We are fortunate to have a number of data sources that allow us to track changes in the care and outcomes for people with diabetes and identify local variation across England.
These include the National Diabetes Audit which provides an annual picture of the management and outcomes for people diagnosed with diabetes. The audit programme has recently expanded to provide data on specific events that may happen to people with diabetes such as a hospital admission, pregnancy or developing foot disease.
Other routine data sources provide valuable information on prescribing for diabetes and hospital admissions.
All these data provide insight into how diabetes is being managed in the country as a whole and between health providers or health economies. However, a question that is increasingly being asked is ‘How do we compare to other countries?’.
Whilst this is a simple question to ask it is not straight forward to answer. Producing data for international comparisons is always difficult because it is often not possible to obtain data that has been collected in the same way or that uses the same definitions, without establishing a costly bespoke data collection system.
Furthermore international comparisons may fail to capture the interactions between national governments and diverse healthcare systems or social, demographic and cultural differences.
However, these limitations do not mean that such comparative work cannot be informative and so should not be attempted.
A recently published study of diabetes care across 30 European countries, the Euro Diabetes Index, placed the UK diabetes care 4th after Sweden, the Netherlands and Denmark.
The Euro Diabetes Index combined data across six domains into a single index of the quality of diabetes care in each country.
The UK performed well on case finding, the range and reach of services, access to treatment, procedures and outcomes. This can be partly attributed to having a universal healthcare system that is free to access (people with diabetes are except from prescription charges in England). England also has established national guidelines, pay for performance systems and a national eye screening programme in place to try and ensure that people with diabetes reliably receive the nine recommended annual care processes.
Whilst there is scope for increasing the proportion of people with diabetes receiving all eight recommended care processes each year (59.9% in 2012/13, source National Diabetes Audit) the NDA has documented clear improvements annual diabetes care processes achievement rates over the past 10 years.
The Euro Diabetes Index found that 11 of the 30 countries surveyed do not have data on the percentage of people who have an HbA1c (measure of blood glucose control) measurement each year. In 12 countries (including the UK) more than 75% of people with diabetes had an annual HbA1c measurement. In six countries, between 50% and 75% of people with diabetes had an annual HbA1c measurement, but one country reported for a yearly HbA1c in less than half of people with diabetes.
The UK did not do so well compared to the other European countries in relation to the prevention of Type 2 diabetes. It scored poorly on indicators relating to adult obesity, the consumption of soft drinks and regular use of bicycles. The proportion of people eating recommended amounts of fruit and vegetables also showed scope for improvement.
Across Europe there are many different healthcare systems and structures and the organisational approach to the management of diabetes varies considerably.
This study suggests that there are some areas of diabetes care where the UK appears to be performing relatively well compared to our European counter-parts and others where we should perhaps be focussing our improvement efforts.
In particular, this study identified the relatively poor performance of the UK in relation to risk factors for and prevention of Type 2 diabetes. This area deserves further attention because reducing the risk of people developing Type 2 diabetes has much greater potential health benefit than optimum care once Type 2 diabetes develops.