Comparison of observed and expected frequencies of diabetes-related care process implementation and new medication initiation in people with type 2 diabetes between March and December 2020 and in April 2020, in England; created by the authors
| Between March and December 2020 | April 2020 | |||||
| Observed frequency | Expected frequency* (95% CI) | Percentage reduction (95% CI) | Observed frequency | Expected frequency (95% CI) | Percentage reduction (95% CI) | |
| Care processes | ||||||
| Haemoglobin A1c | 573 172 | 833 676 (808 345 to 859 800) | 31.2 (29.1 to 33.3) | 19 365 | 85 075 (82 493 to 87 738) | 77.2 (76.5 to 77.9) |
| Blood pressure | 522 907 | 990 146 (956 661 to 1 024 803) | 47.2 (45.3 to 49.0) | 17 652 | 100 551 (97 156 to 104 065) | 82.4 (81.8 to 83.0) |
| Cholesterol | 321 728 | 462 829 (446 824 to 479 407) | 30.5 (28.0 to 32.9) | 5831 | 47 196 (45 565 to 48 885) | 87.6 (87.2 to 88.1) |
| Serum creatinine | 635 863 | 888 188 (857 708 to 919 751) | 28.4 (25.9 to 30.9) | 21 662 | 89 467 (86 399 to 92 645) | 75.8 (74.9 to 76.6) |
| Urine albumin | 244 389 | 338 493 (319 151 to 359 007) | 27.8 (23.4 to 31.9) | 4447 | 33 087 (31 197 to 35 092) | 86.6 (85.7 to 87.3) |
| Body mass index | 352 263 | 590 024 (567 077 to 613 899) | 40.3 (37.9 to 42.6) | 12 051 | 58 423 (56 149 to 60 789) | 79.4 (78.5 to 80.2) |
| New medication | ||||||
| Antidiabetic | ||||||
| DPP-4i | 2722 | 4148 (3847 to 4473) | 34.4 (29.2 to 39.1) | 190 | 455 (422 to 490) | 58.2 (55.0 to 61.2) |
| GLP-1ag | 525 | 712 (633 to 800) | 26.3 (17.1 to 34.4) | 25 | 78 (69 to 88) | 67.9 (63.8 to 71.6) |
| Insulin | 1467 | 1245 (1164 to 1331) | −17.8 (–26.0 to –10.2) | 126 | 146 (136 to 156) | 13.7 (7.4 to 19.2) |
| Metformin | 15 055 | 18 883 (18 026 to 19 781) | 20.3 (16.5 to 23.9) | 845 | 2162 (2065 to 2265) | 60.9 (59.1 to 62.7) |
| SGLT2i | 2852 | 4183 (3656 to 4786) | 31.8 (22.0 to 40.4) | 154 | 440 (385 to 504) | 65.0 (60.0 to 69.4) |
| Sulphonylurea | 2582 | 2579 (2432 to 2735) | −0.1 (–6.2 to 5.6) | 183 | 304 (287 to 322) | 39.8 (36.2 to 43.2) |
| Any† | 15 652 | 19 261 (18 407 to 20 155) | 18.7 (15.0 to 22.3) | 888 | 2219 (2120 to 2321) | 60.0 (58.1 to 61.7) |
| Antihypertensive | ||||||
| ACEi | 3012 | 3883 (3648 to 4134) | 22.4 (17.4 to 27.1) | 153 | 437 (410 to 465) | 65.0 (62.7 to 67.1) |
| α-blocker | 1165 | 1563 (1474 to 1658) | 25.5 (21.0 to 29.7) | 101 | 171 (161 to 182) | 40.9 (37.3 to 44.5) |
| ARB | 1076 | 1534 (1433 to 1641) | 29.9 (24.9 to 34.4) | 74 | 177 (166 to 190) | 58.2 (55.4 to 61.1) |
| β-blocker | 1689 | 2009 (1903 to 2121) | 15.9 (11.2 to 20.4) | 157 | 224 (212 to 237) | 29.9 (25.9 to 33.8) |
| Calcium channel blocker | 2255 | 2994 (2825 to 3172) | 24.7 (20.2 to 28.9) | 192 | 333 (314 to 353) | 42.3 (38.9 to 45.6) |
| Diuretic | 1843 | 2101 (1982 to 2226) | 12.3 (7.0 to 17.2) | 147 | 238 (225 to 252) | 38.2 (34.7 to 41.7) |
| Any‡ | 3430 | 4376 (4159 to 4604) | 21.6 (17.5 to 25.5) | 244 | 491 (467 to 517) | 50.3 (47.8 to 52.8) |
| Lipid lowering | ||||||
| Statin | 8436 | 8041 (7436 to 8695) | −4.9 (–13.4 to 3.0) | 434 | 868 (803 to 939) | 50.0 (46.0 to 53.8) |
| Ezetimibe | 224 | 193 (157 to 236) | −16.1 (–42.7 to 5.1) | 24 | 21 (17 to 26) | −14.3 (–41.2 to 7.7) |
| Fibrate | 97 | 90 (76 to 107) | −7.8 (–27.6 to 9.3) | <5 | – | – |
| Any§ | 8428 | 8040 (7436 to 8693) | −4.8 (–13.3 to 3.0) | 434 | 869 (803 to 939) | 50.1 (46.0 to 53.8) |
| Antiplatelet | ||||||
| Aspirin | 1268 | 1163 (1084 to 1247) | −9.0 (–17.0 to –1.7) | 133 | 133 (124 to 143) | 0 (–7.3 to 7.0) |
| Clopidogrel | 888 | 1158 (1038 to 1291) | 23.3 (14.5 to 31.2) | 82 | 120 (107 to 134) | 31.7 (23.4 to 38.8) |
| Other¶ | 237 | 239 (193 to 295) | 0.8 (–22.8 to 19.7) | 17 | 26 (21 to 33) | 34.6 (19.0 to 48.5) |
| Any | 1592 | 1515 (1419 to 1617) | −5.1 (–12.2 to 1.5) | 153 | 170 (159 to 181) | 10.0 (3.8 to 15.5) |
*The expected frequencies were estimated using negative binomial regression modelling on 10 years of historical data.
†Also includes α-glucosidase inhibitors, meglitinides and thiazolidinediones (glitazones).
‡Also includes central-acting agents, peripheral adrenergic inhibitors and vasodilators.
§Also includes cholestyramine, colesevelam, colestipol, niacin, lomitapide and PCSK9 inhibitors.
¶Includes cangrelor, dipyridamole, glycoprotein inhibitors, prasugrel and ticagrelor.
ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; DPP-4i, dipeptidyl peptidase-4 inhibitor; GLP-1ag, glucagon-like peptide 1 receptor agonist; PCSK9, proprotein convertase subtilisin/kexin type 9; SGLT2i, sodium/glucose cotransporter-2 inhibitor.