Diabetes mellitus (DM) - QOF indicator

Diabetes mellitus in QOF 2026/27

The diabetes mellitus (DM) indicators cover renal protection, structured education, blood pressure and glycaemic control, lipid treatment and routine monitoring. Notable features of the 2026/27 guidance include frailty-dependent targets, recognition of equivalent home blood pressure readings and an indicator covering completion of 8 care processes.

Ongoing management indicators

Why diabetes is included

Diabetes is a frequently encountered endocrine disorder: approximately 4 million people in England had a diagnosis in March 2025. Good treatment and surveillance can lessen illness and premature death. Primary care delivers a substantial proportion of this work, especially for people with type 2 diabetes.

Most of these indicators concern activities that would normally be completed or confirmed at an annual review. Practices do not have to perform every activity themselves, but remain accountable for checking that each has taken place.

Further NICE guidance covers:

• Adult type 2 diabetes: NG28 (2015, updated 2026).

• Diabetic foot problems: NG19 (2015, updated 2019).

• Type 1 and type 2 diabetes in children and young people: NG18 (2015, updated 2023).

• Adult type 1 diabetes: NG17 (2015, updated 2022).

DM006: renal protection

Rationale

DM006 draws on NICE IND134. NICE guidance for adults with either type 1 or type 2 diabetes advises ACE-I or ARB treatment to delay renal disease progression when urine albumin:creatinine ratio (ACR) is ≥3 mg/mmol. Trial findings indicate that the greatest benefit occurs at the maximum dose listed in the BNF. NICE also advises offering SGLT2i to people with type 2 diabetes; these medicines can slow renal disease progression.

An ACE-I or ARB should be started in patients diagnosed with micro-albuminuria or proteinuria.

Reporting and verification

The DM006 definition in the table sets out the criteria used for this indicator.

DM014: structured education

Rationale

DM014 draws on NICE IND88. Much of the day-to-day work of managing diabetes falls to the person living with it, their carer, or both. Knowledge and practical self-management skills are therefore central to good outcomes, but routine consultations may not fully meet these learning needs.

Structured education (SE) combines knowledge and skills development with support for motivation and continued self-management. NICE recommends this approach for adults with type 1 and type 2 diabetes.

Every person with diabetes and/or their carer should be offered SE from diagnosis. Where group sessions are unacceptable or impractical, an alternative programme may be offered, provided its standard is equivalent.

For this indicator, referral within nine months of joining the diabetes register is considered appropriate. This interval accommodates the different expectations for referral after diagnosis in type 1 and type 2 diabetes.

Reporting and verification

Apply the criteria in the DM014 table entry. For measurement, nine months is counted as 279 days.

DM036: blood pressure control

Rationale

DM036 draws on NICE IND249. Reducing blood pressure in diabetes lowers the likelihood of both microvascular and macrovascular complications.

A single BP target for everyone can leave people with less complex needs undertreated while exposing those with complex needs and comorbidities to excessive treatment. By focusing on people without moderate or severe frailty, this indicator seeks to avoid undertreatment and improve control among those most able to benefit.

The indicator target is less stringent than the NG17 recommendation for people with type 1 diabetes aged 79 or under whose ACR is 70 mg/mmol or more: their target should be under 130/80mmHg. Clinical judgement should guide individual targets, with particular care for people of advanced age or with frailty or multimorbidity.

NICE distinguishes between clinic and home blood pressure monitoring (HBPM) targets. The clinic target of 140/90 mmHg corresponds to 135/85 mmHg for HBPM, and DM036 recognises this difference.

Reporting and verification

Assessment of DM036 follows the requirements in its table definition.

DM020: glycaemic control without moderate or severe frailty

Rationale

DM020 draws on NICE IND179. HbA1c reflects glycaemia over the preceding 8-12 weeks and is widely used to assess glucose control. Higher HbA1c is linked to greater mortality and a higher risk of macrovascular and microvascular complications.

Targets that ignore comorbidities can encourage excessive treatment, particularly in older people with type 2 diabetes and those living with frailty. DM020 supports tailoring management to frailty status, allowing people without moderate or severe frailty to gain from tighter glycaemic control.

Its target is above those in NICE guidance for adults with type 1 and type 2 diabetes. It was chosen pragmatically as a level at which clinicians should consider intensifying treatment in type 2 diabetes.

Reporting and verification

Use the DM020 table definition to establish whether its requirements are met.

DM021: glycaemic control with moderate or severe frailty

Rationale

DM021 draws on NICE IND180. Here, adjustment of care to frailty status is intended to limit complications and improve quality of life for people with moderate or severe frailty.

NICE advises agreeing an individual HbA1c target with each person, taking account of everyday activities, personal aspirations, complication risk, comorbidities and occupation. Even where moderate or severe frailty is present, the agreed target should be below the indicator level. That level represents a pragmatic upper limit intended to prevent symptomatic hyperglycaemia, rather than an individual treatment goal.

Reporting and verification

The table entry for DM021 provides its assessment criteria.

DM034: lipid treatment for primary prevention

Rationale

DM034 draws on NICE IND275. Diabetes increases cardiovascular risk. NICE guidance on cardiovascular risk assessment and lipid modification advises offering statins for primary prevention to people with type 1 diabetes if they are older than 40 years, have had diabetes for more than 10 years, or have established nephropathy or other CVD risk factors.

For type 2 diabetes, NICE recommends offering a statin when QRISK3 estimates a 10-year CVD risk of 10% or greater. The indicator's business rules recognise clinical codes for QRISK, QRISK2, QRISK3, Framingham and Joint British Societies risk score.

NICE guidance on CVD risk assessment and reduction, including lipid modification, reiterates the use of high-intensity statins: atorvastatin 20mg for primary prevention and atorvastatin 80mg for secondary prevention. DM034 also accommodates other lipid-lowering medicines when a statin is declined, cannot be tolerated or is otherwise clinically unsuitable.

Reporting and verification

The DM034 table definition specifies the requirements. Exclude from its denominator people with type 2 diabetes whose recorded 10-year CVD risk is less than 10%, where that assessment was documented in the preceding 3 years.

DM035: lipid treatment for secondary prevention

Rationale

DM035 draws on NICE IND276. NICE guidance on cardiovascular risk assessment and lipid modification advises offering lipid-lowering treatment for secondary prevention. For most patients this involves a high-intensity statin, which lowers LDL cholesterol and is associated with fewer myocardial infarctions, coronary heart disease events and strokes.

Atorvastatin 80mg is the recommended starting treatment, although some circumstances call for a lower dose or a different lipid-lowering medicine. DM035 allows for alternatives where statins are declined, not tolerated or otherwise clinically unsuitable.

Reporting and verification

Refer to the DM035 definition in the table for the criteria against which achievement is assessed.

DM037: annual care processes

Rationale

DM037 draws on NICE IND120. NICE guidance for type 1 and type 2 diabetes recommends an annual set of 8 care processes for people aged 12 years or over. Retinal screening is also advised, but is generally arranged through diabetes retinal screening services.

These processes track important risk factors and help detect and monitor complications, allowing findings to shape treatment and subsequent action. Evidence associates completion of all 8 processes with lower mortality among people with diabetes.

Reporting and verification

The DM037 table entry defines the requirements for reporting and verification.