National Diabetes Audit highlights the need to focus on prevention and treatment of heart failure

Missing the target

In answering the question “Are we ‘doing things right’ in Diabetes care?”, a good place to start is to look at all the data we have about patients in the NHS.    The National Diabetes Audit does just that for NHS services in England and Wales.

Over two million people have diabetes in England and Wales.  They have a substantially higher risk of serious illness, hospitalisation and premature death compared to the non-diabetic population.

England and wales

The audit includes data from 88% of GP practices in England and Wales

This audit has very important and useful information that can help patients, professionals and care commissioning groups make decisions about how to optimise diabetes care.

Methods

People with diabetes were identified from data from GP practices and hospitals for the period 2009-2010.  Only patients who were alive at at the end of this period were included.

The prevalence of complications over the following two years – up to March 2012 – was calculated for this group.  This was compared with the risk of the same outcomes amongst the non-diabetic population.  The data were adjusted to take age, sex and geographic location into account.

Results

Data were included from 88% of primary care practices in England and Wales.

Complication Prevalence Relative Risk
(compared with
non-diabetic population)
95% CI
Angina 5.97% 1.76 1.75 – 1.77
Myocardial infarction 1.47% 1.55 1.53 – 1.57
Heart failure 4.15% 1.73 1.72 – 1.74
Stroke 1.79% 1.34 1.33 – 1.36
Major amputation (above ankle) 0.17% 3.21 3.11 – 3.33
Minor amputation (below ankle) 0.30% 4.37 4.26 – 4.48
Renal replacement therapy 0.78% 2.64 2.60 – 2.68

The Report also provides national and regionalised data for complications, diabetic ketoacidosis (DKA), short term mortality and chronic kidney disease.

The high prevalence and high impact of heart failure draw the attention of the report writers.  Their recommendations are to:

1) Reduce the adverse outcomes of vascular disease in people with diabetes and the associated premature mortality through increased emphasis on controlling blood pressure to a level at or below 140/80
2) Manage heart failure to guideline standards.

There is a further summary of the findings of this report on the Healthcare Quality Improvement Partnership website.

Comments

  • The report describes heart failure as a rather “neglected” complication of diabetes, and one that can be prevented.
  • Blood pressure management is identified as the most actionable factor for preventing heart failure, being one area where many people with diabetes are not currently receiving optimal care.

References

  1. HQIP.  National Diabetes Audit 2011 – 2012 Report 2: Complications and Mortality.  Health and Social Care Information Centre, 2013
  2. NICE CG108.  Chronic heart failure: management of chronic heart failure in adults in primary and secondary care.  National Institute for Health and Clinical Excellence, 2010.