This diabetes domain investigates the quality of care given to people with diabetes. The data is not intended to form a basis for judgement or definitive statements of quality, rather to raise questions about potential areas for quality improvement.
The indicators were developed with the help of an expert advisory group.
Selected findings from the Atlas are summarised below. For all indicators and detailed commentary, see the Atlas dashboards, where you can search by age, ethnic group, year, and health district.
If haemoglobin A1c (HbA1c) in a person with diabetes does not meet an agreed target with dietary and lifestyle changes, drug therapy is recommended. Evidence suggests good glycaemic control benefits microvascular outcomes.[1]
Having comprehensive cardiovascular risk management for people with diabetes (such as blood pressure and lipid management) has been shown to improve macrovascular outcomes substantially while good glycaemic control has a smaller and very delayed effect.
Given both the lack of available data on clinical parameters and the inability to split data by diabetes type, medication indicators provide a high-level view. Wide variation may raise questions such as do health districts with lower-than-average rates of medication use have lower or higher rates of diabetes complications.
Metformin remains the standard initial drug treatment for type 2 diabetes.
Newer medicines, including sodium-glucose co-transporter 2 (SGLT-2) inhibitors such as empagliflozin, have been available since February 2021. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as dulaglutide, have been available since September 2021 and liraglutide since March 2023.
These medicines are fully funded for the treatment of people with poorly controlled type 2 diabetes (individuals with HbA1c levels > 53 mmol/mol) who are at high risk of, or have established cardiovascular disease, diabetic kidney disease or heart failure, or who are of Māori or Pacific ethnicity.
As these medicines are new and only funded for some people, interpret these rates with caution. Since we define regular dispensing as people receiving medication for three or four quarters in a year, it is possible to miss individuals who started these medicines later in the year.
Insulin therapy is used for both type 1 and type 2 diabetes.
Intensive management of blood pressure and microalbuminuria is recommended to prevent progression of renal disease in diabetes. ACEI and ARB medicines are first-line treatments. The younger the age at diagnosis, the greater the impact of diabetes on life expectancy; this highlights the importance of glycaemic control, blood pressure management and prevention of kidney disease in younger people with diabetes.
Māori and Pacific peoples have higher rates of ACEI or ARB medicine use at a younger age (25-44 years); however, some data also shows these populations have significantly higher rates of end-stage renal disease. A recent publication from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) found that Māori and Pacific peoples in Aotearoa New Zealand are at a significantly heightened risk of succumbing to the impacts of diabetic kidney disease reaching kidney failure (Māori 65 percent, Pacific peoples 67 percent), a two-fold greater likelihood than non-Māori non-Pacific (29 percent).[2]
Note this indicator counts people with diabetes who had one or more amputations in a year. Our analyses excluded people who died during the year. Also, if someone had multiple amputations within the year, they are counted only once.
This indicator measures the number and percentage of medical and surgical bed-days occupied by people with diabetes (for any reason), compared with total occupied medical and surgical bed-days.
The Laboratory Claims Collection includes tests performed in the community. The exclusion of hospital and point-of-care tests will under-count testing and may affect results more in some districts than in others. Some districts in the Laboratory Claims dataset also had incomplete data, with dramatically lower test volumes than expected. We excluded districts with a significant drop in data volumes for more than two months within the year, as this pattern indicates incomplete or unreliable data rather than genuine changes in service use.
We analysed rates for people with diabetes who received one or more laboratory tests in a year for HbA1c, albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).
In 2024, 84.2 percent of people with diabetes received an HbA1c test, 62.8 percent an ACR test and 83 percent an eGFR test.
Rates differed by ethnic grouping for certain tests. For example, Māori (57.3 percent) and European/Other (61.9 percent) were significantly less likely to have undergone ACR testing, compared with those of Indian (69.3 percent) and Pacific populations (68.8 percent). From 2019 through to 2024 for all age groups, men were more likely to have regular ACR testing compared with women.
Table 1 shows the percentage of people with diabetes receiving all three tests by age and ethnic group (2024).
| Ethnic group | Age group (years) (%) | ||||
| 25 - 44 | 45 - 64 | 65 - 74 | 75+ | Total | |
| Māori | 44.2 | 58.2 | 61.9 | 57.5 | 55.1 |
| Pacific peoples | 55.3 | 72.2 | 74.3 | 65.5 | 67.5 |
| Indian | 54.7 | 74.5 | 76.4 | 66.8 | 67.7 |
| European/other | 48.4 | 62.3 | 65.6 | 58.1 | 59.8 |
| Total (including those under 25 years) | 50.1 | 64.3 | 66.9 | 59.0 | 60.9 |
If haemoglobin A1c (HbA1c) in a person with diabetes does not meet an agreed target with dietary and lifestyle changes, drug therapy is recommended. Evidence suggests good glycaemic control benefits microvascular outcomes.[1]
Having comprehensive cardiovascular risk management for people with diabetes (such as blood pressure and lipid management) has been shown to improve macrovascular outcomes substantially while good glycaemic control has a smaller and very delayed effect.
Given both the lack of available data on clinical parameters and the inability to split data by diabetes type, medication indicators provide a high-level view. Wide variation may raise questions such as do health districts with lower-than-average rates of medication use have lower or higher rates of diabetes complications.
Metformin remains the standard initial drug treatment for type 2 diabetes.
Newer medicines, including sodium-glucose co-transporter 2 (SGLT-2) inhibitors such as empagliflozin, have been available since February 2021. Glucagon-like peptide-1 (GLP-1) receptor agonists, such as dulaglutide, have been available since September 2021 and liraglutide since March 2023.
These medicines are fully funded for the treatment of people with poorly controlled type 2 diabetes (individuals with HbA1c levels > 53 mmol/mol) who are at high risk of, or have established cardiovascular disease, diabetic kidney disease or heart failure, or who are of Māori or Pacific ethnicity.
As these medicines are new and only funded for some people, interpret these rates with caution. Since we define regular dispensing as people receiving medication for three or four quarters in a year, it is possible to miss individuals who started these medicines later in the year.
Insulin therapy is used for both type 1 and type 2 diabetes.
Intensive management of blood pressure and microalbuminuria is recommended to prevent progression of renal disease in diabetes. ACEI and ARB medicines are first-line treatments. The younger the age at diagnosis, the greater the impact of diabetes on life expectancy; this highlights the importance of glycaemic control, blood pressure management and prevention of kidney disease in younger people with diabetes.
Māori and Pacific peoples have higher rates of ACEI or ARB medicine use at a younger age (25-44 years); however, some data also shows these populations have significantly higher rates of end-stage renal disease. A recent publication from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) found that Māori and Pacific peoples in Aotearoa New Zealand are at a significantly heightened risk of succumbing to the impacts of diabetic kidney disease reaching kidney failure (Māori 65 percent, Pacific peoples 67 percent), a two-fold greater likelihood than non-Māori non-Pacific (29 percent).[2]
Note this indicator counts people with diabetes who had one or more amputations in a year. Our analyses excluded people who died during the year. Also, if someone had multiple amputations within the year, they are counted only once.
This indicator measures the number and percentage of medical and surgical bed-days occupied by people with diabetes (for any reason), compared with total occupied medical and surgical bed-days.
The Laboratory Claims Collection includes tests performed in the community. The exclusion of hospital and point-of-care tests will under-count testing and may affect results more in some districts than in others. Some districts in the Laboratory Claims dataset also had incomplete data, with dramatically lower test volumes than expected. We excluded districts with a significant drop in data volumes for more than two months within the year, as this pattern indicates incomplete or unreliable data rather than genuine changes in service use.
We analysed rates for people with diabetes who received one or more laboratory tests in a year for HbA1c, albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR).
In 2024, 84.2 percent of people with diabetes received an HbA1c test, 62.8 percent an ACR test and 83 percent an eGFR test.
Rates differed by ethnic grouping for certain tests. For example, Māori (57.3 percent) and European/Other (61.9 percent) were significantly less likely to have undergone ACR testing, compared with those of Indian (69.3 percent) and Pacific populations (68.8 percent). From 2019 through to 2024 for all age groups, men were more likely to have regular ACR testing compared with women.
Table 1 shows the percentage of people with diabetes receiving all three tests by age and ethnic group (2024).
| Ethnic group | Age group (years) (%) | ||||
| 25 - 44 | 45 - 64 | 65 - 74 | 75+ | Total | |
| Māori | 44.2 | 58.2 | 61.9 | 57.5 | 55.1 |
| Pacific peoples | 55.3 | 72.2 | 74.3 | 65.5 | 67.5 |
| Indian | 54.7 | 74.5 | 76.4 | 66.8 | 67.7 |
| European/other | 48.4 | 62.3 | 65.6 | 58.1 | 59.8 |
| Total (including those under 25 years) | 50.1 | 64.3 | 66.9 | 59.0 | 60.9 |
A short report summarising the rural-urban differences in diabetes indicators during 2019-2022, including diabetes prevalence, medication use, and hospital admissions, can be downloaded as a PDF.
This Atlas domain draws on data contained in the Virtual Diabetes Register (VDR), which was developed by the Ministry of Health Manatū Hauora to estimate and track the number of people diagnosed with diabetes.
The VDR combines and filters various sources of health information, including the National Minimum Dataset, the National Non-admitted Patients Collection (outpatients), the Pharmaceutical Collection, the Laboratory Claims Collection and the Primary Health Organisation Enrolment Collection.
The VDR was used to estimate diabetes prevalence. It is based on health service use rather than confirmed diagnoses or laboratory results, so results should be interpreted with caution. The VDR may include people with prediabetes, which could lead to an overestimation of diabetes prevalence.
Please note some of the source data that informs the VDR has not been consistently reported across all districts in Aotearoa New Zealand. Several data gaps have been identified and are likely to affect the accuracy of the VDR (with sensitivity/coverage). So, results at regional level based on the VDR should be interpreted with some caution. For more information on data quality issues see the Health New Zealand Virtual Diabetes Register Technical Guide
The Pharmaceutical Collection contains claim and payment information from community pharmacists for subsidised dispensing. This collection does not indicate whether a medicine was taken or whether the dose was effective. Over-the-counter medicines are not included. Note our definition of regular medication use only includes people receiving medication for three or more quarters in a year. It should be noted that we did not consider people who initiate medication later in the year.
In selecting indicators for oral hypoglycaemic medication use, the expert advisory group for this Atlas domain decided to focus on medicines like metformin, sulfonylureas, vildagliptin, empagliflozin and GLP-1 agonists as the medicines for people with type 2 diabetes and insulin as the key medication for people with type 1 diabetes.
There is no ideal rate of medicine use in people with diabetes because it depends on clinical need. However, wide variation between districts or ethnic groups raises questions as to why the rate of medicine use varies.
There were some limitations as to what measures could be presented. It was not possible to reliably split people by type of diabetes; hence the indicators represent a combination of those with type 1 and type 2 diabetes. Generally, most people with diabetes aged 0–24 years will have type 1 diabetes, while around 90 percent and over of those aged 25 years and above will have type 2 diabetes.
The method used in the VDR to identify people with diabetes is less accurate at identifying children than adults with diabetes. Local district data may be a better source for identifying prevalence in children. The National Diabetes Register is currently under development. Once it is live, it will be possible to split results by type 1 and type 2 diabetes.
Due to limitations in currently available data, we could not explore certain outcome indicators, including screening for diabetic retinopathy, retinopathy rates and end-stage renal failure. Outcome indicators, including myocardial infarction rates, stroke and other cardiovascular outcomes, are not included in this version of the diabetes Atlas domain, but are likely to be included in future updates. We encourage users to investigate local data in relation to these outcomes to promote improvement and equity initiatives at PHO and general practice level.
The Pharmaceutical Collection contains claim and payment information from community pharmacists for subsidised dispensing. This collection does not indicate whether a medicine was taken or whether the dose was effective. Over-the-counter medicines are not included. Note our definition of regular medication use only includes people receiving medication for three or more quarters in a year. It should be noted that we did not consider people who initiate medication later in the year.
In selecting indicators for oral hypoglycaemic medication use, the expert advisory group for this Atlas domain decided to focus on medicines like metformin, sulfonylureas, vildagliptin, empagliflozin and GLP-1 agonists as the medicines for people with type 2 diabetes and insulin as the key medication for people with type 1 diabetes.
There is no ideal rate of medicine use in people with diabetes because it depends on clinical need. However, wide variation between districts or ethnic groups raises questions as to why the rate of medicine use varies.
There were some limitations as to what measures could be presented. It was not possible to reliably split people by type of diabetes; hence the indicators represent a combination of those with type 1 and type 2 diabetes. Generally, most people with diabetes aged 0–24 years will have type 1 diabetes, while around 90 percent and over of those aged 25 years and above will have type 2 diabetes.
The method used in the VDR to identify people with diabetes is less accurate at identifying children than adults with diabetes. Local district data may be a better source for identifying prevalence in children. The National Diabetes Register is currently under development. Once it is live, it will be possible to split results by type 1 and type 2 diabetes.
Due to limitations in currently available data, we could not explore certain outcome indicators, including screening for diabetic retinopathy, retinopathy rates and end-stage renal failure. Outcome indicators, including myocardial infarction rates, stroke and other cardiovascular outcomes, are not included in this version of the diabetes Atlas domain, but are likely to be included in future updates. We encourage users to investigate local data in relation to these outcomes to promote improvement and equity initiatives at PHO and general practice level.
The diabetes Atlas domain links with The Government Policy Statement on Health and the 2026 National Diabetes Roadmap which outlines priority actions to improve care for people with diabetes in Aotearoa New Zealand.[4,5] This includes work towards each Health New Zealand district meeting the 26 quality standards published in 2020.[6] These standards link with many of the measures presented in the diabetes Atlas domain.
