The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales. It measures the effectiveness of diabetes healthcare against National Institute for Health and Care Excellence (NICE) Clinical Guidelines and NICE Quality Standards. This NICE guidance is based on evidence that regular systematic review of people with diabetes and achievement of glucose, blood pressure and cardiovascular risk standards maintains health and reduces long term complications.

It was estimated that as of 2022 around 24.4 million people in the United States had been diagnosed with diabetes. The number of people diagnosed with diabetes in the U.S. has increased in recent years and the disease is now a major health issue. Diabetes is now the eighth leading cause of death in the United States, accounting for three percent of all deaths.

What is prediabetes? A person is considered to have prediabetes if their blood sugar levels are higher than normal but not high enough to be diagnosed with type 2 diabetes. As of 2021, it was estimated that around 53 million men and 44 million women in the United States had prediabetes. However, according to the CDC, around 80 percent of these people do not know they have this condition. Not only does prediabetes increase the risk of developing type 2 diabetes, but also increases the risk of heart disease and stroke. The states with the highest share of adults who had ever been told they have prediabetes are Hawaii, California, and Alaska.

The prevalence of diabetes in the United States As of 2022, around 8.4 percent of adults in the United States had been diagnosed with diabetes, an increase from six percent in the year 2000. Diabetes is much more common among older adults, with almost a quarter of those aged 65 years and older diagnosed with diabetes, compared to just three percent of those aged 18 to 44 years. The states with the highest prevalence of diabetes among adults are Alabama, Mississippi, and West Virginia, while Colorado and Alaska report the lowest rates. In Alabama, around 17 percent of adults have been diagnosed with diabetes.

The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales. It measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. This is the Type 1 Diabetes report. It details the findings and recommendations relating to diabetes care process completion, treatment target achievement and structured education for people with type 1 diabetes. The 2019-20 audit covers the period 01 January 2019 to 31 March 2020. This is the first NDA report dedicated to people with type 1 diabetes. A new diagnosis validation process, which considers medication as well as recorded diagnosis, has been introduced to try to ensure that only people with true type 1 diabetes are included (see appendix). Results are to be taken in the context of low data submission from specialist services, possibly hampered due to COVID-19.

The National Diabetes Register was introduced in 2016 by the amendment of Act No. 372/2011 Coll. , on health services and conditions of their provision (Act on Health Services), by Act No. 147/2016 Coll. with effect from 1 July 2016.

It is a new type of register that uses as much as possible already existing data in the healthcare sector, namely the data of the National Register of Reimbursed Health Services (NRHZS), i.e. the administrative data of health insurance companies supplemented by data from laboratories that already exist in their information systems and data collection from nursing staff physicians involved in a referral network of providers or in planned observational studies.

Risk and prognostic factors of the disease, data related to the disease and its treatment, personal and family history of the patient related to the disease, including classification of the type and state of diabetes and laboratory values, provision of dispensary care are processed in the register; data needed to identify the provider diagnosing, treating and providing dispensary care.

The basic statistical unit of the record in the register is the record of diabetes.

The register provides an overview of a population-relevant disease from the point of view of epidemiology, treatment and control of diabetes at a hitherto inaccessible detailed level with minimal effort, as it is mostly the use of already existing data.

Mandatory duties and irreplaceable functions of the register:

• Monitoring the epidemiology of diabetes and its treatment as a socially extremely serious disease affecting a significant part of the population
• Monitoring the quality and outcomes of diabetes care
• Data reporting for EUROSTAT, WHO, OECD databases

The National Diabetes Insulin Pump Audit is part of the National Diabetes Audit (NDA).

The National Diabetes Insulin Pump Audit collects information on the number and characteristics of people with Type 1 diabetes using an insulin pump, the reasons for going on an insulin pump and the outcomes achieved since starting on the pump.

Making clinical audit data transparent

In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme.

What information is being made available?

National Diabetes Insulin Pump Audit data for 2016-17 is available at England and Wales, Local Health Board (LHB) and Specialist Diabetes Service level for:

• Participation
• Patient demographics
• Prevalence
• Care process completion
• Treatment targets
• Diabetes characteristics

Using and interpreting the data

Data from the National Diabetes Insulin Pump Audit should not be looked at in isolation when assessing standards of care.

Accessing the data

The data are being made available on the data.gov website. Local Health Boards and Specialist Diabetes Services are identified by organisation code.

What does the data cover?

The audit looks at the following areas:

• Reason for starting on an insulin pump
• Care processes
• Treatment targets
• Structured Education

What period does the data cover?

This data covers the top level findings from the 2016-17 National Diabetes Insulin Pump Audit for the period 1 January 2016 to 31 March 2017. This National Report was published on 14 June 2018.

The worksheets include data for all ICBs and GP practices in England within the November 2024 extraction of NDA data (April to September 2024 data). These data undergo further validation processes at the end of each audit year when data from specialist services are added in, at which point the data are considered to comprise the full annual dataset to be used in the annual NDA publications. Data for Local Health Boards (LHBs) in Wales and specialist diabetes services in England are not included in the quarterly publications. Their 2024-25 data (for the full audit period April 2024 to March 2025) will be extracted as part of the final NDA 2024-25 collection and reported in the NDA 2024-25 full audit period data release, scheduled for late 2025. Disclosure control has been applied to mitigate the risk of patient identification. Zeros are reported, and all numbers are rounded to the nearest 5, unless the number is 1 to 7, in which case it is rounded to ‘5’. This allows for more granular data to be made available, and also for data for all GP practices to be made available. Percentages where the denominator is less than or equal to 20 are not reliable and have therefore not been calculated in this release.

The National Diabetes Audit (NDA) provides a comprehensive view of diabetes care in England and Wales and measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards. Making clinical audit data transparent In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme. What information is being made available? National Diabetes Audit data for 2016-17 is available at England and Wales, Clinical Commissioning Group (CCG), Local Health Board (LHB), English GP practice and Specialist Diabetes Service level for: Participation Patient demographics Diabetes characteristics Structured Education offers These data do not list individual patient information nor do they contain any patient identifiable data. Using and interpreting the data Data from the National Diabetes Audit should not be looked at in isolation when assessing standards of care. Accessing the data The data are being made available on the data.gov website. GP practices and CCGs/LHBs are identified by organisation code. What does the data cover? The audit looks at the following areas: Care processes Treatment targets Structured Education What period does the data cover? This data covers the top level findings from the 2016-17 National Diabetes Audit for the period 1 January 2016 to 31 March 2017. This National Report was published on 10 November 2017.

The National Diabetes Insulin Pump Audit is part of the National Diabetes Audit (NDA). This report provides information on people with Type 1 diabetes on an insulin pump at National, Local Health Board (LHB), and Specialist Diabetes Service level for the audit period 2017-18. Analysis performed on the Type 1 Specialist Diabetes Insulin Pump Services Structures Survey (2018) is included in this publication. This was the first time this survey had been conducted.

According to the data from January 2023, 12 percent of respondents said that rising health care costs were the most important health issue facing the United States. While COVID-19 and cancer each with 11 percent ranked second on the list. Health issues like alcoholism, stroke, and rare diseases were considered important issues by only one percent of respondents.

Issues with healthcare costs

Currently, the most urgent problem facing American healthcare is the high costs of care. The high expense of healthcare may deter people from getting the appropriate treatment when they need medical care or cause them to completely forego preventative care visits. Many Americans reported that they may skip prescription doses or refrain from taking medication as prescribed due to financial concerns. Such health-related behavior can result in major health problems, which may raise the long-term cost of care. Inflation, medical debt, and unforeseen medical expenses have all added to the burden that health costs are placing on household income.

Gun violence issue

The gun violence epidemic has plagued the United States over the past few years, yet very little has been done to address the issue. In recent years, gun violence has become the leading cause of death among American children and teens. By early May 2023, the U.S. has witnessed more than 200 mass shootings, the surge in the frequency of firearm attacks is alarming. Even though more than half of Americans are in favor of tougher gun control regulations, there is little political will to strongly reform the current gun law. Gun violence has a deep traumatic impact on survivors and society, it is developing into a major public health crisis in the United States.

The information available from this webpage comes from the National Diabetes Audit - Diabetes Prevention Programme report.

The NHS Diabetes Prevention Programme (NHS DPP) is a joint commitment from NHS England, Public Health England and Diabetes UK to deliver, at scale, evidence based behavioural interventions that can prevent or delay the onset of Type 2 diabetes in adults who have been identified as having non-diabetic hyperglycaemia.

This report uses data collected alongside the National Diabetes Audit (NDA) for the period January 2017 to March 2018 inclusive.

This report is for England only. Unlike the NDA, it does not include information on Wales.

Making clinical audit data transparent

In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme.

What information is being made available?

National Diabetes Audit - Diabetes Prevention Programme data for 2017-18 is available at England, Clinical Commissioning Group (CCG) and GP practice-level for:

• Patient list size
• Patient demographics
• Diabetes characteristics
• Diabetes Prevention Programme take-up

These data do not list individual patient information nor do they contain any patient identifiable data.

Using and interpreting the data

Data from the National Diabetes Audit - Diabetes Prevention Programme should not be looked at in isolation when assessing standards of care.

Accessing the data

The data are being made available on the data.gov website. Each year a data file from the National Diabetes Audit - Diabetes Prevention Programme will be made available in CSV format. Hospitals are identified by name and their national code.

What does the data cover?

The audit looks at the following areas:

• Registrations and prevalence
• Offers of DPP
• Demographics

What period does the data cover?

This report covers data collected alongside the National Diabetes Audit (NDA) for the period January 2017 to March 2018 inclusive. The audit report was published on 11 July 2019.

This is an overview of the treatment and demographics of 227,435 adults with type 1 diabetes. From 2019 to 2022 glucose control in people with type 1 diabetes in England and Wales improved while blood pressure control deteriorated. Use of diabetes technology (wearable glucose monitoring devices in England and insulin pumps in England and Wales) was associated with lower glucose levels. Diabetes technology was used less by those in the most deprived groups and in ethnic minorities. 30% of people with type 1 diabetes did not attend specialist care in 2021-22 and were less likely to receive annual checks or achieve treatment targets as recommended by the National Institute for Health and Care Excellence (NICE).

The information available from this webpage comes from the National Diabetes Inpatient Safety Audit (NDISA). The NDISA measures the frequency of avoidable diabetic harms. The NDISA audit is part of the National Diabetes Audit (NDA) programme commissioned by the Healthcare Quality Improvement Partnership (HQIP) and managed by NHS England, in collaboration with Diabetes UK. Making clinical audit data transparent In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme (NCAPOP). What information is being made available? NDISA data for 2018-2021 covers the provision of inpatient services in England and Wales and diabetes-specific inpatient harms in England. These data do not list individual patient information nor do they contain any patient identifiable data. Using and interpreting the data Data from NDISA should not be looked at in isolation when assessing standards of care. Accessing the data The data are being made available on the data.gov website. For each NDISA report, a data file will be made available in CSV format. What period does the data cover? The NDISA 2018-2021 report covers: the provision of inpatient services in England and Wales on 1 October 2021; and diabetes-specific inpatient harms in England between May 2018 and October 2021. The report was published on 14 July 2022.

The National Diabetes Audit (NDA) is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP) which is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and funded by NHS England. The NDA is managed by NHS Digital in partnership with Diabetes UK. The NDA measures the effectiveness of diabetes healthcare against NICE Clinical Guidelines and NICE Quality Standards, in England and Wales. The NDA collects and analyses data for use by a range of stakeholders to drive changes and improvements in the quality of services and health outcomes for people with diabetes. This report details the findings for the 2017-18 audit. The audit collected data during May and June 2018, for the period 01 January 2017 to 31 March 2018 and contains the full key findings, recommendations and new analysis relating to cardiovascular disease (CVD) risk, including new treatment targets showing statin prescriptions for CVD risk reduction. This report follows the NDA short report publication in November 2018, which provided the top level findings for the 2017-18 audit, along with local level data made available to services in a timely manner that can help drive improvements in the quality of diabetes care locally.

The information available from this webpage comes from the National Diabetes Inpatient Audit. The National Diabetes Inpatient Audit is a snapshot audit of diabetes inpatient care.

During September and October 2018, hospitals across England and Wales collected data on the characteristics of the hospital, including participation, staffing levels and care improvement initiatives.

2018 was a designated NaDIA Quality Improvement Collaborative (QIC) year. To reduce the burden on QIC participants, the NaDIA 2018 collection undertook the Hospital Characteristics (HC) survey only.

Making clinical audit data transparent

In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme.

What information is being made available?

National Diabetes Inpatient Audit data for 2018 is available at hospital site level for:

• Audit participation
• Measures of staffing levels and care improvement initiatives.

These data do not list individual patient information nor do they contain any patient identifiable data.

Using and interpreting the data

Data from the National Diabetes Inpatient Audit should not be looked at in isolation when assessing standards of care.

Accessing the data

The data are being made available on the data.gov website. Each year a data file from the National Diabetes Inpatient Audit will be made available in CSV format. Hospitals are identified by name and their national code.

What does the data cover?

The audit looks at the following areas: * Participation in the audit * Inpatient staffing levels * Take-up of care improvement initiatives

What period does the data cover?

This report covers hospital characteristics during September and October 2018. The audit report was published on 9 May 2019. Historic data is available for previous audit years (2010-2013, 2015-2017) where survey questions were comparable.

Local reports - breakdown of report 1 (Care Processes and Treatment Targets) and report 2 (Complications and Mortality) by PCT in the West Midlands SHA. In addition to the National reports, the NDA has also produced PCT/LHB profile reports which present key PCT/LHB findings from the 2010-2011 audit for all age groups. The data used to produce the reports is extracted from GP practices in your PCT/LHB and is augmented by secondary care outpatient data and Hospital Episode Statistics and Patient Episode Data for Wales on diabetes related complications. The data is validated, processed and analysed to measure compliance with the National Service Framework (NSF) for Diabetes and NICE quality standards. The analysis contained in the PCT/LHB profile report is benchmarked against the national findings and provides some time trend analysis, allowing you to compare care and treatment results to findings from the 2009-2010 audit. For further information and recommended actions for commissioners please refer to the National Diabetes Audit 2010-2011 Report 1: Care Processes and Treatment Targets and National Diabetes Audit 2010-2011 Report 2: Complications and Mortality Note: NDA 2010-11- Reports Updated: The treatment target section of these reports were updated on 28/09/2012, an error in the data processing rule for HbA1c meant that patients who had their HbA1c values submitted as a percentage had not been included in the reports leading to a misreporting of HbA1c and treatment target bundle completion. This has now been corrected. No other figures were affected. Note: 2010-11 Report 1 PCT breakdowns were published on 28 September 2012.

NaDIA-Harms is a mandatory year-round collection of four harms that can occur to diabetic inpatients in Acute hospitals in England. The objective of NaDIA Harms is to help reduce the rates of serious inpatient harms by collecting and providing case mix adjusted benchmarked feedback to hospital trusts to inform quality improvement work. Making clinical audit data transparent In his transparency and open data letter to Cabinet Ministers on 7 July 2011, the Prime Minister made a commitment to make clinical audit data available from the national audits within the National Clinical Audit and Patient Outcomes Programme. What information is being made available? National Diabetes Inpatient Audit – Harms data for 2019 is available at national level for: Audit participation The number of harms Patient profiles and at NHS trust level for: Audit participation These data do not list individual patient information nor do they contain any patient identifiable data. Using and interpreting the data Data from the National Diabetes Inpatient Audit – Harms should not be looked at in isolation when assessing standards of care. Accessing the data The data are being made available on the data.gov website. Each year a data file from the National Diabetes Inpatient Audit - Harms will be made available in CSV format. What period does the data cover? The report covers impatient harms between May 2018 and October 2019. The audit report was published on 13 November 2020.

Type II diabetes mellitus prevalence by fiscal year (from 2015 to each subsequent year) by sex and age group.

Comparison of final diabetes status from prevalence algorithms in UK Biobank versus diabetes diagnoses in secondary care data at baseline.

The National Pregnancy in Diabetes Audit (NPID) is a workstream of the National Diabetes Audit (NDA) and is managed by NHS Digital under an agreement with the Healthcare Quality Improvement Partnership (HQIP) on behalf of NHS England and the Welsh Government. The NDA is delivered by NHS Digital, in partnership with Diabetes UK and the National Cardiovascular Intelligence Network (part of Public Health England). The audit is a measurement system to support improvement in the quality of care for women with diabetes who are pregnant or planning pregnancy and seeks to address three key questions: Were women with diabetes adequately prepared for pregnancy? Were adverse maternal outcomes during pregnancy minimised? Were adverse fetal/infant outcomes minimised? NPID is the largest continuous audit of pregnancy in women with diabetes in the world (more than 4,400 pregnancies in 2018). This has allowed a depth of analysis not previously possible, including the development of locally relevant standardised ratios for key outcomes.