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Type 2 diabetes: the management of type 2 diabetes [CG87]

Measuring the use of this guidance

Recommendation: 1.3.4

Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. This should include measurement of total cholesterol, HDL cholesterol, non‑HDL cholesterol and triglyceride concentrations. A fasting sample is not needed.

What was measured: Patients who had total cholesterol checked in the last 12 months
Data collection end: December 2010
93.4%
Number that met the criteria: / 1033
Area covered: National
Source: Stone MA et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guidelines Adherence to Enhance Care (GUIDANCE) Study. Diabetes Care. Vol 36,pp 2628-2638

What was measured: Patients who had HDL checked in the last 12 months
Data collection end: December 2010
77.1%
Number that met the criteria: / 1033
Area covered: National
Source: Stone MA et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guidelines Adherence to Enhance Care (GUIDANCE) Study. Diabetes Care. Vol 36,pp 2628-2638

What was measured: Patients who had total cholesterol checked in the last 12 months
Data collection end: March 2010
93.2%
Data collection end: March 2011
93.1%
Data collection end: March 2012
92.4%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.


Recommendation: 1.8.1

Measure blood pressure at least annually in a person without previously diagnosed hypertension or renal disease. Offer and reinforce preventive lifestyle advice

What was measured: Patients who had their bloood pressure checked within the last year
Data collection end: March 2010
96.1%
Data collection end: March 2011
95.9%
Data collection end: March 2012
95.8%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.


Recommendation: 1.8.5

Add medications if lifestyle advice does not reduce blood pressure to below 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage).

What was measured: Patients with T2DM who have BP below ‘target’ BP (see notes)
Data collection end: March 2010
34%
Data collection end: March 2011
35%
Data collection end: March 2012
37.7%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.


Recommendation: 1.10.1.1

Review cardiovascular risk status annually by assessment of cardiovascular risk factors, including features of the metabolic syndrome and waist circumference, and change in personal or family cardiovascular history.

What was measured: Patients who had waist circumference checked in the last 12 months
Data collection end: December 2010
11.2%
Number that met the criteria: / 1033
Area covered: National
Source: Stone MA et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guidelines Adherence to Enhance Care (GUIDANCE) Study. Diabetes Care. Vol 36,pp 2628-2638


Recommendation: 1.10.1.6

Consider intensifying cholesterol-lowering therapy (with a more effective statin or ezetimibe in line with NICE guidance)[8] if there is existing or newly diagnosed cardiovascular disease, or if there is an increased albumin excretion rate, to achieve a total cholesterol level below 4.0 mmol/litre (and HDL cholesterol not exceeding 1.4 mmol/litre) or an LDL cholesterol level below 2.0 mmol/litre.

What was measured: Patients with T2DM who have a total cholesterol <4.0
Data collection end: December 2010
45.5%
Number that met the criteria: / 1033
Area covered: National
Source: Stone MA et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guidelines Adherence to Enhance Care (GUIDANCE) Study. Diabetes Care. Vol 36,pp 2628-2638


Recommendation: 1.12.1

Ask all people with or without detected nephropathy to bring in a first-pass morning urine specimen once a year. In the absence of proteinuria/urinary tract infection (UTI), send this for laboratory estimation of albumin:creatinine ratio. Request a specimen on a subsequent visit if UTI prevents analysis.

What was measured: Patients who had urine checked for microalbuminuria in the last 12 months
Data collection end: December 2010
76.1%
Number that met the criteria: / 1033
Area covered: National
Source: Stone MA et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guidelines Adherence to Enhance Care (GUIDANCE) Study. Diabetes Care. Vol 36,pp 2628-2638


Recommendation: 1.12.3

Measure serum creatinine and estimate the glomerular filtration rate (using the method-abbreviated modification of diet in renal disease [MDRD] four-variable equation) annually at the time of albumin:creatinine ratio estimation

What was measured: Patients with type 2 diabetes who had their creatinine checked in the last 12 months
Data collection end: March 2010
93.9%
Data collection end: March 2011
93.8%
Data collection end: March 2012
93.8%
Area covered: National
Source: Health and Social Care Information Centre. National Diabetes Audit.


Recommendation: 1.13.1

Arrange or perform eye screening at or around the time of diagnosis. Arrange repeat of structured eye surveillance annually

What was measured: Patients who had their eyes checked in the last 12 months
Data collection end: December 2010
88.6%
Number that met the criteria: / 1033
Area covered: National
Source: Stone MA et al (2013) Quality of Care of People with Type 2 Diabetes in Eight European Countries: Findings from the Guidelines Adherence to Enhance Care (GUIDANCE) Study. Diabetes Care. Vol 36,pp 2628-2638



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