The latest report from the National Diabetes Audit has found significant declines in all nine recommended care processes since before the COVID-19 pandemic.
In England, only a fifth (21%) of patients with type 2 diabetes received all nine care processes, including digital retinal screening, in 2020-2021, compared with more than half (52%) the previous year.
In Wales, where data for retinal screening are not reported, only 21% of patients received eight care processes, down from 43% in the year before the pandemic.
The greatest impact was on processes that required face-to-face appointments: foot examination, weight measurement, and retinal screening.
Of all the recommended care processes, urine albumin ratio (UACR) checks remain lowest, as they have been since 2015-16. While more than 90% of patients with type 2 diabetes in England had serum creatinine checked in 2019-20, falling to 86% in 2020-21, only 53% had their ACR checked in 2020-21. In Wales this figure dropped to 40% during the pandemic.
Other key findings include:
- During the COVID-19 pandemic, glucose control improved in people with type 1 diabetes but deteriorated in those with type 2 and other types of diabetes; blood pressure deteriorated in all; and use of statins was relatively unchanged.
- 2% of those with type 1 diabetes and 5.3% with type 2 or other types of diabetes have severe frailty.
- 65,970 people with type 2 diabetes have both severe frailty and HbA1c ≤53 mmol/mol.
- 18,690 people with diabetes with severe frailty and HbA1c ≤53mmol/mol are on insulin or sulfonylurea or both.
The NDA has called on all practices to identify this ‘small number’ of people and consider de-intensification of glucose-lowering treatment. Providers – including general practice – should also work towards restoring annual reviews, and work with patients to help them achieve individualised targets for blood glucose and blood pressure control.
| TABLE. PERCENTAGE OF PATIENTS WITH TYPE 2 DIABETES RECEIVING NICE-RECOMMENDED CARE PROCESSES |
| - |
England (%) |
- |
Wales (%) |
| Care process |
2019-20 |
2020-21 |
2019-20 |
2020-21 |
| HbA1c |
93.5 |
86.2 |
91.3 |
80.7 |
| Blood pressure |
95.4 |
82.6 |
91.1 |
73.9 |
| Serum cholesterol |
91.0 |
79.3 |
82.9 |
69.7 |
| Serum creatinine |
92.3 |
85.7 |
92.1 |
82.3 |
| UACR |
68.6 |
52.7 |
55.0 |
40.1 |
| Foot surveillance |
83.9 |
59.4 |
68.6 |
38.9 |
| BMI |
88.3 |
72.8 |
79.4 |
62.1 |
| Smoking history |
95.4 |
89.5 |
89.3 |
78.7 |
| Retinal screening |
80.4 |
49.5 |
– |
– |
| 8 care processes* |
58.5 |
36.9 |
42.6 |
21.4 |
| 9 care processes* |
52.2 |
21.2 |
– |
– |
UACR, urinary albumin: creatinine ratio; BMI, body mass index.
*Nine care processes include retinal screening data which are not provided for Wales
