommended by NICE in a UK sample of people with Type 2 diabetes. The study also compared UK adherence with levels achieved across 7 other European countries. Results found that recording of process measures was generally high in all countries. Of 1,033 UK participants, HbA1c was checked in the past year in 98.3% of cases, and blood pressure was recorded in 99.1%.

Practice appears to be in line with guidance National

This page was last updated: 22 November 2013

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.