GPs drive up diabetes patients meeting BP targets to 76%

Over three quarters of diabetes patients are now meeting target BP levels, but the proportion receiving all recommended checks is down and regional variation in care persists, the National Diabetes Audit (NDA) warns.

A new high of 76% of patients with type 1 diabetes and 74% of type 2 diabetes patients managed their BP down to target levels of 140/80 or less in 2014/15.

Just five years earlier, in 2009/10, 69% of type 1 and 61% of type 2 patients were achieving these target levels.

The BP target is one of three recommended by NICE to help cut the risk of diabetes-associated cardiovascular problems.

The 2014/15 NDA draws from data on 1.9m patients with diabetes across England and Wales, and aims to provide a comprehensive view of diabetes care against NICE guidelines.

In addition to BP checks, NICE says patients should have their HbA1c, cholesterol and creatinine blood levels checked, their urine albumin/creatinine ratio checked, BMI and smoking history recorded and their feet examined.

Diabetes targets

Last year, 39% of type 1 patients received all eight checks, a fall from 45% the year before. A higher proportion – 59% – of type 2 diabetes patients received all checks, down from 68%.

The survey shows that patients under 40 are less likely than older patients to receive all checks and highlights clear geographical variation among CCG areas.

This closely follows recent warnings from ministers that variation in diabetes care is ‘unacceptable’, and any CCGs failing to meet average levels of care should be identified and forced to improve.

The minsters, comprising the House of Commons public accounts committee (PAC), also called for GP participation in the NDA to be made mandatory, citing figures that showed participation dropped below 75% in 2012/13.

This year, GP participation overall stood at just 57% of practices, but this varied largely across CCG areas, with more than a fifth of CCGs achieving over 90% participation.

Postcode lottery

The report advises practices to ‘sustain focus’ on providing glucose and BP control and investigate reasons of underachievement in people of working age and under.

Dr Bob Young, clinical lead for the audit, said: ‘It is encouraging to see that there has been a notable improvement in the blood pressure of diabetes patients. This will help to reduce heart disease, strokes and severe diabetic eye and kidney disease.

‘To further improve on these latest results… we would ask GPs and specialist services to sustain focus on improving blood pressure and blood glucose control.

‘There continues to be wide regional variation in the care and treatment of diabetes patients. We recommend that CCGs and local health boards support care providers to participate in the audit and provide forums for sharing best practice to improve underachievement.’

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