Full annual checks for diabetes are a postcode lottery, finds audit

BMJ 2012; 344 doi: (Published 13 June 2012) Cite this as: BMJ 2012;344:e4142
  1. Zosia Kmietowicz
  1. 1London

The likelihood of diabetes patients having all nine essential checks that are recommended every year varies widely across England and Wales with a full battery of tests four times more common in some areas than in others, an audit has found.1

The National Diabetes Audit report on care processes shows that in 2010-11 more patients (54% in England and 60% in Wales) received the nine annual checks and services recommended by the National Institute for Health and Clinical Excellence than in 2009-10 (51% and 58% respectively).

However, 36 primary care trust areas in England (out of 151) recorded fewer than half of their patients as having had all their annual GP checks. In one trust—Mid Essex Primary Care Trust—only 16% of patients received all nine checks. By comparison 71% of patients in Darlington Primary Care Trust received all the checks in 2010-11.

In Welsh local health boards, the percentage varied from 51 to 65%.

Failure to attend appointments could partly explain the variation, but varying provision of care could also be a factor, says the report.

The audit is the most up to date and the largest assessment of diabetes care in the UK. It is carried out by the Health and Social Care Information Centre in partnership with Diabetes UK and is commissioned by the Healthcare Quality Improvement Partnership.

It looked at care processes recorded by 83% of GP practices in England covering 2.15 million patients, and 49% of practices and 850 000 patients in Wales between January 2010 and March 2011.

In May a report from Diabetes UK warned that fewer than half of all patients with diabetes in England received the nine annual checks in 2009-10.2

The latest audit also shows that younger patients below the age of 55 are less likely to have all of the checks compared with older patients (see table).

Annual checks for diabetes

View this table:

Bob Young, clinical lead for the audit, said: “The small overall improvement is welcome but quite insufficient. The high performing localities show that this core essential care can and should be delivered much more reliably.”

The audit recommends that all providers of diabetes care need to prioritise four areas for improvement: the organisation and recording of annual reviews for people with diabetes by general practices; glucose control and cardiovascular risk reduction by general practices and specialist diabetes services; early identification of patients with type 1 diabetes and better co-ordination of care between primary and secondary care to reduce the risks in these patients; and a review of services for younger people to better meet their needs and reduce risks.

The nine regular checks recommended by the national framework and NICE are: blood glucose concentrations, blood pressure, cholesterol concentrations, kidney function (blood and urine tests), retinal screening, foot and leg checks, and assessment of weight and smoking status.


Cite this as: BMJ 2012;344:e4142


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