Despite having spent more years than I can comfortably remember writing about diabetes -and even more years living with the condition- the subject still continues to bring a wealth of new angles to see the condition from. NICE has recently unveiled their new HbA1c targets for type 1 diabetes –and they’re tighter.
Some people with type 1 have viewed the new targets with a sense of horror but should we be shocked? On Facebook, Martine Molson wrote: “only time I achieved 7 was during pregnancy and I was permanently hypo”.
Yes, the new targets are going to be tough for many people to meet, however, they’re not impossible to reach.
The worry that some people may have is if they feel that not hitting the target is failure.
Sugar level targets are always tough to set as people’s abilities and circumstances can greatly differ. One of the benefits of the new target is that it makes communication of the target simpler for doctors and nurses. NICE are no doubt aware that most people with type 1 will have some difficulty in hitting the tighter target and have tried to lay out methods to help people with type 1 diabetes to achieve or get closer to the target.
The guidelines state that all type 1 adults should be offered the chance to go on a structured education course, such as the DAFNE course.
The guidelines also state that people with type 1 diabetes should be supported in testing at least four times a day and up to 10 times a day if one of a number of factors apply (including planning for pregnancy, to ensure safe driving and before, during and after sport). If you are having trouble with hypos, you can join our Hypo Awareness Program which has helped thousands of people to get to grips with hypos.
Large population data analysis provides useful clinical feedback to healthcare providers and national organisations, which aids the wider communication and understanding about changing healthcare demographics. In 2008, a report by Diabetes UK1 estimated that diabetes accounted for around 10% of NHS expenditure, equating to ?9 billion per year, or ?1 million every hour.
This epidemic of diabetes in the UK is mirrored around the world as a result of rising obesity rates and increasing longevity. The Scottish Diabetes Action Plan5 suggests that “Diabetes has been recognised for at least 10 years as an exemplar long-term condition, both in terms of the growing number of people with type 2 diabetes and in terms of the serious and expensive complications it can bring in its train. In its report “Delivering for Health”, NHS Scotland set out a focus on preventive self-care (promoting wellness), and decreasing costly acute care necessitated by illness events6.
The annual Scottish Diabetes Survey (SDS)4 collects quality performance data from all health care trusts in Scotland through the SCI-diabetes diabetes Informatics platforms.
In England, the national diabetes audit serves a similar purpose but suffers from a lack of uniformity in data collection.
Reporting on diabetes prevalence, complication rates and care quality is essential to inform the government, health sector, Non-Government Organisations (NGOs) and the public at large, and allows appropriate resource allocation and policy directive. What are the Impact and Cost Savings of Better Informed Decisions using Data Reporting for Diabetes Care? In Scotland, the development of a diabetes disease registry (SCI-diabetes) and regular data reporting around quality measures has been widely cited as an example of international best practice.
Figure 2A: Incidence of adjusted total amputation with 95% confidence intervals (solid lines) and incidence of adjusted major amputation with 95% confidence intervals (dashed lines) per 1000 patients with diabetes.
This figure was taken from an original paper “Decreasing amputation rates in patients with Diabetes- a population-based study” by Schofield et al10, demonstrating a 40% reduction in diabetes-related amputations between 2000 and 2009- following the introduction of the SCI-diabetes informatics platform. Figure 2B: Contains the amputation and eye laser figures from above combined into one graph.
Both graphs show the trends in laser treatment during 2001-2006, for Type 1 and Type 2 diabetes. The Kuwait Scotland e-Health Innovation Network was formed in 2010 to improve care of chronic disease, with diabetes as an exemplar. Aridhia built an informatics disease registry platform for primary health care clinics in Kuwait.
Diabetes care data was collated through KHN and care-mapped against the standard of care dictated by the Kuwait Standard and Clinical Guidelines. Regular semi-automated reports of diabetes prevalence, complication rates and care quality were created on a quarterly basis to inform individual clinics about their performance, in addition to a large annual survey.

In addition to giving population and disease profiling, these reports also allow comparisons between different clinics and against the national averages for care parameters. Here we show further examples of population and disease profiling that is based on anonymised data from the Kuwait Health Network. Disease profile reporting allows healthcare providers to track disease markers over time, and to make comparisons with national standards and guidelines, with other local healthcare providers, and with national averages. Example: HbA1C (a long-term measure of blood sugar control) should be recorded on all patients at around six-monthly intervals. Example plot showing % of patients with HbA1C recorded (within the last 15 months) and the comparison to target. Changes in parameters over time can be mapped using run charts; this is a useful tool for assessing quality improvement.
Comparing data with national averages and with other healthcare providers can be useful to determine deficiencies in care provision and allow for appropriate resource allocation, thus improving equity in care. The following spine chart compares data for Clinic 1 against the national average for a defined list of metrics. The clear display of data in an appropriate format can help readers to quickly assimilate large amount of information.
Aridhia has developed scripts which will automatically calculate the key quality performance indicators (QPIs) for diabetes care using any dataset containing the appropriate fields. Have your blood pressure measured and recorded at least once a year, and set a personal target that is right for you. Have your feet checked – the skin, circulation and nerve supply of your feet should be examined annually. Receive care planning to meet your individual needs – you live with diabetes every day so you should have a say in every aspect of your care. Get information and specialist care if you are planning to have a baby as your diabetes control has to be a lot tighter and monitored very closely.
Pamela joined Aridhia in 2011, bringing several years' experience in marketing and communications to the company.
Diabetes chart- convert hba1c to equivalent blood glucose, Easily convert your hba1c test result to its equivalent blood glucose reading.
Plasma glucose levels throughout the day and hba1c, Plasma glucose levels throughout the day and hba 1c interrelationships in type 2 diabetes implications for treatment and monitoring of metabolic control. A1c chart & calculator using the dcct formula, A1c chart has a1c to bs conversion using dcct formula. There’s now one ideal target to aim for with individual targets to be tailored for each individual. People newly diagnosed with type 1 diabetes should be offered the chance to go on a structured education course within six to 12 months after diagnosis. A focus on risk-factor profiling enables early preventive care strategies, reducing subsequent complications and costly hospital admissions.
This was double a 2001 estimate (Department of Health, 2001)2, showing the impact of a rising prevalence across the UK.
Many countries with rapidly emerging economies such as China, South East Asia, South America and Africa will see the most dramatic rises in diabetes rates over the next few decades, as wealth generation leads to adoption of more sedentary behaviour and poorer, high-fat, Western-style diets.
Maintaining and improving the quality of diabetes services against a backdrop of increased incidence and prevalence, and the consequent pressure on those services, forms a key challenge facing NHS Scotland”.
This national annual report informs the diabetes community about care quality and drives care improvements ….
General Practitioners are financially rewarded for achieving targets relating to care quality. SCI-diabetes, which started as a research database in NHS Tayside, has been rolled out and developed throughout Scotland.
Incidence of adjusted total amputations with 95% confidence intervals (solid lines) and incidence of adjusted major amputations with 95% confidence intervals (dashed lines) per 1000 patients with diabetes. Kuwait’s adult population has the sixth highest prevalence of diabetes in the world, affecting approximately 24% of the population. The Kuwait Health Network (KHN) informatics platform was piloted in four primary health care clinics in Kuwait capital region.

These reports were also be used by Ministry of Health and wider national bodies to decide on care priorities and resource allocation.
The dotted line represents the median based on the most recent 15 data points for each chart. The red dots show where it is doing worse than the national average; the green dots show where it is doing better than the national average. An HbA1c blood test will measure your overall blood glucose control and help you and your diabetes healthcare team set your own target.
Like blood glucose levels and blood pressure, you should have your own target that is realistic and achievable.
Using a specialised digital camera, a photo of each eye will be taken and examined by a specialist who will look for any changes to your retina (the seeing part at the back of your eye).
You should be told if you have any risk of foot problems, how serious they are and if you will be referred to a specialist podiatrist or specialist foot clinic. You should have two tests for your kidneys: urine test for protein (a sign of possible kidney problems) and a blood test to measure kidney function. Your yearly care plan should be agreed as a result of a discussion between you and your diabetes healthcare team, where you talk about your individual needs and set targets. If you have to stay in hospital, you should still continue to receive high-quality diabetes care from specialist diabetes healthcare professionals, regardless of whether you have been admitted due to your diabetes or not. You should expect care and support from specialist healthcare professionals at every stage from preconception to post-natal care. Diabetes affects different parts of the body and you should have the opportunity to see specialist professionals such as an ophthalmologist, podiatrist or dietician.
Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. She has been involved in some of Aridhia’s highest profile projects, including DECIPHER Health and the launch of AnalytiXagility, and is a valued member of the commercial team.
In many Middle Eastern countries, around 1 in 5 of the population already has diabetes (see later example).
Timely analytic reporting could help support this and many of the other priorities of this plan – particularly those around patient safety, complication prevention, and emergency admission reduction through early risk stratification and a system to monitor quality improvement. Regular monitoring of diabetes care targets for this purpose is therefore essential for individual practices, primary care collectives and commissioning bodies. Schofield et al12 demonstrated a reduction in diabetes amputation, and Vallance et al13 a reduction of retinopathy requiring laser treatment over the period of informatics implementation and data usage (Figures 2 and 3). The generation of these reports can be as frequent as data is refreshed, for example, daily or as required for team meetings, through to national reports (weekly, monthly, quarterly, yearly as required).
When the time comes to leave paediatric care, you should know exactly what to expect so you have a smooth change over to adult health services. You should be able to talk about your issues and concerns with specialist healthcare professionals.
Pamela likes to make simple messages out of complicated concepts and works closely with the entire Aridhia team, collaborative partners, products, and perceptions to build relationships, brands and marketing strategies. Study design was a randomised, multicentre trial of glycaemic therapies in newly diagnosed type two diabetes patients. The prevalent national diabetes population of Scotland has increased from 103,835 (2%) in 2002 to 258,570 in 2012, representing 5% of the Scottish population (Scottish Diabetes Survey)4. This has the potential to translate into massive long-term cost savings for the NHS through the prevention of costly hospital admissions and complications care. Figures are the Relative Risk Reduction observed per 1% reduction in mean updated HbA1c at 10 years (n=3,642).

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