The National Diabetes Audit (NDA) continues to provide 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, in England and Wales. This national report presents the key findings and recommendations on care processes and treatment target achievement rates from 2013-2015 in all age groups in England and Wales along with information on offers and attendance for structured education places. To provide users with more timely information the National Diabetes Audit undertook two rounds of collection in 2015. Data were collected for the audit period January 2013 to March 2014 and January 2014 to March 2015. Both audit years are presented in this report. The report has also been revamped this year, we hope that this is a welcomed change and value your feedback on the new style. The main report contains information on the national key findings and recommendations. The main report has also been developed as a power point presentation, along with slides highlighting the national findings there is also space to allow the incorporation of locally produced slides, we hope that users will find this beneficial to help disseminate the results of the audit locally. Supplementary data for England and Wales are contained in the excel spreadsheets. There are 4 excel spreadsheets, one spreadsheet contains the tables and charts in the report along with some supplementary national figures. There are also 3 interactive excel spreadsheets which allow users to select the GP practice (England only), Local Health Board (Wales only) or Secondary Care Service (England only) of choice, information for the chosen site is then displayed in tables and charts. The interactive excel spreadsheets replace the pdf reports published for Clinical Commissioning Groups and Local Health Boards in previous publications. Please note that the interactive excel spreadsheets are large files (approximately 12MB) and may take some time to open. For the first time this year the National Diabetes Audit will also be reporting on the number of patients on insulin pumps, this will be reported in the Spring of 2016. The National Diabetes Audit also reports on the complications of diabetes and mortality, this will be published in Report 2 later in the year.

What information is being made available? Trust, service, and clinical commissioning group (CCG) audit participation and data completeness for the key fields 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. The National Diabetes Foot Care Audit (NDFA) is a continuous audit of diabetic foot disease in England and Wales. The audit enables all diabetes foot care services to measure their performance against NICE clinical guidelines and peer units, and to monitor adverse outcomes for people with diabetes who develop diabetic foot disease. Measures about the process of care given to patients Information about care outcomes and treatment. 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 Foot Care 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 Foot Care Audit will be made available in CSV format. Trusts, CCGs and Networks are identified by name and their national code. Foot care services are identified by name and locally derived code. What does the data cover? The audit looks at the following areas: Structures: are the nationally recommended care structures in place for the management of diabetic foot disease? Processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance?

The National Pregnancy in Diabetes (NPID) Audit is part of the National Diabetes Audit (NDA) programme, and is commissioned by The Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit programme (NCA). The NPID 2014 report is the second annual report from a continuous audit of the quality of care and outcomes for women with diabetes who become pregnant. The audit looks at three key questions: - Were women adequately prepared for pregnancy? - Were adverse maternal outcomes minimised? - Were adverse fetal/infant outcomes minimised? This report includes data on women with diabetes who became pregnant where their pregnancy was completed between 1 January 2014 and 31 December 2014 and the data was submitted to the audit by 12 February 2015. 150 hospitals/Trusts submitted data to the 2014 audit. In addition to the National report, the NPID Audit has produced reports presenting key findings for nine ONS Regions in England, and for Wales. These reports show comparisons with the national data for England and Wales. Adverse measures such as stillbirth and congenital anomalies are too infrequent to report annually at this level, and are therefore reported only in the National Summary report.

The National Diabetes Audit identified an issue with data supplied to the HSCIC for the 2011-12 Audit, regarding HbA1c (blood glucose) recording across a number of practices. While this did not materially affect the findings in the National report, in November 2014 we removed the CCG level care process and treatment target reports covering potentially affected practices. The 2011-2012 Data has been re-published in the 2012-2013 CCG reports with the following Data Quality note; There has been an issue identified with data supplied to the HSCIC for the 2011-12 Audit, regarding HbA1c (blood glucose) recording across a number of practices in this CCG. This does not materially affect the findings in the National report. Caution should be taken when comparing data, for HbA1c and all eight care processes. The issue does not affect the 2012-2013 data and is restricted only to the 2011-2012 data presented in Table 3, Figure 3, Figure 4, and Figure 5 in the CCG level reports for those affected. We are working with our suppliers to resolve this issue and will update this page as soon as possible. 2011-2012 National Diabetes Audit (NDA) report. Report 1 shows Care Processes and Treatment targets. This national report from the ninth year of the audit presents key findings on key care processes and treatment target achievement rates from 2011-2012 in all age groups in England and Wales. The care processes and treatment target standards are specified in NICE Clinical Guidelines and the NICE Diabetes in Adults Quality Standards. The NDA also reports on the complications of diabetes, mortality and other complications. These will be published in report 2 towards the end of the year. Due to the size of this publication, the data have been organised alphabetically by CCG profile and split into several pages, which are linked to below. On 9th April 2014 a National Diabetes Audit (NDA) Report 2011-12 summary report was added to this release. This presents the NDA care processes, treatment targets, complications and mortality data in a more accessible patient friendly format.

The National Diabetes Transition Audit (NDTA) is a joint enterprise between the National Diabetes Audit (NDA) and the National Paediatric Diabetes Audit (NPDA). The NDA and NPDA datasets have been linked so that the care of young people with diabetes can be tracked during the transition from paediatric diabetes services to adult diabetes services. The audit measures against the National Service Framework and NICE Clinical Guidelines and Quality Standards. This, the first report, has been developed from the linked data sets and presents the key findings and recommendations on care processes and treatment target achievement rates from 2003-04 - 2014-15 in age groups of 12 - 24 years in England and Wales. Key Findings Annual Care Processes •KF1: Annual measurement of HbA1c decreases after transition. •KF2: Annual measurements of blood pressure and cholesterol remain similar, whereas kidney, foot, retinopathy and smoking check completion rates increase after transition. •KF3: The differences in care process completion pre and post transition do not appear to be influenced by gender, ethnicity, or living in a deprived area. •KF4: Pre-transition annual care process completion rates fall as age at transition increases, while post-transition completion rates increase as age at transition increases. A similar pattern is seen for duration of diabetes. •KF5: The least variation in care process completion rates was found where transition occurred between the age of 16 and 19 years. This may be because planned transition usually occurs during this time window. Planned movement from paediatric to adult care is less likely at younger and older ages. Treatment Targets (HbA1c) •KF6: The HbA1c target is more likely to be reached pre-transition compared to post-transition; the difference is greatest at younger ages. •KF7: The decrease in meeting the HbA1c target is not influenced by gender, ethnicity, or living in a deprived area. Risk Factors •KF8: For both cholesterol and blood pressure, the percentage of children achieving the targets are higher pre-transition compared to post-transition. Diabetic Ketoacidosis (DKA) •KF9: There are a higher number of DKA admissions post-transition. However, this maybe due to the fact that DKA rates increase with increasing duration of diabetes.

The National Diabetes Foot Care Audit (NDFA) is a continuous audit of diabetic foot disease in England and Wales. The audit enables all diabetes foot care services to measure their performance against NICE clinical guidelines and peer units, and to monitor adverse outcomes for people with diabetes who develop diabetic foot disease. All organisations which provide a diabetic foot ulcer treatment service are eligible for inclusion in the audit. The audit reports on the following: Structures: are the nationally recommended care structures in place for the management of diabetic foot disease? Processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance? Outcomes: are the outcomes of diabetic foot disease optimised? The NDFA is part of the National Diabetes Audit (NDA) portfolio within the National Clinical Audit and Patient Outcomes Programme (NCAPOP), commissioned by the Healthcare Quality Improvement Partnership (HQIP) As well as a national report, which provides information about foot care across England and Wales, separate local reports are also available. The comparative local reports show data at service (specialist foot care teams), provider (Trust/Local Health Board), commissioner (Clinical Commissioning Group) and network (Strategic Clinical Network) level. 8 January 2020: text in glossary section on page 91 for questions 5 and 6 updated to correctly match the questions in the 2018 NDFA Provider Survey.

Local reports - breakdown of report 1 (Care Processes and Treatment Targets). In addition to the National reports, the NDA has also produced CCG/LHB profile reports which present key CCG/LHB findings from the 2012-2013 audit for all age groups. The data used to produce the reports is extracted from GP practices in your CCG/LHB and is augmented by secondary care outpatient data. 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 CCG/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 2011-2012 audit. For further information and recommended actions for commissioners please refer to the National Diabetes Audit 2012-2013 Report 1: Care Processes and Treatment Targets. An issue has been identified with approximately 17,000 records out of 2 million submitted nationally to the 2012-2013 National Diabetes Audit which equates to less than 1% of the total submitted overall. It has been found that through an error in the data loading process these records were not included in the final analysis. The technical reason relates to an error in how the records extracted from the GP systems were transformed into the data used for analysis. Initial investigations have confirmed that the National Publication is not materially affected. In some sub-national reports the care process and treatment target percentages are likely to be affected along with participation and those CCGs where we are aware of any substantial changes to the published data will be contacted directly. We are still investigating exactly what impact including these records will have on the relevant sub-national reports it is therefore recommended that users use sub-national figures with caution until the revised figures are available. We expect to re publish corrected sub national data in July 2015. The HSCIC apologises for any inconvenience caused. The National Diabetes Audit identified an issue with data supplied to the HSCIC for the 2011-12 Audit, regarding HbA1c (blood glucose) recording across a number of practices. While this did not materially affect the findings in the National report, in November 2014 we removed the CCG level care process and treatment target reports covering potentially affected practices. The data which was identified in the issue above from the 2011-12 audit was included in 2012-13 Audit CCG reports without a data quality note. The affected reports have been updated with the following data quality note. There has been an issue identified with data supplied to the HSCIC for the 2011-12 Audit, regarding HbA1c (blood glucose) recording across a number of practices in this CCG. This does not materially affect the findings in the National report. Caution should be taken when comparing data, for HbA1c and all eight care processes. The issue does not affect the 2012-2013 data and is restricted only to the 2011-2012 data presented in Table 3, Figure 3, Figure 4, and Figure 5 in the CCG level reports for those affected.

The excel file contains unit, regional and national level data obtained from the 2014-15 National Paediatric Diabetes Audit.

Specifically, it includes information on patient characteristics, completion of health checks and outcomes achieved (as recommended by the National Institute for Clinical Excellence) for infants, children and young people with type 1 diabetes, under the age of 25, who attended paediatric diabetes units in England and Wales between 1 April 2014 and the 31 March 2015.

Data are included for the seven key health checks:

• Glycated Haemoglobin A1c (HbA1c)

• Body Mass Index (BMI)

• Cholesterol

• Blood pressure

• Urinary albumin

• Foot examination

• Eye screening

Data on other health checks include:

• Psychological support

• Structured Education

• Screening for autoimmune disease (coeliac and thyroid disease)

Data on outcomes of care include:

• HbA1c target measurements

• Small vessel (microvascular) disease

• Large vessel (macrovascular) disease

• Autoimmune disease (coeliac and thyroid disease)

The data were first published in May 2016 alongside the National Paediatric Diabetes Audit Report 2014-15. Data suppressed due to small numbers (<5).

NB: Due to data corruption of ethnicity data submitted, this 2014-15 report does not include ethnicity data for patients in individual units for comparison across units regionally and nationally. Ethnicity has therefore not been used as a variable in the HbA1c case-mix adjustments.

For further information and details on the audit please refer to:

• Supporting documents (see below): link to National Paediatric Diabetes Audit Report 2014-15

• NPDA results online: http://npda-results.rcpch.ac.uk/default.aspx

• The RCPCH website: https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/national-paediatrics-diabetes-audit

The excel file contains unit, regional and national level data obtained from the 2013-14 National Paediatric Diabetes Audit.

Specifically, it includes information on patient characteristics, completion of health checks (care processes) and outcomes achieved (as recommended by the National Institute for Clinical Excellence) for infants, children and young people with type 1 diabetes, under the age of 25, who attended paediatric diabetes units in England and Wales between 1 April 2013 and the 31 March 2014.

Data are included for the seven key health checks:

• Glycated Haemoglobin A1c (HbA1c)

• Body Mass Index (BMI)

• Cholesterol

• Blood pressure

• Urinary albumin

• Foot examination

• Eye screening

Data on other health checks include:

• Psychological support

• Structured Education

• Screening for autoimmune disease (coeliac and thyroid disease)

Data on outcomes of care include:

• HbA1c target measurements

• Small vessel (microvascular) disease

• Large vessel (macrovascular) disease

• Autoimmune disease (coeliac and thyroid disease)

The data were first published in March 2015 alongside the National Paediatric Diabetes Audit Report 2013-14. Data suppressed due to small numbers (<5).

For further information and details on the audit please refer to:

• Additional resources (see below): link to National Paediatric Diabetes Audit Report 2013-14

• The RCPCH website: https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/national-paediatrics-diabetes-audit

The data set contains data from the National Paediatric Diabetes Audit Report 2012-13.

These data describe measurements of HbA1c levels for infants, children and young people under the age of 25 years with diabetes (as recommended by the National Institute for Clinical Excellence).

The data contained in the file was first published in October 2014 in the National Paediatric Diabetes Audit Report 2012-13

For further information and details on the audit please refer to the National Paediatric Diabetes Audit Report 2012-13 or the RCPCH website (https://www.rcpch.ac.uk/work-we-do/quality-improvement-patient-safety/national-paediatrics-diabetes-audit).

This set of files contains public data used to validate the grocery data. All references to the original sources are provided below.CHILD OBESITYPeriodically, the English National Health Service (NHS) publishes statistics about various aspects of the health and habits of people living in England, including obesity. The NHS National Child Measurement (NCMP) measures the height and weight of children in Reception class (aged 4 to 5) and year 6 (aged 10 to 11), to assess overweight and obesity levels in children within primary schools. The program is carried out every year in England and statistics are produced at the level of Local Authority (that corresponds to Boroughs in London). We report the data for the school year 2015-2016 (file: child_obesity_london_borough_2015-2016.csv). For the school year 2013-2014, statistics in London are also available at ward-level (file: child_obesity_london_ward_2013-2014.csv)The files are comma-separated and contain the following fields: area_id: the id of the boroughnumber_reception_measured: number of children in reception year measurednumber_y6_measured: number of children in reception year measuredprevalence_overweight_reception: the prevalence (percentage) of overweight children in reception year prevalence_overweight_y6: the prevalence (percentage) of overweight children in year 6prevalence_obese_reception: the prevalence (percentage) of obese children in reception yearprevalence_obese_y6: the prevalence (percentage) of obese children in year 6ADULT OBESITYThe Active People Survey (APS) was a survey used to measure the number of adults taking part in sport across England and included two questions about the height and weight of participants. We report the results of the APS for the year 2012. Prevalence of underweight, healthy weight, overweight, and obese people at borough level are provided in the file london_obesity_borough_2012.csv.The file is comma-separated and contains the following fields: area_id: the id of the boroughnumber_measured: number of people who participated in the surveyprevalence_healthy_weight: the prevalence (percentage) of healthy-weight peopleprevalence_overweight: the prevalence (percentage) of overweight peopleprevalence_obese: the prevalence (percentage) of obese peopleBARIATRIC HOSPITALIZATIONThe NHS records and publishes an annual compendium report about the number of hospital admissions attributable to obesity or bariatric surgery (i.e., weight loss surgery used as a treatment for people who are very obese), and the number of prescription items provided in primary care for the treatment of obesity. The NHS provides both raw counts at the Local Authority level and numbers normalized by population living in those areas. In the file obesity_hospitalization_borough_2016.csv, we report the statistics for the year 2015 (measurements made between Jan 2015 and March 2016).The file is comma-separated and contains the following fields:area_id: the id of the boroughtotal_hospitalizations: total number of obesity-related hospitalizationstotal_bariatric: total number of hospitalizations for bariatric surgeryprevalence_hospitalizations: prevalence (percentage) of obesity-related hospitalizations prevalence_bariatric: prevalence (percentage) of bariatric surgery hospitalizations DIABETESThrough the Quality and Outcomes Framework, NHS Digital publishes annually the number of people aged 17+ on a register for diabetes at each GP practice in England. NHS also publishes the number of people living in a census area who are registered to any of the GP in England. Based on these two sources, an estimate is produced about the prevalence of diabetes in each area. The data (file diabetes_estimates_osward_2016.csv) was collected in 2016 at LSOA-level and published at ward-level.The file is comma-separated and contains the following fields:area_id: the id of the wardgp_patients: total number of GP patients gp_patients_diabetes: total number of GP patients with a diabetes diagnosisestimated_diabetes_prevalence: prevalence (percentage) of diabetesAREA MAPPINGMapping of Greater London postcodes into larger geographical aggregations. The file is comma-separated and contains the following fields:pcd: postcodelat: latitudelong: longitudeoa11: output arealsoa11: lower super output areamsoa11: medium super output areaosward: wardoslaua: borough

Quali informazioni vengono messe a disposizione?

Partecipazione all'audit di Trust, Service e Clinical Commissioning Group (CCG) e completezza dei dati per i settori chiave

Rendere trasparenti i dati degli audit clinici

Nella sua lettera di trasparenza e dati aperti ai ministri del Consiglio dei ministri del 7 luglio 2011, il primo ministro si è impegnato a rendere disponibili i dati degli audit clinici provenienti dagli audit nazionali nell'ambito del programma nazionale di audit clinico e risultati dei pazienti.

Il National Diabetes Foot Care Audit (NDFA) è un audit continuo della malattia del piede diabetico in Inghilterra e Galles.L'audit consente a tutti i servizi di cura del piede diabetico di misurare le loro prestazioni rispetto alle linee guida cliniche NICE e alle unità peer e di monitorare gli esiti avversi per le persone con diabete che sviluppano la malattia del piede diabetico.

Misure relative al processo di cura dei pazienti

Informazioni sui risultati dell'assistenza e sul trattamento.

Questi dati non elencano informazioni sui singoli pazienti né contengono dati identificabili dai pazienti.

Utilizzo e interpretazione dei dati

I dati del National Diabetes Foot Care Audit non dovrebbero essere considerati in modo isolato quando si valutano gli standard di cura.

Accesso ai dati

I dati vengono resi disponibili sul sito data.gov. Ogni anno un file di dati del National Diabetes Foot Care Audit sarà reso disponibile in formato CSV. I trust, i CCG e le reti sono identificati dal nome e dal loro codice nazionale. I servizi di cura dei piedi sono identificati per nome e codice derivato localmente.

Cosa coprono i dati?

L'audit prende in esame i seguenti settori:

• Strutture: esistono le strutture di assistenza raccomandate a livello nazionale per la gestione della malattia del piede diabetico?

• Processi: il trattamento della malattia attiva del piede diabetico è conforme alle linee guida raccomandate a livello nazionale?

• Risultati: i risultati della malattia del piede diabetico sono ottimizzati?

Qual è il periodo coperto dai dati?

Questi dati riguardano i pazienti che sono stati osservati per la prima volta con un'ulcera del piede diabetico da un team specializzato tra il 14 luglio 2014 e l'8 aprile 2016. La presente relazione nazionale è stata pubblicata l'8 marzo 2017.

The National Diabetes Foot Care Audit (NDFA) Interval Review is the 6th NDFA report. The NDFA is a continuous audit of diabetic foot disease in England and Wales. The audit enables all diabetes foot care services to measure their performance against the National Institute for Health and Care Excellence (NICE) clinical guidelines and peer units, and to monitor adverse outcomes for people with diabetes who develop diabetic foot disease. All organisations which provide a diabetic foot ulcer treatment service are eligible for inclusion in the audit. The audit reports on the following: Structures: are the nationally recommended care structures in place for the management of diabetic foot disease? Processes: does the treatment of active diabetic foot disease comply with nationally recommended guidance? Outcomes: are the outcomes of diabetic foot disease optimised?

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. Each year data from the National Diabetes Inpatient Audit will be made available in CSV format. The data are also being made available on the data.gov website. What information is being made available? - Audit participation by NHS Trust and data completeness for the key fields. - Measures about the process of care given to patients. - Information about care outcomes and treatment. Trusts and Networks are identified by name and their national code. These data do not list individual patient information, nor do they contain any patient identifiable data. The National Diabetes Inpatient Audit (NaDIA) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and delivered by the Health and Social Care Information Centre, working with Diabetes UK. The National Diabetes Inpatient Audit is a snapshot audit of diabetes inpatient care in England and Wales. The audit is set out to answer the following questions: - Did diabetes management minimise the risk of avoidable complications? - Did harm result from the inpatient stay? - Was patient experience of the inpatient stay favourable? - Has the quality of care and patient feedback changed since NaDIA 2010, NaDIA 2011 and NaDIA 2012? This publication was produced in two parts: the comparative hospital-level analysis was published 5 March 2014 and the National Report was published 26 June 2014.

The National Diabetes Inpatient Audit (NaDIA) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) and delivered by NHS Digital, working with Diabetes UK. The National Diabetes Inpatient Audit is a snapshot audit of diabetes inpatient care. Between 26-30 September 2016, the National Diabetes Inpatient Audit was conducted in hospitals across England and Wales, collecting data on characteristics of the hospital including staffing structures, patient clinical data and patient experience information. The audit looks at the following areas: • Did diabetes management minimise the risk of avoidable complications? • Did harm result from the inpatient stay? • Was patient experience of the inpatient stay favourable? • Has the quality of care and patient feedback changed? The Annual Report provides a summary of the 2016 audit findings for England and Wales, and where possible compares to the 2011, 2012, 2013 and 2015 audit findings. There was no audit collection or report in 2014, so 2014 data is not available. The audit is supported by the Hospital Level Analysis, which provides results at individual site level. This publication has changed in terms of structure from previous years in that the main report is now available in PowerPoint and PDF format. Each individual section/chapter of the report is also available as separate standalone PDF/PowerPoint documents in the Short Reports zip folder below.

The National Pregnancy in Diabetes Audit (NPID) is a workstream of the National Diabetes Audit (NDA) and is managed by NHS England (formally NHS Digital) under an agreement with the Healthcare Quality Improvement Partnership (HQIP). The NDA is delivered by NHS England, in partnership with Diabetes UK. The audit has been running since 2014. This is the seventh National Pregnancy in Diabetes (NPID) audit report on pregnancy outcomes in women with pre-existing diabetes in pregnancy in England and Wales. This State of the Nation overview details the findings and recommendations relating to the demographics, treatment and pregnancy outcomes of mothers with type 1 and early-onset type 2 diabetes. It covers the period 01 January 2021 to 31 December 2022.

The National Pregnancy in Diabetes Audit (NPID) is a workstream of the National Diabetes Audit (NDA). It aims to support clinical teams to deliver better care and outcomes for women with diabetes who become pregnant and has been running since 2014. The dashboard presents service level data and is intended to support local, regional and national quality improvement. The latest version of the dashboard reports on data collected for pregnancies that ended between 1 January 2022 and 31 December 2024 and includes data on continuous glucose monitoring (CGM). Data are submitted by antenatal services in England and Wales.