Route to improving Type 1 diabetes mellitus glycaemic outcomes: real‐world evidence taken from the National Diabetes Audit

• Published in: Diabetic medicine 2018-01, Vol.35 (1), p.63-71
• Main Authors: Heald, A. H., Livingston, M., Fryer, A., Moreno, G. Y. C., Malipatil, N., Gadsby, R., Ollier, W., Lunt, M., Stedman, M., Young, R. J.
• Format: Article
• Language: English
• Subjects: Audits; Blood glucose; Blood Glucose - metabolism; Blood Glucose Self-Monitoring; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - metabolism; England; Glucose monitoring; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - therapeutic use; Insulin; Insulin - administration & dosage; Insulin - therapeutic use; Insulin Infusion Systems; Medical Audit; Practice Patterns, Physicians' - statistics & numerical data; Primary care; Primary Health Care; Quality Improvement; Treatment Outcome; Variation
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13541

Aim To use general practice‐level data for England, available through the National Diabetes Audit, and primary care prescribing data to identify prescription treatment factors associated with variations in achieved glucose control (HbA1c). Methods General practice‐level National Diabetes Audit data on Type 1 diabetes, including details of population characteristics, services, proportion of people achieving target glycaemic control [HbA1c ≤58 mmol/mol (7.5%)] and proportion of people at high glycaemic risk [HbA1c >86 mmol/ml (10%)], were linked to 2013–2016 primary care diabetes prescribing data on insulin types and blood glucose monitoring for all people with diabetes. Results A wide variation was found between the 10th percentile and the 90th percentile of general practices in both target glycaemic control (15.6% to 44.8%, respectively) and high glycaemic risk (4.8% to 28.6%, respectively). Our analysis suggests that, given the extrapolated total of 280 000 people with Type 1 diabetes in the UK, there may be the potential to increase the number of those within target glycaemic control from 80 000 to 101 000; 53% of this increase (11 000 people) would result from service improvements and 47% (10 000 people) from medication and technology changes. The same improvements would also provide the opportunity to reduce the number of people at high glycaemic risk from 42 000 to 26 500. A key factor associated with practice‐level target HbA1c achievement would be greater use of insulin pumps for up to an additional 56 000 people. Conclusion If the HbA1c achievement rates in service provision, medication and use of technology currently seen in practices in the 90th percentile were to be matched with regard to HbA1c achievement rates in all general practices, glycaemic control might be improved for 36 500 people, with all the attendant health benefits. What's new? Using publically available general practice‐level National Diabetes Audit and prescribing data for England, we examined achieved glycaemic control and prescribing patterns in Type 1 diabetes. A wide variation was found between the 10th percentile and 90th percentile of general practices in both proportion of people achieving target glycaemic control (15.6% to 44.8% of people) and those at high glycaemic risk (4.8% to 28.6% of people). Our model indicates that if all practices in the UK performed as well as the top decile in England, then, of the extrapolated 280 000 people with Type 1 diabetes, 21 000 would