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National diabetes audit: Premature deaths are down but progress has stalled

The National Audit Office has released its new report on adult diabetes services in the NHS.

The National Audit Office has released its new report on adult diabetes services in the NHS. The report follows on from a 2012 evaluation, which highlighted a poor standard of care and led the Committee of Public Accounts to make seven recommendations for improvement. The current report has evaluated the progress made in achieving these recommendations.

The report concludes that significant improvement has been made in reducing the additional risk of death attributed to diabetes and its complications: from 44% in 2011 to 34% in 2013. Furthermore, the relative risks of developing a diabetes complication fell or remained stable for most complications, with the exception of minor amputations (below the ankle), the relative risk for which increased from 812% in 2011 to 827% in 2013.

However, the report also concludes that NHS performance in delivering the nine recommended care processes (HbA1c measurement, blood pressure measurement, cholesterol measurement, retinal screening, foot and leg checking, kidney function testing [urine], kidney function testing [blood], weight checking and smoking status checking) has stalled, with around 60% of adults with diabetes receiving all nine processes – no improvement over previous years. Furthermore, the proportion of patients achieving the three NICE treatment  standards to control blood glucose, blood pressure and cholesterol levels, which improved between 2009 and 2010, have not improved further since then.

Finally, the report concludes that there was significant variation in treatment standards, both for different patient groups and according to geographical location. For instance, compared with the general population, the relative risk of death was greatest in younger people, women and in those with type 1 diabetes. There was wide variation across clinical commissioning groups in terms of the proportion of patients receiving all nine care processes, with a rate of 70% in the best-performing groups but only 30% in the worst, and with the yearly excess risk of death ranging from 10% to 65%.

Commenting on the report, Amyas Morse, Head of the National Audit Office, said: “Our previous report on diabetes services showed that there was an improvement in delivering the key care processes that the NHS has identified as essential for diabetes patients. Data available since then shows that these improvements have been reflected in an uplift in long-term outcomes for these patients. However, the improvements in delivery of these key care processes have stalled, as today’s report shows, and this is likely to be reflected in a halt to outcomes improvement for diabetes patients.”

The report can be read in full here.

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