Introducing the Atlas of Variation in Healthcare for People with Diabetes


There are thought to be more than 3 million people with diabetes in England. Only 2.3 million of these have been diagnosed. By 2020, 3.8 million are expected to have diabetes – more than 1 in 12 of the total population.The risk of diabetic complications can be reduced through good glycaemic control, reducing hypertension, reducing cholesterol and appropriate screening and preventative care, but there are major variations in the delivery of diabetic care across England.

“.. the indicators in this Diabetes Atlas clearly demonstrate there is considerable variation in both the processes and outcomes of care. Although it is acknowledged that some areas are providing very good care for people with diabetes, sadly, there are a substantial number of patients who are not receiving all of the nine basic care processes designed to identify treatable risks and early complications of diabetes. In the absence of these care processes, patients do not know if their level of health matches the recommended outcomes or if further care is needed, and neither do the healthcare professionals”.

Dr Rowan Hillson MBE
National Clinical Director for Diabetes

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The aim of the Diabetes Atlas is to identify and quantify the extent of ‘unwarranted’ variation that may be due to unjustified geographical differences in medical practice and/or patients not gaining access to the appropriate level of intervention for their need. The resulting suboptimal (either over-use or under-use) uptake of medical intervention is defined as ‘unwarranted’.

The Atlas has been produced in partnership with the National Diabetes Information Service and Diabetes Health Intelligence and Yorkshire and Humber PHO. It includes 22 maps of indicators relating to the key care processes and outcomes, utilisation of secondary care, diabetic complications and prescribing.

National Diabetes Information Service (NDIS)

The National Diabetes Information Service is a partnership of leading diabetes organisations, funded by NHS Diabetes, which supplies health commissioners, providers and people with diabetes with the necessary information to aid decision-making and improve services on a local and national level. NDIS provides free access for the NHS to a comprehensive suite of diabetes information products, datasets and tools through a single web portal:

Examples of resources include the:

Variation in Inpatient Activity: Diabetes (VIA: Diabetes) tool which compares inpatient activity data for those with and without diabetes to give evidence of differing patterns of care. See: VIA Diabetes tool

Diabetes Outcome Versus Expenditure (DOVE tool) which compares expenditure on diabetes care with clinical outcomes. See: DOVE tool

Diabetes Community Health Profiles benchmark key areas of diabetes care against others and can be used as a starting point for health needs assessment work. See: community health profiles

Diabetes Footcare Activity Profiles examine the scale of inpatient care of people with diabetes who are admitted to hospital for a range of footcare conditions and relate this to similar. See: footcare profiles


Other available tools

Diabetes-E can be used to measure and benchmark the performance of all aspects of a system of diabetes care, and its use actively encourages continuous improvement to meet and surpass national standards. Further information

PCT Spend and Outcome Factsheets and Tool (SPOT) helps commissioners to link health outcomes and expenditure using programme budgeting, a technique for assessing programmes of care rather than services. It provides information on spending and outcomes across a range of programme budgets for each PCT. See: SPOT

National Diabetes Audit (NDA) compiles data on the care processes received, treatment outcomes, and hospital admissions and treatment for diabetic complications. A dashboard has been produced that confers the ability to compare care processes, treatment targets and complications at PCT level. Further details

Disease Management Information Toolkit (DMIT) – Diabetes has information on emergency hospital admissions for patients aged less than 19 years with a primary diagnosis of diabetes at primary care trust (PCT) level. DMIT enables PCTs to compare their emergency admission rates, bed-days and lengths of stay with a range of comparators. See: DMIT