Transcript www.secscn.nhs.uk

Diabetes Clinical Advisory Group
Strategic Clinical Cardiovascular network, for heart, stroke,
renal and diabetes
“Bringing people together to advise on what good services
look like to improve health care for our population now and
for future generations”
SEC Strategic Clinical Networks
September 2013
2 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
The human cost of diabetes
Diabetic
retinopathy
Leading
cause
of blindness
in
working‐age
adults
Diabetic
nephropathy
Leading cause of
end‐stage renal disease
3 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Stroke
2‐ to 4‐fold increase
in cardiovascular
mortality and stroke
Cardiovascular
disease
8/10 die from CV
events
Diabetic
neuropathy
Leading cause of
non‐traumatic lower
extremity
amputations
National Priorities
The following priorities were identified by, Jonathan Valabhji, NHS England
National Clinical Director (NCD) for Diabetes:
• Tackle obesity
• Early diagnosis – approximately 750,000 undiagnosed people with diabetes
• Managing people well – 9 standard primary care processes (54% nationally
last year); control glucose, blood pressure and cholesterol
• Integrated care and proactive management - Efficient management of those
with complications
• Diabetic Foot disease
• Identify groups at high risk of CVD
4 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
SEC CCG Priorities
• Diabetes integrated care models
• Footcare for patients with diabetes (being led by Diabetes
UK)
• 9 primary care quality check processes
• Training and education for both clinicians and patients
5 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
CCG Outcome Indicators
Domain
1
Reducing premature death in CVD patients
• 1.4 Myocardial infarction, stroke and stage 5 chronic kidney disease in people with
diabetes
Domain
2
Enhancing quality of life for people with long term conditions
• 2.4 People with diabetes who have received nine care processes
• 2.5 People with diabetes diagnosed less than a year who are referred to structured
education
• 2.7 Unplanned hospitalisation for asthma, diabetes and epilepsy (under 19s)
• 2.8 Complications associated with diabetes, including emergency admission for
diabetic ketoacidosis and lower limb amputation
Domain
3
Helping people recover from illness or injury
• 3.2 Emergency readmissions within 30 days of discharge from hospital
Domains 4 and 5
Ensuring people have a positive experience of care
Treating and caring for people in a safe environment and protecting them from harm
6 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Driving forces
• CVD Outcomes Strategy 2013
• CCG Clinical outcome indicators
• National Diabetes Clinical Director work programme
• Diabetes National Services Framework
• Diabetes UK Integrated Care
• NICE guidance
• Diabetes UK Foot-care programme
7 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Cardiovascular (CVD) Outcomes Strategy 2013
• Manage CVD as a single family of disease
• Improve prevention and risk management by making benchmarked data
about CVD risk factors available
• Improve prevention and risk management by supporting the successful
implementation of the NHS Health Check programme.
• Improving and enhancing case finding in primary care
• Better identification of very high risk families and individuals
• Better early management and secondary prevention in the community
• Improve acute care
• Improve care for patients living with CVD
• Improve end of life care for patients with CVD
• Improve intelligence, monitoring and research and support commissioning
8 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Challenges for CVD SCN team so far
• Obtaining legacy information
• Data
• Sources / validation
• No data analyst support in the SCN
• Organisational start-up and negotiating within the
new NHS environment
• Small team
• Geographical area
9 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Increasing prevalence
• It is estimated there are more than 3million people in the
UK living with diabetes. 2.5 million people are diagnosed
and by 2020 3.8 million are expected to have diabetes
• If current trends continue these numbers will rise to 5
million, or 8% of the population, by 2025
– 10% have Type 1 diabetes
– 90% have Type 2 diabetes
• Up to 7 million people at high risk
Diabetes is the No.1 health threat in the UK
• > 3m with diabetes today
%
Population
7
• 5m people by 2025
Diabetes
6
5
4
Heart
disease
3
2
1
Cancer
0
2006–7
2007–8
Diabetes
Cancer
2008–9
Coronary Heart Disease
Stroke and mini-stroke
2009–10
Increasing prevalence
Levels of diabetes in the South East coast area
2030 estimate of diabetes, assuming obesity
continues to rise at the current rate
2013 estimated prevalence of diabetes
by local authority
2030 estimate of diabetes, assuming obesity stabilises
at the 2010 rate
13 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: Diabetes Prevalence Model for local authorities in England, YHPHO Diabetes Health Intelligence 2012
Contains Ordnance Survey data © Crown copyright and database right 2013
Increase in unnecessary complications 2006-10
Amputations
Angina
Cardiac failure
Kidney failure
Stroke
Retinopathy
26%
33%
43%
56%
87%
118%
Source: Derived from National Diabetes Audit Data
National Diabetes Audit Participation
2011-12 GP practice participation by PCT
120.00%
England average
100.00%
SEC average
80.00%
Brighton and Hove City PCT
60.00%
East Sussex Downs and Weald
PCT
Eastern and Coastal Kent PCT
40.00%
Hastings and Rother PCT
Medway PCT
20.00%
Surrey PCT
West Kent PCT
0.00%
Brighton
and Hove
City PCT
East
Eastern Hastings Medway
Sussex
and
and Rother
PCT
Downs
Coastal
PCT
and Weald Kent PCT
PCT
Surrey
PCT
15 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
West Kent
PCT
West
Sussex
PCT
Variation in Care
Source: NDA
2009/10
Quality of diabetes care in the South East coast area
There are nine care processes which have been identified as essential in high quality care for people with diabetes. The National
Institute for Clinical Excellence (NICE) recommends that all patients age over 12 should have all nine care processes each year.
These are:
 Urinary albumin
 Eye screening
 Foot exam
 Smoking review
 Body Mass Index (BMI)
 Cholesterol
 Blood creatinine
 HbA1c
 Blood pressure
Percentage of those with diabetes receiving all nine care processes by primary care trust (PCT)
for 2010/11
Type 1
diabetes
Type 2
diabetes
17 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The information on this poster is taken from National Diabetes Audit 2010-2011 Report 1: Care Processes and Treatment Targets, produced by
the Health and Social Care Information Service. Contains Ordnance Survey data © Crown copyright and database right 2013
Quality of diabetes care in the South East coast area
Percentage of those with Type 1 and Type 2 diabetes receiving all nine care processes
by PCT for 2010/11
Type 2 diabetes
Type 1 diabetes
England
England
Hastings and Rother
48.6%
67.5%
Eastern and Coastal Kent
41.2%
62.4%
Surrey
38.7%
56.2%
Brighton and Hove City
38.6%
43.3%
West Sussex
34.8%
52.0%
East Sussex Downs and Weald
30.1%
47.3%
West Kent
28.8%
44.1%
Medway
28.4%
36.5%
0%
40%
80%
0%
40%
80%
Percentage of those with Type 1 and Type 2 diabetes meeting all treatment targets
by PCT for 2010/11
Type 2 diabetes
Type 1 diabetes
England
England
Hastings and Rother
16.4%
21.1%
Brighton and Hove City
16.1%
19.7%
Surrey
14.5%
20.9%
East Sussex Downs and Weald
13.6%
21.8%
Eastern and Coastal Kent
13.2%
21.1%
West Sussex
11.6%
20.3%
West Kent
11.6%
18.1%
Medway
11.0%
21.8%
0%
10%
20%
30%
0%
10%
18 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
20%
30%
Source: The information on this poster is taken from National Diabetes Audit 2010-2011 Report 1: Care Processes and Treatment Targets, produced by
the Health and Social Care Information Service. Contains Ordnance Survey data © Crown copyright and database right 2013
Inpatient activity in the South East coast
Acute complications - Diabetic
Ketoacidosis (DKA) by primary care
trust (PCT) 2010/11
Above expected
As expected
Below expected
Additional risk of death among
people with diabetes compared to
the local population by primary
care trust (PCT) 2010/11
Above expected
As expected
Below expected
Source: The information is taken from National Diabetes Audit 2010-2011 Report 2:
Complications and Mortality, produced by the Health and Social Care Information
Service.
Contains Ordnance Survey data © Crown copyright and
database right 2013
Inpatient activity in the South East coast
Day case rates for people with diabetes compared to those without diabetes 2010/11 by
clinical care group (CCG) % difference between observed and expected counts.
Dartford, Gravesham
and Swanley
Surrey
Heath
Medway
Swale
NW
Surrey
Thanet
Crawley
Canterbury and coastal
Surrey
Downs
E Surrey
W Kent
NE Hampshire
and Farnham
Guilford and
Waverley
Ashford
Horsham and
Mid Sussex
S Kent coast
High Weald
Lewes Havens
Hastings
and Rother
West Sussex
Brighton
and Hove
Eastbourne, Hailsham
and Seaford
20 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: Hospital Episode Statistics, The Information Centre for Health and Social Care. Contains Ordnance Survey data © Crown copyright and database right 2013
Contains National Statistics data © Crown copyright and database right 2013
Inpatient activity in the South East coast
Length of stay for people with diabetes compared to those without diabetes 2010/11
by clinical care group (CCG) % difference between observed and expected counts.
Dartford, Gravesham
and Swanley
Surrey
Heath
Medway
Swale
NW
Surrey
Thanet
Crawley
Canterbury and coastal
Surrey
Downs
E Surrey
W Kent
NE Hampshire
and Farnham
Guilford and
Waverley
Ashford
Horsham and
Mid Sussex
S Kent coast
High Weald
Lewes Havens
Hastings
and Rother
West Sussex
Brighton
and Hove
Eastbourne, Hailsham
and Seaford
21 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: Hospital Episode Statistics, The Information Centre for Health and Social Care. Contains Ordnance Survey data © Crown copyright and database right 2013
Contains National Statistics data © Crown copyright and database right 2013
Inpatient activity in the South East coast
Emergency readmissions for people with diabetes compared to those without diabetes
2010/11 by clinical care group (CCG) % difference between observed and expected
counts.
Dartford, Gravesham
and Swanley
Surrey
Heath
Medway
Swale
NW
Surrey
Thanet
Crawley
Canterbury and coastal
Surrey
Downs
E Surrey
W Kent
NE Hampshire
and Farnham
Guilford and
Waverley
Ashford
Horsham and
Mid Sussex
S Kent coast
High Weald
Lewes Havens
Hastings
and Rother
West Sussex
Brighton
and Hove
Eastbourne, Hailsham
and Seaford
22 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: Hospital Episode Statistics, The Information Centre for Health and Social Care. Contains Ordnance Survey data © Crown copyright and database right 2013
Contains National Statistics data © Crown copyright and database right 2013
Inpatient activity in the South East coast
Emergency length of stay for people with diabetes compared to those without diabetes
2010/11 by clinical care group (CCG) % difference between observed and expected
counts.
Dartford, Gravesham
and Swanley
Surrey
Heath
Medway
Swale
NW
Surrey
Thanet
Crawley
Canterbury and coastal
Surrey
Downs
E Surrey
W Kent
NE Hampshire
and Farnham
Guilford and
Waverley
Ashford
Horsham and
Mid Sussex
S Kent coast
High Weald
Lewes Havens
Hastings
and Rother
West Sussex
Brighton
and Hove
Eastbourne, Hailsham
and Seaford
23 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: Hospital Episode Statistics, The Information Centre for Health and Social Care. Contains Ordnance Survey data © Crown copyright and database right 2013
Contains National Statistics data © Crown copyright and database right 2013
Understanding your outcomes and expenditure
Increasingly, local areas are finding it useful to compare what they spend on services with the outcomes patients actually
experience. The charts below show outcomes and expenditure information 2011/12 for clinical commissioning groups (CCGs) in
the South East coast.
Total spend on prescribing compared to people with diabetes with a HbA1c of 59mmol/mol or less
CCGs in South East Coast
All other CCGs
Code CCG name
3
Low costs
Good Outcomes
09C
09E
09J
09W
10A
10D
10E
99J
09D
09F
09G
09H
09L
09N
09P
09X
09Y
10C
99H
99K
High costs
Good Outcomes
2
09N
10C
09F
1
People with
diabetes with
a HbA1c of
59 mmol/mol
or less
0
99K
10A
09P
09W 09C
09X
99H
09E
99J
09Y
10E
09D
09L
10D
09J
09H
09G
-1
-2
95% confidence box
Low costs
Poor Outcomes
-3
-3
-2
High costs
Poor Outcomes
-1
0
1
Total spend on prescribing
24 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The Information Centre for Health and Social Care
2
3
NHS Ashford
NHS Canterbury and Coastal
NHS Dartford, Gravesham and Swanley
NHS Medway
NHS South Kent Coast
NHS Swale
NHS Thanet
NHS West Kent
NHS Brighton and Hove
NHS Eastbourne, Hailsham and Seaford
NHS Coastal West Sussex
NHS Crawley
NHS East Surrey
NHS Guildford and Waverley
NHS Hastings and Rother
NHS Horsham and Mid Sussex
NHS North West Surrey
NHS Surrey Health
NHS Surrey Downs
NHS High Weald Lewes Havens
Understanding your outcomes and expenditure
Increasingly, local areas are finding it useful to compare what they spend on services with the outcomes patients actually
experience. The charts below show outcomes and expenditure information 2011/12 for clinical commissioning groups (CCGs) in
the South East coast.
Spend on blood glucose testing items compared to people with diabetes with a HbA1c of
59mmol/mol or less
CCGs in South East Coast
All other CCGs
Code CCG name
3
Low costs
Good Outcomes
High costs
Good Outcomes
2
10C
1
People with
diabetes with
a HbA1c of
59 mmol/mol
or less
09C
09E
09J
09W
10A
10D
10E
99J
09D
09F
09G
09H
09L
09N
09P
09X
09Y
10C
99H
99K
10A
09C
09W
10E
09N
09P
09F
99H
09E
09Y
99K
09X
99J
09D
0
09L
09H
09G
10D
-1
-2
09J
95% confidence box
Low costs
Poor Outcomes
-3
-3
-2
High costs
Poor Outcomes
-1
0
1
2
Spend on blood glucose testing items
25 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The Information Centre for Health and Social Care
3
NHS Ashford
NHS Canterbury and Coastal
NHS Dartford, Gravesham and Swanley
NHS Medway
NHS South Kent Coast
NHS Swale
NHS Thanet
NHS West Kent
NHS Brighton and Hove
NHS Eastbourne, Hailsham and Seaford
NHS Coastal West Sussex
NHS Crawley
NHS East Surrey
NHS Guildford and Waverley
NHS Hastings and Rother
NHS Horsham and Mid Sussex
NHS North West Surrey
NHS Surrey Health
NHS Surrey Downs
NHS High Weald Lewes Havens
Understanding your outcomes and expenditure
Increasingly, local areas are finding it useful to compare what they spend on services with the outcomes patients actually
experience. The charts below show outcomes and expenditure information 2011/12 for clinical commissioning groups (CCGs) in
the South East coast.
Average spend on insulin items compared to people with diabetes with a HbA1c of 59mmol/mol or less
CCGs in South East Coast
All other CCGs
Code CCG name
3
Low costs
Good Outcomes
09C
09E
09J
09W
10A
10D
10E
99J
09D
09F
09G
09H
09L
09N
09P
09X
09Y
10C
99H
99K
High costs
Good Outcomes
2
09N
10C
99K
1
99J
People with
diabetes with
a HbA1c of
59 mmol/mol
or less
09F 09P
09X
99H
09C 09W
10A
09E
09Y
10E
0
09D
09J
09L
-1
-2
10D
09G
09H
95% confidence box
Low costs
Poor Outcomes
-3
-3
-2
High costs
Poor Outcomes
-1
0
1
Average spend on insulin
26 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The Information Centre for Health and Social Care
2
3
NHS Ashford
NHS Canterbury and Coastal
NHS Dartford, Gravesham and Swanley
NHS Medway
NHS South Kent Coast
NHS Swale
NHS Thanet
NHS West Kent
NHS Brighton and Hove
NHS Eastbourne, Hailsham and Seaford
NHS Coastal West Sussex
NHS Crawley
NHS East Surrey
NHS Guildford and Waverley
NHS Hastings and Rother
NHS Horsham and Mid Sussex
NHS North West Surrey
NHS Surrey Health
NHS Surrey Downs
NHS High Weald Lewes Havens
Foot care in the South East coast area
Episodes of inpatient care for diabetic foot disease per 1,000 people with diabetes
Incidence
per 1,000
30
25
09F
10E
20
10C
09D
09P
09N
09C
99K
09L
15
10D
09H
10
09J
09X
09W
99H
10A
09Y
09E
99J
09G
5
0
10000
20000
30000
40000
Population with diabetes
Significance Limits
England
All CCGs
SE coast
27 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The information on this poster is taken from Hospital Episode Statistics (HES) and Information Centre for Health and Social Care
Foot care in the South East coast area
Average length of stay for diabetic foot disease per 1,000 people with diabetes
Nights
per
1,000
250
09F
09P
200
09D
09N
09W
09J
10E
99K
09C09L
10A
09Y
10C
99J
10D
150
09G
99H
09H
100
09X
09E
50
0
10000
20000
30000
40000
Population with diabetes
Significance Limits
All CCGs
England
SE coast
28 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The information on this poster is taken from Hospital Episode Statistics (HES) and Information Centre for Health and Social Care
Foot care in the South East coast area
Major amputations
Incidence
per 1,000
3
2
10E 09F
10A
09C
09Y
10D
09L
1
09X09P 09D
09H
10C
09J
09N 09E
99H
99K
09G
09W
99J
0
0
10000
20000
30000
Population with Diabetes
Significance Limits
All CCGs
England
SE coast
29 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The information on this poster is taken from Hospital Episode Statistics (HES) and Information Centre for Health and Social Care
40000
Foot care in the South East coast area
Minor amputations
Incidence
per 1,000
4
3
09F
09J
99J
09H 10E
09C
09D 09W 09Y
10C 09L 99K
09P
10A
10D
09E 99H
09N
09X
2
1
09G
0
0
10000
20000
30000
Population with Diabetes
Significance Limits
All CCGs
England
SE coast
30 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The information on this poster is taken from Hospital Episode Statistics (HES) and Information Centre for Health and Social Care
40000
Foot care in the South East coast area
Number of episodes of inpatient care per patient
One episode of care
NHS Dartford, Gravesham and Swanley
39%
NHS Guildford and Waverley
43%
NHS Surrey Downs
50%
NHS Crawley
47%
NHS Ashford
57%
NHS Surrey Health
45%
NHS Brighton and Hove
36%
NHS Medway
48%
NHS High Weald Lewes Havens
NHS Coastal West Sussex
Two or three episodes of care
Four or more episodes of care
NHS Eastbourne, Hailsham and Seaford
49%
37%
14%
17%
NHS Horsham and Mid Sussex
52%
34%
14%
33%
17%
NHS Hastings and Rother
43%
43%
13%
36%
16%
NHS Thanet
47%
41%
13%
16%
NHS West Kent
51%
36%
12%
16%
NHS East Surrey
51%
37%
12%
15%
NHS North West Surrey
57%
37%
14%
NHS South Kent Coast
63%
49%
36%
14%
NHS Swale
50%
47%
39%
14%
NHS Canterbury and Coastal
65%
0%
25%
43%
19%
40%
27%
39%
49%
50%
75% 100%
31 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Source: The information on this poster is taken from Hospital Episode Statistics (HES) and Information Centre for Health and Social Care
0%
25%
31%
12%
28% 10%
41%
8%
28% 6%
50%
75% 100%
% Admitted with foot Disease
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
32 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Amputation rates
CCG
Major amputations
per 1000 with
diabetes
0.9
All amputations per
1000 with diabetes
1.7
4.2
0.9
2.7
High Weald, Lewes & 0.5
Havens
Brighton & Hove
0.9
2.5
West Kent
0.8
3.3
Dartford, Gravesham 0.8
& Swanley
3.3
National average
Eastbourne,
Hailsham & Seaford
Hastings & Rother
33 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
2.6
2.9
Amputation rates cont.
CCG
National average
Major amputations
per 1000 with
diabetes
0.9
All amputations per
1000 with diabetes
2.6
South Kent Coast
Canterbury & Coastal 0.8
2.1
Thanet
1.6
3.8
Ashford
1.3
3.4
Swale
1.1
2.2
Medway
0.9
2.8
34 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Amputation rates cont.
CCG
National average
Major amputations All amputations per
per 1000 with
1000 with diabetes
diabetes
0.9
2.6
Coastal West Sussex
1.0
3.0
Horsham & Mid
Sussex
Crawley
0.9
1.8
0.7
2.9
Surrey Downs
0.7
2.0
Guildford & Waverley
0.7
1.8
Surrey Heath
0.6
2.5
East Surrey
0.8
2.7
North West Surrey
1.1
3.0
35 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Type 1 Diabetes Patient
Structured Education
Programmes
MINT1E
DAFNE
LOCAL
36 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Type 2 Diabetes Patient
Structured Education
Programmes
Derek
DESMOND
XPERT
LOCAL
37 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
SEC Inpatient Patient Satisfaction
120.0%
100.0%
80.0%
60.0%
40.0%
20.0%
0.0%
38 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Emerging Themes
• Integrated Models of Care
• Footcare pathways
• The NICE 9 Primary Care Checks
• GP and patient education
• Retinopathy
• Early diagnosis/misdiagnosis
39 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Cross-network emerging priorities
• Palliative Care
• Smooth transition for patients moving between children’s
and adult healthcare services
• Rehabilitation
• Seven day a week services
40 ] NHS | CVD SCN Presentation to Diabetes CAG September 2013
2012
Resident population
1 NHS Ashford CCG
2 NHS Brighton and Hove CCG
3 NHS Canterbury and Coastal CCG
4 NHS Eastbourne, Hailsham and Seaford CCG
5 NHS Coastal West Sussex CCG
6 NHS Crawley CCG
7 NHS Dartford, Gravesham and Swanley CCG
8 NHS East Surrey CCG
9 NHS Guildford and Waverley CCG
10 NHS Hastings and Rother CCG
11 NHS Medway CCG
12 NHS Horsham and Mid Sussex CCG
13 NHS North West Surrey CCG
14 NHS South Kent Coast CCG
15 NHS Surrey Heath CCG
16 NHS Swale CCG
17 NHS Thanet CCG
18 NHS West Kent CCG
19 NHS High Weald Lewes Havens CCG
20 NHS Surrey Downs CCG
Number
Prevalence
Lower
uncertainty
limit
Upper
uncertainty
limit
6,601
14,080
11,733
12,352
31,061
5,838
14,150
9,311
10,538
12,571
14,175
11,611
18,331
13,085
4,970
6,003
8,916
7.1%
6.2%
7.2%
8.2%
7.9%
6.9%
7.2%
6.7%
6.4%
8.4%
6.7%
6.5%
6.8%
7.9%
6.6%
7.1%
8.2%
5.1%
4.2%
5.2%
6.1%
5.8%
4.5%
5.0%
4.8%
4.6%
6.0%
4.7%
4.7%
4.7%
5.6%
4.7%
5.0%
5.7%
10.6%
9.4%
10.4%
11.7%
11.5%
11.6%
11.3%
10.7%
10.5%
11.9%
10.3%
10.6%
11.3%
11.3%
11.1%
10.2%
11.7%
24,622
6.7%
4.9%
10.3%
9,885
7.3%
5.4%
10.9%
15,379
6.8%
4.9%
11.4%
42 ] NHS | CVD SCN Diabetes CAG Presentation September 2013
Diagnosed Missing
Prevalence
5.7%
4.0%
5.5%
5.8%
5.9%
5.7%
5.7%
4.6%
4.3%
5.9%
6.6%
4.7%
5.3%
6.4%
5.0%
6.7%
6.8%
5.1%
5.2%
4.6%
1.4%
2.2%
1.7%
2.4%
2.0%
1.2%
1.5%
2.1%
2.1%
2.5%
0.1%
1.8%
1.5%
1.5%
1.6%
0.4%
1.4%
1.6%
2.1%
2.2%
Based
Upper
On
Certainty
Lower
Certainty
-0.6%
0.2%
-0.3%
0.3%
-0.1%
-1.2%
-0.7%
0.2%
0.3%
0.1%
-1.9%
0.0%
-0.6%
-0.8%
-0.3%
-1.7%
-1.1%
-0.2%
0.2%
0.3%
4.9%
5.4%
4.9%
5.9%
5.6%
5.9%
5.6%
6.1%
6.2%
6.0%
3.7%
5.9%
6.0%
4.9%
6.1%
3.5%
4.9%
5.2%
5.7%
6.8%