National clinical audits as distributed diabetes surveillance infrastructure: Consensus lessons from Ireland

Diabetes increasingly shapes acute-care demand through cardiovascular disease, critical illness, frailty, stroke and preventable metabolic emergencies. Yet in health systems without mature diabetes registries, much of this burden may be visible only indirectly through national clinical audits and registries.

To assess how Ireland's National Office of Clinical Audit (NOCA) captures diabetes-related intelligence across major healthcare pathways and what this reveals about national chronic disease surveillance capacity.

A structured narrative review of publicly available NOCA reports and audit publications from 2021 to 2025 was undertaken. Eligible reports had direct diabetes relevance or addressed conditions in which diabetes is a major comorbidity, risk factor or outcome modifier. Data extraction focused on population coverage, diabetes-related variables, temporal trends, hospital-level variation and reporting limitations.

Diabetes-specific reporting was recent and uneven. The 2022 paediatric diabetes feasibility study identified 3332 children and young people with type 1 diabetes across 19 centres, with major variation in multidisciplinary staffing, transition pathways, HbA1c measurement and data systems. Paediatric critical care reporting identified 232 DKA admissions among 15,288 admissions during 2014-2023. In adult acute care, diabetes was recorded in 430/1615 STEMI cases in 2024, rising from 18% in 2021 to 27% in 2024, while overall timely reperfusion declined from 67% in 2017 to 58% in 2024. Stroke, ICU, hip fracture and mortality audits were highly diabetes-relevant but did not publish diabetes-stratified outcomes.

National clinical audit infrastructures may function as distributed chronic disease intelligence systems even in the absence of mature integrated diabetes registries.