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

Executive Summary

A summary of the methods, findings, discussion and recommendations of the report

Page last updated: December 2011

ANDIAB [Australian National Diabetes Information Audit & Benchmarking] is a well established, important biennial, quality activity conducted by the National Association of Diabetes Centres [NADC], in specialist diabetes services across Australia, in all States and Territories, [although in some years, some States and Territories have not submitted data]. Participating specialist diabetes services, [Diabetes Centres and specialist endocrinologists in private practice], receive an individualised report comparing their diabetes practice processes, and patient outcome data, with their peers.

In 2011, 39 Diabetes Centre members of the NADC and 3 specialist endocrinologists in private practice, provided de-identified data on a total of 4629 individuals seen during the one-month survey period of May [or June] 2011, or a period of 2011 from those using an in-house database. The dataset collected was the Australian Diabetes Society [ADS] NDOQRIN [National Diabetes Outcomes Quality Review INitiative] minimum dataset for quality care in diabetes, published as The Data Set Specification - Diabetes – National Health Data Dictionary Version 12 – Australian Institute of Health and Welfare [AIHW]. This dataset has since been enhanced, and is now online as part of the AIHW – Metadata Online Registry [‘METeOR’] as the Diabetes (clinical) Data Set Specification at http://meteor.aihw.gov.au/content/index.phtml/itemId/304865. The dataset contains demographic, clinical, biochemical and outcome data items that have standardised definitions, and has been promulgated for collection in all clinical practice settings. The participants in the ANDIAB 2011 survey completed a one page scannable form, or provided data electronically by email, containing these data items.

Based on feedback from participants in previous ANDIAB collections, and review of experience in the 2006 Diabetes Collaborative, several enhancements were made to the dataset collected in 2009. It was decided to collect the same dataset in 2011 with the addition of just two fields related to eGFR [see What's New? - E]. The previously created separate data collection form for individuals eighteen years of age or less containing data items of most relevance to them, was not utilised as Specialist Paediatric Hospitals and services did not contribute data in 2011.

In addition to the primary output audit report to participants, the data form an important source of cross-sectional data on the clinical status of individuals attending specialist diabetes services across the country. Analysis of the pooled data from this exercise forms the basis of this report. Prior to analysis and reporting, every effort was made to ensure data were complete and correct. Sites were given an opportunity to supply any missing data and to validate questionable data. This reduced the missing data in six of the nine elements sought, by a half - to over 85% {52.2-86.9%} [see Table 24[a] page 24]. Any remaining questionable data after site review and correction were excluded from analysis. All identified duplicate records were removed.

Data have been analysed in total, and reported as Adult Forms [all 4629 individuals reported], since there were no Paediatric data collected in 2011. Outcomes are reported as the % of the total patient group unless otherwise indicated. An exception example is the percent with microalbuminuria, where the analysis is noted to represent the percent of those where the test result was provided.

Pooled data analysis has been undertaken and data have been grouped in order to assess various aspects of patient status. Results indicate:

      • a slight preponderance of males [53.5% overall];
                        [52.0 % - Adult Forms in 2009];
      • an average age of 57.2 17.3 years, [56.8 17.3 years - Adult Forms in 2009];
      • an average duration since diagnosis of diabetes of 13.9 10.6 years, [13.3 10.4 years - Adult Forms in 2009]; and
      • a total of 72.5% Type 2 diabetes and 22.7% Type 1 diabetes overall.
        Patient Status
        All Forms
        % / Mean + SD
        Adult Forms
        % / Mean + SD
        Paediatric Forms
        % / Mean + SD
        Gender - Males
        53.5%
        Average Age
        57.2 17.3
        Average Duration
        13.9 10.6
        Diabetes Type - Type 1
        22.7%
        Diabetes Type - Type 2
        72.5%
In regards to Risk Factors there were:
      • 9.9% current smokers [10.3% in Adult Forms in 2009];
      • 57.0% on anti-hypertensive therapy [52.2% in Adult Forms in 2009]; and
      • 60.2% on anti-lipid therapy [52.9% in Adult Forms in 2009].
        Risk Factors
        All Forms %
        Adult Forms %
        Paediatric Forms %
        Current Smokers
        9.9%
        Past Smokers
        23.5%
        On Anti-hypertensive therapy
        57.0%
        On Anti-lipid therapy
        60.2%
Blood Glucose Control data showed a Mean Glycated Haemoglobin of 8.5 + 1.8% for Type 1 & 8.0 + 1.7% Type 2 for All (first Table below), with 30.2% <1% above the Upper Limit of Normal & 42.6% >2% above the Upper Limit of Normal (second Table below).
Glycated Hb
[All n]
All
n = 4629
Adult
n = 4629
Paediatric
n = 0
Overall
4244
8.1 1.7
Type 1
993
8.5 1.8
Type 2
3114
8.0 1.7
Glycated Hb
[All n]
All
n = 4629
Adult
n = 4629
Paediatric
n = 0
≤1% above ULN
1281
30.2%
1-2% above ULN
1156
27.2%
Type 2>2% aboe ULN
1807
42.6%
Missing ULN or HbA1c
385
9.1%
In those where a lipid test result was reported [Adult Forms] (see Table below):
      • 11.3% had an elevated Total Cholesterol level [above 5.5 mmol/L];
      • 19.9% had an elevated Total Cholesterol level [above 5.0 mmol/L];
      • 34.5% had an elevated LDL Cholesterol level [> 2.5 mmol/L];
      • 27.8% had an elevated Triglyceride level [above 2.0 mmol/L]; and
      • 27.6% had a reduced HDL Cholesterol level [below 1.0 mmol/L].
        Lipid test results
        All Forms %
        Adult Forms %
        Paediatric Forms %
        Total Cholesterol > 5.5
        11.3%
        Total Cholesterol > 5.0
        19.9%
        LDL Cholesterol > 2.5
        34.5%
        Triglyceride > 2.0
        27.8%
        HDL Cholesterol < 1.0
        27.6%
Data regarding current patient status [Adult Forms] revealed the presence of:
      • a current foot ulcer in 2.1% [1.7 % in 2009];
      • an active foot lesion [other than an ulcer] in 2.5% [1.8 % in 2009];
      • a previous foot ulcer history in 5.5% [3.9 % in 2009];
      • Peripheral Vascular Disease in 11.7% [9.8 % in 2009]; and
      • Peripheral Neuropathy in 21.9% [18.6 % in 2009].
        Current patient status
        All Forms %
        Adult Forms %
        Paediatric Forms %
        Current foot ulcer
        2.1%
        Active foot lesion
        2.5%
        Previous foot ulcer
        5.5%
        Peripheral Vascular Disease
        11.7%
        Peripheral Neuropathy
        21.9%
Diabetes Complications [or Events], were reported as either having developed or been discovered in the previous twelve months, or prior to the last twelve months. An assessment of ‘This Complication/Event at Any Time’ represents the percent of the Adult patient group [n=4629] where each individual with an event in and/or prior to the last 12 months [or both] is counted only once; for example 12.0% of individuals had at least one Myocardial Infarct [see Table below & Tables 7a-7c pages 12-13].
Findings were:
Last 12 months
Prior to Last 12 months
This Event at Any Time
Severe Hypoglycaemia
4.8%
Not Assessed
N/A
Myocardial Infarct
4.0%
8.8%
12.0%
CABG/Angioplasty/Stent
2.7%
9.5%
11.6%
Cerebral Stroke
1.6%
4.2%
5.6%
End Stage Renal Disease #
0.4%
2.4%
2.8%
Lower Limb Amputation
0.7%
2.1%
2.6%
New Blindness
0.9%
1.0%
1.3%
Erectile Dysfunction [%males] #
2.1%
22.6%
25.2%

[ # Represents data for ‘Yes’ in the last 12 months & ‘No’ previously for these items {excluding those with ‘Yes’ in last 12 months and ’Missing’ previously}. If these are included the respective Adult % would be ESRD 0.5% and ED 2.6%}. See Table 7[a] page12 for full explanation of these calculations].


Notes

[1] In 2009 a significant amount of the data provided [5498 of the 8563 individuals] came from established in-house databases [ie Electronic data]. In 2011 this was again substantial [1300 of the 4629 individuals]. Some data fields not recorded in these databases have contributed to the increased amount of Missing Data overall, and make comparison of ‘ANDIAB Process performance’ difficult to compare to previous years.

[2] In 2009 Six ‘Electronic’ data sites provided ‘grouped’ rather than ‘individual’ data for Blood Pressure [BP], HbA1c and Lipids, [ie they provided their BP data, in fact, as either <130/80 or >=130/80 rather than the actual recorded BP level, as this is how they recorded and stored these data in their databases]. These sites subsequently made the decision to change the way they collected and recorded these data (to enable them to be able to compare with their peers), and thus in 2011 provided actual results for Blood Pressure, HbA1c and Lipids.

ANDIAB is a biennial quality exercise undertaken in specialist diabetes services, from which large amounts of previously unavailable data are provided. These data can assist in reporting diabetes indicators, and be analysed to inform on the health status of, and outcomes present in, individuals with diabetes assessed in this clinical practice setting.

ANDIAB could be applied to diabetes management assessment in other clinical practice settings including primary care, and the process has potential applicability in other chronic disease settings.

ANDIAB 2011 had participation of every State and Territory (except NT), but no participation by Specialist Paediatric Centres. Despite this, with the equal second largest number of participating sites [42] since 1999, and the fourth largest number of individuals’ data ever reported [4629], it has been a successful initiative this year.

In its current form, with a minimal number of sites with in-house databases providing data (and thus a reliance on scannable paper form technology), ANDIAB will, in our view, be difficult for sites to sustain. There needs to be a concerted effort by Specialist Diabetes Services to acquire electronic databases from which they can not only run their day-to-day activities and communicate with referring health professionals, but also undertake research and participate in quality initiatives such as ANDIAB. If most sites had in-house databases the potential would exist to extract data more frequently and provide comparative audit reports, perhaps again on an annual basis.

Another issue of concern relates to the ‘repetitive’ nature of the data collection, a concern raised at the Best Practice and Diabetes Centres [BPDC] Meeting in July 2011. It was suggested that an alternative could be a smaller and/or more targeted data collection if ANDIAB continues in the future. A further option could be to conduct a longitudinal follow-up review analysis as was done in 2003, however this would be labour intensive for Sites and possibly a less attractive alternate option.

Finally, it should be noted that the Commonwealth funded ANDIAB Project 2011-2012 has provided funds not only for ANDIAB 2011, but also an ANDIAB2 collection in 2012 and for the Central ANDIAB database application to be further reviewed and revised. One of several enhancements to ANDIAB reporting capabilities in 2009, was our ability to provide FULL Site and Doctor Reports, and this Final Report of Pooled Data, in .pdf format, including all Tables and Graphs. Thus, because of the way reports are now generated, we have the ability to provide participants with complete electronic as well as hard copy reports – [the former having not been possible prior to 2009].

We recommend

  • ANDIAB continue as a regular audit activity in specialist diabetes services;
  • That said, there needs to be a concerted effort by Specialist Diabetes Services to acquire electronic databases from which they can not only run their day-to-day activities and communicate with referring health professionals, but also undertake research and participate in quality initiatives such as ANDIAB;
  • That further improvements to the format of the data that are collected be supported in order to ensure the relevance of this exercise to participants is retained. This should include consideration of smaller and/or more targeted data collection in the future, or perhaps a longitudinal follow-up review analysis as was done in 2003;

Document download

This publication is available as a downloadable document.

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