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Factors influencing variation in participation in the National Diabetes Audit and the impact on the Quality and Outcomes Framework indicators of diabetes care management
  1. Caroline E Wright1,
  2. Stephen Yeung1,
  3. Helen Knowles1,
  4. Antoinette Woodhouse1,
  5. Emma Barron2,
  6. Sian Evans1
  1. 1 Local Knowledge and Intelligence Service (East), Public Health England Midlands and East Region, Cambridge, UK
  2. 2 National Cardiovascular Intelligence Network, Public Health England Yorkshire and the Humber, Leeds, UK
  1. Correspondence to Dr Caroline E Wright; caroline.wright{at}


Objective Participation in the National Diabetes Audit (NDA) has become a contractual requirement for all general practices in England and is used as part of the assessment framework for sustainability and transformation partnership (STP) footprints. The study aimed to investigate general practice-related factors which may influence participation in the NDA, and the impact that participation in the NDA may have on diabetes management and patient care.

Research design A cross-sectional analysis of routine primary care data from 45 725 646 patients aged 17+ years registered across 7779 general practices in England was performed using logistic regression. The main outcome measures included general practice voluntary participation in the NDA, general practice-related factors (practice size, deprivation, diabetes prevalence, geographic area, practice population age) and diabetes management outcomes (cholesterol, blood pressure, hemoglobin A1c (HbA1c)).

Results Participation in the NDA differed significantly according to practice size (t(7653)=−9.93, p=0.001), level of deprivation (χ2(9)=36.17, p<0.0001), diabetes prevalence (p<0.0001), practice population age (p<0.0001), and geographic area (χ2(26)=676.9, p<0.0001). In addition, the Quality and Outcomes Framework diabetes indicator HbA1c (OR 1.01, CI 1.0 to 1.01, p=0.0001) but not cholesterol (p=0.055) or blood pressure (p=0.76) was independently associated with NDA participation when controlling for practice-related factors.

Conclusion Variation in NDA participation exists. It is suggested that some practices may need additional support when submitting data to the NDA and that NDA participation may have an impact on diabetes outcomes. However, the use of NDA outcomes as a measure of progress with diabetes care by STPs is still unclear and further investigation is needed.

  • national diabetes audit
  • diabetes management
  • primary care
  • diabetes outcomes

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  • Contributors HK conceived the study and this was developed further by CEW. Statistical design was led by CEW and SY, who extracted and analyzed the data with AW. All authors contributed to the interpretation of the results. CEW led the writing of the manuscript, to which all authors reviewed and contributed. CEW is the guarantor for this work. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and accuracy of the data analysis.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data sets used aggregated, anonymized data and did not require patient consent. The study used routinely collected data that are openly available in the public domain. The statistical code and analysis is available on request from the corresponding author (

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