Short form National Diabetes Audit, 2017-18 (published 8/11/18)

[bulkbiker]

@bulkbiker I only go to the vet when I'm sick, in fact I'm going in a coupe of days. My diabetic disease is dealt with at the hospital. I'm not sure how informed my vet is on T1 but he certainly knew enough to send me straight to hospital last year. I agree though that the numbers are surprising indeed.

That's interesting but as these are NHS figures shouldn't they include T1's treated by hospital clinics too?
@DCUKMod do you know how these figures are collated.
I do wish sometime that they would explain the methodology of collection it would make understanding the figures so much easier..

 

[SueJB]

That's interesting but as these are NHS figures shouldn't they include T1's treated by hospital clinics too?
@DCUKMod do you know how these figures are collated.
I do wish sometime that they would explain the methodology of collection it would make understanding the figures so much easier..

Yep @bulkbiker good point about how the figures are arrived at. You are always very perceptive. Thanks, good insight

 

[Alison54321]

Sorry if I've confused you @Alison54321 we've always referred to the doctor as a vet. I have nothing but admiration for the profession and my vet in particular but can't shake the habit of using the name. Good on your mum

I was rather taken with the idea of you going to the vet and saying you felt ill, and he diagnosed it.

I've met some good doctors, and some bad ones. I'm keener on the idea of respecting people for their individual achievements, rather than assuming that because they are a member of a group, that they should automatically be respected.

 

[SueJB]

I was rather taken with the idea of you going to the vet and saying you felt ill, and he diagnosed it.

I've met some good doctors, and some bad ones. I'm keener on the idea of respecting people for their individual achievements, rather than assuming that because they are a member of a group, that they should automatically be respected.

Yep totally in agreement with that @Alison54321 . For me too, respect is always earned not automatically bestowed. I've not been to a real vet for donkey's years but hope to adopt a dog soon so who knows what they'll be able to diagnose.

 

[SamJB]

Maybe I'm wrong, and it's been over a year since I was involved, but I thought the NDA 6.5% was raise to 7.5% to be brought in line with NICE's. If it wasn't NICE's it was some other national body, maybe it was a QoF target, but it was definitely change to 7.5% to be brought in-line with some national target.

@bulkbiker the data is collected for all UK diabetics, no matter whether they are under the care of a GP or a hospital. The data is all kept in a standard format by NHS Digital (except retinopathy data, which is why it isn't collected yet), so it can be accessed by the stats people (HQIP) working for the NDA.

I'm in work, so don't have time, but poke around here, the methods for collection and analysis are always explained.

 

[bulkbiker]

Maybe I'm wrong, and it's been over a year since I was involved, but I thought the NDA 6.5% was raise to 7.5% to be brought in line with NICE's. If it wasn't NICE's it was some other national body, maybe it was a QoF target, but it was definitely change to 7.5% to be brought in-line with some national target.

@bulkbiker the data is collected for all UK diabetics, no matter whether they are under the care of a GP or a hospital. The data is all kept in a standard format by NHS Digital (except retinopathy data, which is why it isn't collected yet), so it can be accessed by the stats people (HQIP) working for the NDA.

I'm in work, so don't have time, but poke around here, the methods for collection and analysis are always explained.

Thanks for that Sam very interesting. A bit odd that GP surgeries have to opt in for their data to be included. But I'm guessing that the data cannot "include" those that don't opt in so that can't explain the missing..

 

[DCUKMod]

Maybe I'm wrong, and it's been over a year since I was involved, but I thought the NDA 6.5% was raise to 7.5% to be brought in line with NICE's. If it wasn't NICE's it was some other national body, maybe it was a QoF target, but it was definitely change to 7.5% to be brought in-line with some national target.

@bulkbiker the data is collected for all UK diabetics, no matter whether they are under the care of a GP or a hospital. The data is all kept in a standard format by NHS Digital (except retinopathy data, which is why it isn't collected yet), so it can be accessed by the stats people (HQIP) working for the NDA.

I'm in work, so don't have time, but poke around here, the methods for collection and analysis are always explained.

Thanks for responding @SamJB. I was about to go all smarty-pants by declaring "I have no idea, but I know a man who can". @bulkbiker .

 

[KK123]

Well I've read it and it seems clear that they will be putting in an extra effort to get ALL diabetics on statins regardless of anything else, it's now an actual target.

I also quote their para on what diabetes is referring to type 1 and type 2 (no mention of the rest):

'Diabetes is a condition where the amount of glucose in the blood is too high because the pancreas doesn’t produce enough insulin. Insulin is a hormone produced by the pancreas that allows glucose to be used as a body fuel and other nutrients to be used as building blocks. There are two main types of diabetes: Type 1 diabetes (no insulin); Type 2 diabetes (insufficient insulin)'

Is that correct?, my understanding of type 2 was that they (can) be producing a normal amount of insulin or even too much? Either way, I find this leaflet very lightweight considering it is published by the NHS.

 

[bulkbiker]

Is that correct?, my understanding of type 2 was that they (can) be producing a normal amount of insulin or even too much?

No its completely incorrect.. in my view most "classic" Type 2's are overproducing insulin. There are some who underproduce who I imagine may well end up Type 1 or one of the variants. That's why I think the fasting insulin test is so important and cannot understand why it isn't used by the NHS. It would save so many misdiagnoses and so much mis-prescribing of the wrong medication.

Edit to add I mean you are quite correct and the audit is incorrect.. I didn't make it very clear sorry

 

[KK123]

No its completely incorrect.. in my view most "classic" Type 2's are overproducing insulin. There are some who underproduce who I imagine may well end up Type 1 or one of the variants. That's why I think the fasting insulin test is so important and cannot understand why it isn't used by the NHS. It would save so many misdiagnoses and so much mis-prescribing of the wrong medication.

Edit to add I mean you are quite correct and the audit is incorrect.. I didn't make it very clear sorry

Ha ha, yep, I knew what you meant.

 

[tim2000s]

Either way, I find this leaflet very lightweight considering it is published by the NHS.

This is just a summary document (as it says). There's a ton of data supporting it, which is all available through the NHS Digital platform - you might want to go and have a google if you want the greater detail.

It's probably worth adding to @SamJB 's point that the reporting is done at a CCG/Practice level, even if the collection is done in hospitals.

 

[slip]

The pressure!!!

Christmas is coming...........!

 

[KK123]

This is just a summary document (as it says). There's a ton of data supporting it, which is all available through the NHS Digital platform - you might want to go and have a google if you want the greater detail.

It's probably worth adding to @SamJB 's point that the reporting is done at a CCG/Practice level, even if the collection is done in hospitals.

Hi Tim, I am sure the data is correct but you'd think they would expand the paragraph about what diabetes actually is?

 

[zand]

Well I've read it and it seems clear that they will be putting in an extra effort to get ALL diabetics on statins regardless of anything else, it's now an actual target.

I think you are right in your assumption. That's nothing short of criminal!!! There has never been any clinical evidence that statins have been of any benefit to women. Older women need higher cholesterol. I don't understand how this target fits with 'First do no harm' . It's also totally at odds with the news reports of 'diabetics costing the NHS so much'...so don't prescribe them statins then. That will save a lot of money and some lives too.

 

[Scott-C]

I actually think a NICE target of 6.5% is useful, because in reality you can't achieve it without Libre, and the ,more people who reach the target when using it, the harder it becomes to resist it.

I'm going to bookmark the link below, might be worth keeping an eye on it.

http://www.diabetologists-abcd.org.uk/n3/FreeStyle_Libre_Audit.htm

It's ABCD, Association of British Clinical Diabetologists, doing a nationwide survey of real world clinical outcomes from libre use instead of trials. Will be interesting to see what they come up with and whether refusenik ccgs pay any attention to it.

Going by all of our N=1 anecdotal experiences, what's already emerging from the Edinburgh early adopter gig, and the SHTG report, I reckon the ABCD report is going to be favourable, but there's still going to be some ccgs who'll hold out for no other reason than that they have a weak Board and a strong, but misguided, Chief Executive who just doesn't like being told what to do.

Meanwhile, in the real world, we not only have Dr Gibb doing his stuff, but also his colleague at RIE, Dr Anna Dover, cutting to the chase with this sort of stuff from yesterday. Good to see someone in the frontline saying it how they see it without any politics:

 

[DCUKMod]

Hi Tim, I am sure the data is correct but you'd think they would expand the paragraph about what diabetes actually is?

I wish I had that level of confidence in the data. Data gathering is usually poor (NHS or not) - especially where much of it is governed by accurate coding.

 

[SamJB]

I wish I had that level of confidence in the data. Data gathering is usually poor (NHS or not) - especially where much of it is governed by accurate coding.

I agree that no audit is every going to be 100% accurate, but believe me, the NDA is run by complete experts. There are 2 people with MBEs for diabetes research and care on the steering committee; and the stats and data gathering is run by professional statisticians from HQIP.

If the numbers are out, it will only be by a very small amount; certainly the trends and significant outcomes in the data are accurate.

 

[DCUKMod]

I agree that no audit is every going to be 100% accurate, but believe me, the NDA is run by complete experts. There are 2 people with MBEs for diabetes research and care on the steering committee; and the stats and data gathering is run by professional statisticians from HQIP.

If the numbers are out, it will only be by a very small amount; certainly the trends and significant outcomes in the data are accurate.

My misgivings are around the donor data - presumably generated at the GP surgery end, based on manually input information (creating a background flag, and therefore countable).

 

[SamJB]

My misgivings are around the donor data - presumably generated at the GP surgery end, based on manually input information (creating a background flag, and therefore countable).

I'm out of my depth on this one - no idea, sorry! Must be a recent addition to the audit since I left.

 

[bulkbiker]

I agree that no audit is every going to be 100% accurate, but believe me, the NDA is run by complete experts. There are 2 people with MBEs for diabetes research and care on the steering committee; and the stats and data gathering is run by professional statisticians from HQIP.

If the numbers are out, it will only be by a very small amount; certainly the trends and significant outcomes in the data are accurate.

Analysing the data will be fine but seeing the general level of incompetence at my surgery alone then I'm not too hopeful about the data quality and however smart the guys analysing it are if it's garbage going in...