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Summary of Results

Health Topic:   Endocrine, nutritional and metabolic
Guidance:   Type 2 Diabetes - newer agents (partial update of CG66)
Description:   The summary of the published clinical guideline on Type 2 Diabetes - newer agents (partial update of CG66). It links to the published guidance and key documents.

NICE implementation uptake reports

Implementation uptake report Assessment Published Date Coverage

External literature

External literature Assessment Coverage

The NHS Information Centre for Health and Social Care (2010) Prescribing for Diabetes in England: 2004/5 to 2009/10

Description: This publication reviews prescribing for diabetes over the period 2004/5-2009/10. There was a 73.3% increase in metformin items prescribed from 7.6 million in 2004/5 to 13.2 million in 2009/10. The number of items for sulphonylureashas continued to increase year on year with a growth of 31.5% from 2004/5 to 2009/10. In 2009/10 there was a 7.3% growth in the number of items compared with 8.0% in the previous year. The increase in items prescribed for both drugs are in line with NICE guidance.

Practice appears to be in line with guidance National

Right Care (2010) The NHS Atlas of Variation in Healthcare

Description: The Atlas maps the variations in health spending and outcomes across England. It comprises of 34 maps covering a range of specialities. The Atlas found considerable variation, 35-fold across the country, among the number of diabetes patients who are receiving the 9 NICE key care processes at their annual check-up. Even when the five PCTs with the highest percentages and the five PCTs with the lowest percentages are excluded, a fivefold variation remains.

Doubts about or mixed impact in practice National

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

Hawthorne, G. et al (2012) Diabetes Care Provision in UK Primary Care Practices PLoS ONE 7(7):e41562.doi:10.1371/journal.pone.0041562

Description: This study investigated diabetes care delivered by UK primary care. Postal surveys sent between September and December 2008 were returned by 326 doctors, 163 nurses and 3591 patients with Type 2 diabetes across 99 practices. While clinicians reported routinely advising about calorie restriction (88%) and increasing exercise (99.6%), over 40% of patients reported having not agreed a plan to manage their diabetes, discussed their goals or received advice about levels of physical activity.

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 (2012) Use of NICE-appraised medicines in the NHS in England - 2010 and 2011, Experimental Statistics

Description: This is the 3rd report published by the HSCIC on behalf of the DH to look at the variation in use of positively appraised medicines in relation to the expected use as predicted by NICE. In all, 52 medicines in 25 groups, relating to 35 technology appraisals were considered. Out of the 12 groups where a comparison could be made, observed use by the NHS in England was higher than the predicted use for 6 and lower for 6. For one drug group use was lower on one measure, and higher on another.

Not graded National

Health and Social Care Information Centre (2013) National Diabetes Audit 2010-11 - Report 2: Report into the Data Quality of Diabetes Structured Education

Description: This audit presents data on the provision and uptake of Structured Education in England and Wales for 2009?10 and 2010?11 for people included in the National Diabetes Audit and diagnosed in 2009. 8.42% of people with diabetes newly diagnosed in 2008?09 have a record of being offered Structured Education during 2009?2011, while 3.46% have a record of attending Structured Education. The audit was unable to conclude how much low uptake is due to poor recording and how much to genuine deficiencies.

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) Prescribing for Diabetes, England 2005-06 to 2012-13

Description: This publication reviews prescribing for diabetes for the period 2005/6-2012/13. The data covers prescriptions issued in primary care in England and dispensed in the community in the United Kingdom. Results found a 97% increase in items prescribed for the drug metformin from 8.6 million items in 2005/6 to 16.9 million items in 2012/13. In 2012/13 there was a 6.3 per cent growth in the number of items prescribed (1.0 million), compared with 8.9 per cent (1.3 million) in the previous year.

Not graded National

Twigg, M. J. et al (2013) An audit of prescribing for type 2 diabetes in primary care: optimising the role of the community pharmacist in the primary healthcare team Primary Health Care Research & Development. 2013 14 (3) PAGES 315-319

Description: This audit aimed to determine the adherence to prescribing guidelines for type 2 diabetes patients. Nine practices from NHS Norfolk participated, from which data for 194 patients were collected. Results found that all prescribing was within guidance for anti-hyperglycaemics. 87.4% of patients prescribed an anti-hypertensive were prescribed an angiotensin-converting enzyme inhibitor or equivalent. A large number of patients remain uncontrolled with respect to blood glucose or blood pressure.

Doubts about or mixed impact in practice Local

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: 01 August 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.