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Type 1 diabetes in adults: diagnosis and management [NG17]

Measuring the use of this guidance

Recommendation: 1.3.1

Offer all adults with type 1 diabetes a structured education programme of proven benefit, for example the DAFNE (dose-adjustment for normal eating) programme. Offer this programme 6–12 months after diagnosis. [new 2015]

What was measured: Proportion of people with type 1 diabetes offered structured education within one year of diagnosis.
Data collection end: March 2015
24.1%
Data collection end: March 2016
35%
Data collection end: March 2017
40.3%
Area covered: National
Source: NHS Digital. National Diabetes Audit.

What was measured: DM014: The percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register.
Data collection end: March 2015
66.27%
Data collection end: March 2016
71.1%
Data collection end: March 2017
69.6%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.


Recommendation: 1.3.2

If a structured education programme has not been undertaken by an adult with type 1 diabetes by 12 months after diagnosis, offer it at any time that is clinically appropriate and suitable for the person, regardless of duration of type 1 diabetes. [new 2015]

What was measured: Proportion of people with type 1 diabetes offered structured education (no time limit).
Data collection end: March 2015
41.1%
Data collection end: March 2016
49.8%
Data collection end: March 2017
50.8%
Area covered: National
Source: NHS Digital. National Diabetes Audit.


Recommendation: 1.6.1

Measure HbA1c levels every 3–6 months in adults with type 1 diabetes. [new 2015]

What was measured: Proportion of people with type 1 diabetes who had their HbA1c levels recorded in the previous year.
Data collection end: March 2015
83.2%
Data collection end: March 2016
83.7%
Data collection end: March 2017
84.3%
Area covered: National
Source: NHS Digital. National Diabetes Audit.


Recommendation: 1.6.6

Support adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise the risk of long‑term vascular complications. [new 2015]

What was measured: Proportion of people with type 1 diabetes who achieved an HbA1c target of 48mmol/mol or lower in the previous year.
Data collection end: March 2015
8.7%
Data collection end: March 2016
8.5%
Number that met the criteria: 13693 / 161335
Data collection end: March 2017
8.5%
Number that met the criteria: 15880 / 187665
Area covered: National
Source: NHS Digital. National Diabetes Audit.


Recommendation: 1.13.2

Assess cardiovascular risk factors annually, including: albuminuria smoking blood glucose control blood pressure full lipid profile (including HDL and LDL cholesterol and triglycerides) age family history of cardiovascular disease abdominal adiposity. [2004, amended 2015]

What was measured: Proportion of people aged 12 or over with type 1 diabetes who had their blood pressure checked within the last year.
Data collection end: March 2015
89%
Data collection end: March 2016
89.1%
Data collection end: March 2017
90.3%
Area covered: National
Source: NHS Digital. National Diabetes Audit.

What was measured: Proportion of people aged 12 or over with type 1 diabetes who had their cholesterol checked within the last year.
Data collection end: March 2015
78.7%
Data collection end: March 2016
79.1%
Data collection end: March 2017
79.9%
Area covered: National
Source: NHS Digital. National Diabetes Audit.

What was measured: Proportion of people aged 12 or over with type 1 diabetes who had their smoking status recorded in the last year.
Data collection end: March 2015
77.9%
Data collection end: March 2016
78.5%
Data collection end: March 2017
79.2%
Area covered: National
Source: NHS Digital. National Diabetes Audit.


Recommendation: 1.14.7

From the time of admission, the adult with type 1 diabetes and the team caring for him or her should receive, on a continuing basis, advice from a trained multidisciplinary team with expertise in diabetes.

What was measured: Proportion of people with diabetes who received a diabetic foot risk assessment within 24 hours of admission to hospital.
Data collection end: September 2015
35.8%
Area covered: England
Source: Health and Social Care Information Centre. National Diabetes Inpatient Audit.

What was measured: Proportion of diabetes inpatients who were visited by a member of the diabetes team.
Data collection end: September 2012
31.6%
Data collection end: September 2013
34.4%
Area covered: England
Source: Health and Social Care Information Centre. National Diabetes Inpatient Audit.

What was measured: Percentage of inpatients with type 1 diabetes seen by the diabetes team where it was deemed appropriate.
Data collection end: September 2015
78.3%
Data collection end: September 2016
82%
Data collection end: September 2017
78.5%
Area covered: England and Wales
Source: NHS Digital. National Diabetes Inpatient Audit.


Recommendation: 1.15.11

Ask all adults with type 1 diabetes with or without detected nephropathy to bring in the first urine sample of the day ('early morning urine') once a year. Send this for estimation of albumin:creatinine ratio. Estimation of urine albumin concentration alone is a poor alternative. Serum creatinine should be measured at the same time. [2004]

What was measured: Proportion of people aged over 12 with type 1 diabetes who had their serum creatinine checked within the last year.
Data collection end: March 2015
80.5%
Data collection end: March 2016
81.5%
Data collection end: March 2017
82.7%
Area covered: National
Source: NHS Digital. National Diabetes Audit.

What was measured: Proportion of people aged 12 or over with type 1 diabetes who had their urine albumin checked within the last year.
Data collection end: March 2015
55.9%
Data collection end: March 2016
50.2%
Data collection end: March 2017
50.1%
Area covered: National
Source: NHS Digital. National Diabetes Audit.


Recommendation: 1.15.14

Start angiotensin‑converting enzyme (ACE) inhibitors and, with the usual precautions, titrate to full dose in all adults with confirmed nephropathy (including those with moderately increased albuminuria ['microalbuminuria'] alone) and type 1 diabetes. [2004, amended 2015]

What was measured: DM006: The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with an ACE-I (or ARBs).
Data collection end: March 2015
81.24%
Data collection end: March 2016
80.85%
Data collection end: March 2017
80.29%
Area covered: National
Source: Health and Social Care Information Centre. Quality and Outcomes Framework.



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