Australian National Diabetes Information Audit & Benchmarking (ANDIAB) 2011 Final Report

2.4 NSW Clinical Management Guidelines for Diabetes

A summary of the process and outcome for the seven key areas of the NSW Clinical Management Guidelines for Diabetes; namely, Blood Glucose Control, Eyes, Weight, Blood Pressure, Feet, Lipids and Renal Function

Page last updated: December 2011

The NSW Clinical Management Guidelines for Diabetes12 concentrate on 7 key areas of patient assessment and management, namely Blood Glucose Control, Eyes, Weight, Blood Pressure, Feet, Lipids, and Renal Function. Also NHMRC Evidence Based [EB] Guidelines Criteria where relevant

With regard to these, for all data [except Feet (see below)] :

Blood Glucose Control

See section 2.4.1 for more detail

Process:

HbA1c – Overall 91.7% of patients had an HbA1c measurement and of these 100% of patients had an HbA1c assay upper limit of normal range [ULN] measurement recorded. Thus in 91.7%, an assessment of the relationship of the HbA1c result to the ULN could be made.

Outcome:

See Table 10 and 10[a] for more results
≤1% above ULN (30.2%);
1-2% above ULN (27.2%);
>2% above ULN (42.6%).

Eyes

See section 2.4.2 for more detail

Process:

A total of only 41.0% of patients were recorded as having seen an Ophthalmologist and 38.1% an Optometrist in the last 12 months.
[25.2% had seen either an Ophthalmologist or an Optometrist].
A total of 65.2% [R] & 65.2% [L] had a retinal assessment recorded. Only 48.6% [R] & 48.5% [L] had a visual acuity recorded.

Outcome:

A total of 25.6% [Right] and 25.7% [Left] & 27.4% [Either or Both] of those with a retinal assessment recorded, had a Diabetes Abnormality. A total of 5.3% [Right] and 5.3% [Left] of those who had a visual acuity recorded, had V/A ≥ 6/36.

Weight /Height [BMI kg/m2]

See section 2.4.3 for more detail

Process:

96.2% of patients had a weight measurement and 86.5% of patients and had a height measurement, so BMI could be calculated for 86.2% of patients overall.

Outcome:

≤25 kg/m2 (18.7%); 25-27 kg/m2 (10.6%); >27 kg/m2 (70.8%)

Blood Pressure

See section 2.4.4 for more detail

Process:

Blood Pressure was recorded for 96.9% [n=4484] of individuals. BP plus Age were recorded for 95.9% [n=4437]. Whether or not on Antihypertensive therapy was recorded as ‘Yes’ for 67.9%, and of these, 52.2% were recorded as being on an ACE Inhibitor, 8.4% on an ACE Inhibitor+Thiazide, 34.2% on an A2 Antagonist, 19.9% on an A2 Antagonist+Thiazide, 39.0% on a Calcium Antagonist, 32.9% on a Beta Blocker, 8.5% on a Thiazide & 17.3% ‘Other’.

Outcome:

≤60 yrs and BP <140/90 (75.5%);
≤60 yrs and BP ≥140/90 (24.5%);
>60 yrs and BP <160/90 (87.2%);
>60 yrs and BP ≥160/90 (12.8%);
Overall NHMRC EB Guidelines Criteria ≤130/80 (53.0%) & >130/80 (47.0%).

Feet

See section 2.4.5 for more detail

Process:

A total of 28.0% of patients were identified as having a ”high risk foot” and a total of 34.9% were recorded as having seen a Podiatrist in the last 12 months.

Outcome:

2.1% of individuals had a current foot ulcer, an additional 2.5% an active foot lesion other than a current ulcer, and 5.5% a past history of a foot ulcer. In the last 12 months 0.7% had had a lower limb amputation. Peripheral Vascular Disease was recorded in 11.7% & Peripheral Neuropathy in 21.9%. Further analysis showed that 78/98 [79.6%] of those with current foot ulceration and 26/33 [78.8%] of those with a lower limb amputation in the past 12 months had had previous foot ulceration. 4.4% had a Foot Deformity reported.

Lipids

See sections 2.4.6 and 2.7.2 for more detail

Process:

76.2% of patients had a Cholesterol level recorded, 62.3% had an LDL Cholesterol level 66.3% had an HDL Cholesterol level, and 75.3% a Triglyceride level. Whether these lipid levels were collected fasting was recorded in 52.6% of individuals. A total of 68.5% of cases [where any lipid level was recorded] were fasting specimens.

Outcome:

Cholesterol [n=3526]
<5.5 mmol/L 87.5% 5.5-6.5 mmol/L 9.0% >6.5 mmol/L 3.5%
<5.0 mmol/L 77.7% 5.5-6.5 mmol/L 18.8% >6.5 mmol/L 3.5%
Fasting Cholesterol [n=2416]
<5.5 mmol/L 87.8% 5.5-6.5 mmol/L 8.6% >6.5 mmol/L 3.6%
<5.0 mmol/L 78.4% 5.5-6.5 mmol/L 18.0% >6.5 mmol/L 3.6%

LDL Cholesterol [n=2946]
<2.5 mmol/L 65.9% ≥2.5 mmol/L 34.0%
Fasting LDL Cholesterol [n=2090]
<2.5 mmol/L 65.5% ≥2.5 mmol/L 34.5%

NB Data in Table 15[b] (section 2.4.6) differ as they use Calculated LDL if not provided by sites

HDL Cholesterol [n=3067]
<1.0 mmol/L 27.6% ≥1.0 mmol/L 72.4%
Fasting HDL Cholesterol [n=2172]
<1.0 mmol/L 28.1% ≥1.0 mmol/L 71.9%

Triglyceride [n=3487]
<2.0 mmol/L 69.5% 2.0-4.0 mmol/L 25.2% >4.0 mmol/L 5.4%
Fasting Triglyceride [n=2394]
<2.0 mmol/L 70.2% 2.0-4.0 mmol/L 24.4% >4.0 mmol/L 5.4%

Renal Function

See table 16 section 2.4.7 for more detail

Process:

A microalbumin or urinary protein level was recorded for 65.1% of patients. Of these, 100% of patients had an assay upper limit of normal range [ULN] measurement recorded, and 85.0% of patients had the assay units stated. Thus in 55.3% of individuals overall, an assessment of the relationship of the urinary microalbumin or protein result to the ULN and respective assay units could be made.
These are the % where the text was done

Outcome:

Microalbumin [n=2256]
Normal (60.8%);
Microalbuminuria (27.0%);
Macroalbuminuria (12.3%)

Proteinuria [n=81]
<150 mg/24hr (53.1%);
150-300 mg/24hr (17.3%);
>300 mg/24hr (29.6%)

Sections 2.4.1 to 2.4.7 provide further detail on data reported in line with the NSW Clinical Management Guidelines for Diabetes12 in terms of the 7 key management areas, (one page per Guideline topic).

Appendix 4 provides a copy of the 3 page Guideline Report that formed part of the Site Data Reports (see section 1.7), - this being the Report for All Data.

[Findings / Results thence continue from section 2.5 onward].

Document download

This publication is available as a downloadable document.

Australian National Diabetes Information Audit & Benchmarking (ANDIAB) 2011 Final Report(PDF 559 KB)