Diabetes NHS Long Term Plan Commitments ‘Met and Exceeded’ – Medscape
Outcomes in diabetes are something to be proud of, said England’s National Specialty Advisor for Diabetes, addressing the opening session of the Diabetes Professional Conference 2021.
He added that the last decade had seen rates of amputations, cardiovascular disease, and ho…….
Outcomes in diabetes are something to be proud of, said England’s National Specialty Advisor for Diabetes, addressing the opening session of the Diabetes Professional Conference 2021.
He added that the last decade had seen rates of amputations, cardiovascular disease, and hospital admissions all drop significantly, and much of this had been led by primary care as well as specialty services.
Professor Partha Kar, national specialty advisor for diabetes, together with Professor Jonathan Valabhji, national clinical director for diabetes and obesity, presented the annual update on the NHS England Diabetes and Obesity Programmes at the meeting, held in-person in London.
The update was dominated by the effect of the pandemic on delivery of care from the perspective of both clinicians and patients. Prof Valabhji pointed out that faced with the onslaught of COVID and the desperate need for a solution, the emphasis was on disentangling the unknowns at that time. “In severe outcomes there was a clear association between COVID and HbA1c, and BMI in the obese range. Our rich NHS datasets have provided info that other countries’ can’t do.”
QCOVID Risk Prediction Algorithm
He pointed out that in trying to identify the most at-risk patients, they were challenged with creating the QCOVID risk prediction algorithm for risk of hospitalisation and mortality from COVID-19 in adults.
“The QCOVID database stratifies diabetes by type as well as by level of deprivation and provides an absolute and relative risk score,” explained Prof Valabhji. “This work fed into prioritisation groupings for roll out of COVID vaccines.”
QCOVID was also extended to look at risk of COVID post-vaccination. “The absolute risk of hospitalisation and death was massively reduced by the vaccine, but the relative risk is similar to pre-vaccine times in patients with diabetes,” Prof Valabhji pointed out. “For type 2 diabetes after vaccination, there remains a 28% higher risk of COVID mortality with HbA1c below 59 mmol/mol and 76% higher risk in patients with type 2 diabetes and HbA1c above 59 mmol/mol.”
Diabetes 8 Care Processes Pre-COVID and Since COVID
Turning to the recovery of routine diabetes care post-COVID, Prof Valabhji pointed out that the surrogate measure for routine diabetes care is the state of delivery of the eight diabetes care processes. “By ethnicity, one would have expected the biggest fall in routine care in Black and Asian communities rather than White populations, but our data show the opposite, so the fall off in routine care was biggest in White patients.”
Between 2016-17 and 2020-21 there was a year-on-year modest but steady increase in the completion of all eight care processes up to 2019-20, but this declined in the year of COVID, he said. In 2017-18 (the year in which the highest percentage of patients …….
