Diabetes Audit 2017/18 Summary for Cambridgeshire and Peterborough CCG
The 2017/18 National Diabetes Audit for Cambridgeshire and Peterborough CCG reveals that 46,695 people are registered with diabetes in the region, with similar profiles to England. The audit shows disparities in diabetes registrations based on age and deprivation levels, and highlights improvements in care processes for both type 1 and type 2 diabetes patients in the area compared to England.
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2017/18 National Diabetes Audit 2017/18 National Diabetes Audit Cambridgeshire and Peterborough CCG local summary Public Health Intelligence, Cambridgeshire and Peterborough : April 2019 Version 1
Registrations Registrations Total registrations 100% of Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) GP practices participated in the audit (102). 46,695 people are registered as having diabetes in 2017/18. C&P CCG and England have a similar profile of registrations. 56% of type 1 diabetes patients, and 57% type 2, were male. 90% of people registered with type 1 diabetes, and 82% with type 2 diabetes were from a white ethnic group. The age profile for type 1 diabetes is younger than type 2 diabetes - 44% are under 40 years of age. 42% of type 2 diabetes patients are 40-64 years of age. Fewer diabetes registrations are recorded in more deprived areas overall. This is because Cambridgeshire has proportionally fewer areas that are categorised into the more deprived quintiles. Nationally, type 1 registrations are more evenly proportioned across the deprivation quintiles and type 2 registrations are higher in more deprived areas. Registrations by age; Registrations by deprivation (IMD)
Care Processes : type 1 diabetes Care Processes : type 1 diabetes 2017/18 type 1 C&P CCG is statistically significantly better than England for care process completion of all eight care processes. Each locality has shown improvement in 2017/18 for this indicator. Peterborough is statistically significantly worse than England for urine albumin and foot surveillance. C&P CCG has improved its completion of foot surveillance in 2017/18 to a level statistically similar to England. Type 1 diabetes - Care Process Completion (%), 2017/18 All eight care processes Blood Pressure Serum Creatinine Urine Albumin Foot HbA1c Cholesterol Surveillance BMI Smoking CCG locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 89.8 87.8 90.9 89.3 88.9 85.4 96.0 88.9 93.7 92.4 92.4 91.1 85.2 81.0 83.5 78.2 81.5 81.1 86.8 85.0 88.0 83.4 85.5 83.5 72.0 57.5 57.6 46.4 58.8 52.3 76.8 76.5 74.7 71.6 74.9 75.1 90.0 80.4 86.1 86.3 85.8 82.7 93.6 88.2 92.4 91.5 91.2 90.4 54.3 50.0 46.3 42.9 47.7 42.9 2016/17 type 1 Type 1 diabetes - Care Process Completion (%), 2016/17 All eight care processes Blood Pressure Serum Creatinine Urine Albumin Foot HbA1c Cholesterol Surveillance BMI Smoking CCG locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 88.8 88.6 90.8 89.1 88.7 84.9 93.9 92.5 92.4 90.9 92.1 90.6 80.5 85.8 84.1 80.2 81.7 80.8 85.7 88.1 87.6 83.2 85.9 83.3 68.0 58.2 55.9 53.3 59.4 51.0 71.4 75.4 69.0 58.4 67.9 70.1 84.0 76.9 84.8 84.3 82.7 75.8 78.4 82.8 80.7 82.7 80.7 79.8 40.2 36.9 37.3 36.4 37.7 34.4
Care Processes : type 2 diabetes Care Processes : type 2 diabetes 2017/18 type 2 C&P CCG is statistically significantly better than England for completion of many care processes. Despite some local improvement for some indicators, increases at a national level between 2016/17 and 2017/18 result in a red indicator locally. Foot surveillance continues to be statistically significantly worse than England for C&P CCG. Type 2 diabetes - Care Process Completion (%), 2017/18 All eight care processes Blood Pressure Serum Creatinine Urine Albumin Foot HbA1c Cholesterol Surveillance BMI Smoking CCG locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 95.7 96.9 96.5 95.0 95.9 95.3 96.3 97.6 97.2 96.0 96.7 96.3 92.0 93.7 93.7 92.3 92.9 92.9 95.5 96.5 97.1 95.6 96.2 95.1 71.8 70.4 62.6 69.6 68.7 66.2 83.7 88.2 86.0 83.7 85.1 86.8 89.7 88.3 91.8 90.1 90.0 88.0 95.2 95.4 94.9 96.1 95.5 95.5 62.5 63.4 55.4 62.1 61.0 58.8 2016/17 type 2 Type 2 diabetes - Care Process Completion (%), 2016/17 All eight care processes Blood Pressure Serum Creatinine Urine Albumin Foot HbA1c Cholesterol Surveillance BMI Smoking CCG locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 96.0 96.5 97.0 94.8 96.0 95.3 96.6 97.4 97.3 96.2 96.8 96.4 92.9 94.4 94.4 93.1 93.6 93.1 95.5 96.6 97.0 95.5 96.1 95.1 72.9 72.8 66.4 71.5 70.9 65.6 74.1 77.0 67.9 66.0 70.4 79.4 87.5 82.6 91.0 89.4 88.0 83.3 86.9 88.4 87.8 91.3 88.8 85.7 51.4 48.3 42.0 47.5 47.3 47.7
Treatment Targets: type 1 diabetes Treatment Targets: type 1 diabetes 2017/18 type 1 C&P CCG is statistically significantly better than England for treatment target achievement of HbA1c ( 58mmol/mol and 86mmol/mol) C&P CCG is statistically significantly worse than England for treatment target achievement of blood pressure and cholesterol (<4mmol/L) Peterborough is statistically significantly worse than England for blood pressure. Cambridge is statisticallysignificantly better than England for every treatment target. Type 1 diabetes - Treatment Target Achievement (%), 2017/18 HbA1c < 48 mmol/mol (6.5%) HbA1c <= 58 mmol/mol (7.5%) HbA1c <= 86 mmol/mol (10.0%) Blood Pressure <= 140/80 All three treatment targets Cholesterol < 4 mmol/L Cholesterol < 5 mmol/L CCG Locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 13.0 14.6 10.8 12.1 8.7 8.1 39.1 34.3 29.1 28.6 32.4 29.9 89.5 85.4 84.5 81.9 85.6 84.2 66.5 73.5 72.1 68.6 70.3 74.8 27.7 25.8 29.5 30.5 26.9 29.9 69.0 63.7 68.9 72.0 68.6 70.3 24.2 22.8 17.4 19.9 18.7 18.6 2016/17 type 1 Type 1 diabetes - Treatment Target Achievement (%), 2016/17 HbA1c < 48 mmol/mol (6.5%) HbA1c <= 58 mmol/mol (7.5%) HbA1c <= 86 mmol/mol (10.0%) Blood Pressure <= 140/80 All three treatment targets Cholesterol < 4 mmol/L Cholesterol < 5 mmol/L CCG Locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 14.8 13.6 11.5 13.3 8.5 8.5 38.1 31.1 28.8 27.6 31.5 30.4 88.3 87.1 82.0 80.6 85.5 84.8 67.3 79.8 70.9 76.0 72.3 76.0 25.8 22.6 29.2 31.0 25.3 28.7 65.1 62.6 70.0 73.4 66.7 69.4 23.4 20.2 18.5 21.0 18.1 19.0 Meeting all three treatment targets' is achieved where a patient has HbA1c 58mmol/mol, cholesterol <5mmol/L and blood pressure 140/80.
Treatment Targets: type 2 diabetes Treatment Targets: type 2 diabetes 2017/18 type 2 C&P CCG, and each locality, continues to be statistically significantly worse than England for most treatment targets. Numerically, there has been an increase in some HbA1c and cholesterol indicators for the C&P CCG between 2016/17 and 2017/18. Cambridge is statistically significantly better than England for two HbA1c treatment targets. Type 2 diabetes - Treatment Target Achievement (%), 2017/18 HbA1c < 48 mmol/mol (6.5%) HbA1c <= 58 mmol/mol (7.5%) HbA1c <= 86 mmol/mol (10.0%) Blood Pressure <= 140/80 All three treatment targets Cholesterol < 4 mmol/L Cholesterol < 5 mmol/L CCG Locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 27.8 26.2 25.2 26.9 26.6 29.0 66.8 62.2 62.3 63.8 63.9 65.8 94.3 92.0 93.1 92.0 92.9 93.1 70.2 68.4 71.4 64.6 68.4 73.8 39.2 34.4 39.9 42.1 39.3 42.3 74.9 72.2 74.5 75.3 74.3 76.6 38.2 33.8 35.3 34.1 35.3 40.1 2016/17 type 2 Type 2 diabetes - Treatment Target Achievement (%), 2016/17 HbA1c < 48 mmol/mol (6.5%) HbA1c <= 58 mmol/mol (7.5%) HbA1c <= 86 mmol/mol (10.0%) Blood Pressure <= 140/80 All three treatment targets Cholesterol < 4 mmol/L Cholesterol < 5 mmol/L CCG Locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 28.2 27.1 26.3 26.7 27.0 30.6 67.4 63.5 62.4 61.9 63.7 67.0 94.0 92.9 92.8 91.7 92.8 93.3 69.1 70.1 72.4 65.6 69.0 74.4 36.3 32.4 38.4 42.2 38.1 41.3 72.2 70.9 73.7 76.1 73.6 76.2 37.5 34.4 35.4 34.2 35.3 41.1 Meeting all three treatment targets' is achieved where a patient has HbA1c 58mmol/mol, cholesterol <5mmol/L and blood pressure 140/80.
Treatment Targets : new for 2017/18 Treatment Targets : new for 2017/18 2017/18 type 1 New treatment targets have been introduced into the NDA. For patients of type 1 diabetes, Primary prevention and Combined prevention are statistically significantly worse for C&P CCG and Huntingdon. For patients of type 2 diabetes, the NEW treatment targets are almost all statistically significantly worse than the national average for C&P CCG and all the CCG localities. Type 1 diabetes - Treatment Target Achievement - NEW (%), 2017/18 Secondary Prevention - On Statins with CVD History Meeting All three treatment targets NEW Primary prevention - On Statins without CVD History Combined - On Statins CCG Locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 61.8% 59.0% 62.3% 61.5% 61.6% 65.4% 93.5% 89.5% 89.5% 85.3% 86.8% 85.3% 66.9% 62.8% 66.7% 67.5% 65.9% 68.9% 23.7% 20.0% 16.7% 20.2% 18.7% 18.9% 2017/18 type 2 'Meeting all three treatment targets NEW' refers to the new treatment targets that have been introduced in 2017-18: 1. Primary prevention of cardiovascular disease (CVD): The percentage of people with diabetes aged 40 to 80 years with no history of heart disease that received statins during the audit period. 2. Secondary prevention of CVD: The percentage of people with diabetes (any age) with a history of heart disease that received statins during the audit period. 3. Combined prevention of CVD: The percentage of people with diabetes that fall into either of the primary or secondary prevention groups that received statins during the audit period. The 'Meeting all three treatment targets NEW' in this report is achieved where a person has an HbA1c value 58mmol/mol, blood pressure 140/80 and, for people who fall into the combined prevention of CVD group, is receiving statins. If a person does not fall into the combined prevention of CVD group, 'All three treatment targets' is defined as HbA1c and blood pressure only. For patients under 12 years of age 'All three treatment targets' is defined as HbA1c only, as other treatment targets are not recommended in the NICE guidelines for this age group. Type 2 diabetes - Treatment Target Achievement - NEW (%), 2017/18 Secondary Prevention - On Statins with CVD History Meeting All three treatment targets NEW Primary prevention - On Statins without CVD History Combined - On Statins CCG Locality Cambridge Huntingdon Isle of Ely/Wisbech Peterborough C&P CCG England 69.0% 65.4% 68.6% 69.0% 68.2% 72.2% 86.1% 84.6% 85.1% 86.1% 85.6% 86.7% 73.4% 70.6% 73.3% 73.2% 72.8% 76.1% 38.5% 33.4% 35.4% 33.4% 35.2% 40.2%
Education Education Type 1 diabetes - education for new registrations C&P CCG and England have a similar profile of education for newly diagnosed diabetes patients. In C&P CCG in 2016, 32% of type 1 newly registered diabetes patients were offered an education programme within 12 months of diagnosis. 9% of type 1 patients attended a course within 12 months of diagnosis. In C&P CCG in 2016, 74% of type 2 newly registered diabetes patients were offered an education programme within 12 months of diagnosis. 9% of type 2 patients attended a course within 12 months of diagnosis. Substantially more type 2 patients are offered an education programme within 12 months of diagnosis than type 1 patients, locally and nationally. Attendance of educational courses is low, locally and nationally. There is improvement between 2015 and 2016 for all indicators. Type 2 diabetes education for new registrations
Useful links Useful links National Diabetes Audit information https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit Full set of the data included in this report: NDA 2017-18 Interactive report for England, 8th November 2018 https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-audit/report-1- care-processes-and-treatment-targets-2017-18-short-report Previous Cambridgeshire and Peterborough CCG summaries: https://cambridgeshireinsight.org.uk/health/topics/diabetes/ For further information on this report please contact Public Health Intelligence, Cambridgeshire County Council & Peterborough City Council CCCPublicHealthIntelligenceTeam@cambridgeshire.gov.uk
