National Diabetes Transition Audit, 2003-2014

The National Diabetes Transition Audit (NDTA) is a joint enterprise between the National Diabetes Audit (NDA) and the National Paediatric Diabetes Audit (NPDA).

The NDA and NPDA datasets have been linked so that the care of young people with diabetes can be tracked during the transition from paediatric diabetes services to adult diabetes services. The audit measures against the National Service Framework and NICE Clinical Guidelines and Quality Standards.

This, the first report, has been developed from the linked data sets and presents the key findings and recommendations on care processes and treatment target achievement rates from 2003-04 - 2014-15 in age groups of 12 - 24 years in England and Wales.

Key Findings

Annual Care Processes

•KF1: Annual measurement of HbA1c decreases after transition.

•KF2: Annual measurements of blood pressure and cholesterol remain similar, whereas kidney, foot, retinopathy and smoking check completion rates increase after transition.

•KF3: The differences in care process completion pre and post transition do not appear to be influenced by gender, ethnicity, or living in a deprived area.

•KF4: Pre-transition annual care process completion rates fall as age at transition increases, while post-transition completion rates increase as age at transition increases. A similar pattern is seen for duration of diabetes.

•KF5: The least variation in care process completion rates was found where transition occurred between the age of 16 and 19 years. This may be because planned transition usually occurs during this time window. Planned movement from paediatric to adult care is less likely at younger and older ages.

Treatment Targets (HbA1c)

•KF6: The HbA1c target is more likely to be reached pre-transition compared to post-transition; the difference is greatest at younger ages.

•KF7: The decrease in meeting the HbA1c target is not influenced by gender, ethnicity, or living in a deprived area.

Risk Factors

•KF8: For both cholesterol and blood pressure, the percentage of children achieving the targets are higher pre-transition compared to post-transition.

Diabetic Ketoacidosis (DKA)

•KF9: There are a higher number of DKA admissions post-transition. However, this maybe due to the fact that DKA rates increase with increasing duration of diabetes.