October 11, 2022 A snapshot of diabetes management in Canada

The biggest health burden diabetes creates is through complications like heart attack, stroke, kidney failure, or lower-limb amputation. These complications can often be prevented or delayed with timely screening and treatment.

According to Diabetes Canada’s Clinical Practice Guidelines (CPG), adults with diabetes should have four screening tests at least once a year to determine the management of their diabetes and the risk of complications. These tests are A1C (every 3-6 months, depending on the previous level), blood pressure (once a year, or more if blood pressure is high), LDL cholesterol (once a year), and kidney function (once a year).

What did we do?

Diabetes Canada commissioned a study to find out how well people living with diabetes are meeting these screening targets. The researchers used data from primary care electronic medical records that had no identifying details but still allowed them to track the care of individual patients over a two-year period.

While our study only reported data for Ontario, the type of diabetes, age, gender, height, and body-mass index of the patients are typical of people throughout Canada who live with diabetes.

What did the results tell us?

Test frequency

Our study revealed that the vast majority of adults with diabetes are not being tested at the recommended frequency.

Test frequency was analyzed for 15,203 adults. Most Canadian adults with diabetes are not getting the recommended number of tests at the right time. A1C should have been tested at least 4 times over the two-year study period, and more often if results were high, to meet the CPG recommendations. But only 17% of the people we studied met this target.

While the results for blood pressure were somewhat better with 69% meeting the target, that still means that nearly a third did not.

And the majority of people in the study were not tested for LDL cholesterol or kidney function at the recommended times, with less than a third meeting targets.

How many tests are completed during a two-year period?

^{Source: IQVIA Canadian Primary Care EMR Database (Ontario), January 2018-December 2019. All IQVIA database content is based exclusively on anonymized information sourced from participating health clinics. The data in question was subjected to robust anonymization measures prior to its delivery to IQVIA, and was independently assessed against risks of re-identification to ensure an optimal protection of patient privacy.}

More about our snapshot

The healthcare data captured is not necessarily a comprehensive account of all healthcare resources accessed by these patients. It does not include treatment information by out-of-clinic physicians to which the patient was referred, primary care that is accessed outside of the medical clinic system (for example, another walk-in clinic system), care obtained outside of the province, and any trips to the hospital where the patient does not provide the hospital with the contact information of their clinic’s primary care physician. However, when you pair the low-frequency rate of recommended tests with the actual test results, a picture emerges of less-than-optimal diabetes management.

Test results 

More than two-thirds and up to as many as three-quarters of adults with diabetes have test results that are above recommended target levels.

Risk factors, including smoking status, were analyzed for 4,609 adults. Ninety-six per cent of adults with diabetes in this study group had at least one result higher than the recommended level. The results ranged from 38% above target for A1C, to a majority of people (75%) above target for blood pressure. Fifty-two per cent had higher-than-recommended results for LDL cholesterol, and 40% for kidney function.

How many adults with diabetes have test results above recommended target levels?

_{*For some people, a higher A1C target is appropriate.}

^{Source: IQVIA Canadian Primary Care EMR Database (Ontario), January 2018-December 2019. All IQVIA database content is based exclusively on anonymized information sourced from participating health clinics. The data in question was subjected to robust anonymization measures prior to its delivery to IQVIA, and was independently assessed against risks of re-identification to ensure an optimal protection of patient privacy.}

What could account for these test results?

Active management of diabetes means that healthy behaviour and medication changes are addressed when results are above recommended targets. What we don’t know is why these results are missing the mark. There are a variety of factors that could play a role, including but not limited to:

• Reduced access to timely health care
• Unaffordability of diabetes medications
• Unfamiliarity with the risks associated with diabetes-related complications
• Competing demands for healthcare providers that limit their ability to fully support people with diabetes
• Stigma experienced by people living with diabetes
• Lack of equity in health-care delivery across Canada

The good news?

There are steps you can take to help prevent or reduce complications and improve outcomes for people with diabetes whether you’re a healthcare provider, caregiver or an adult living with diabetes.

Healthcare providers

• Ensure your patients are being screened according to the CPG recommendation. Help your patients stay healthy with the ABCDESSS of diabetes care.

Adults living with diabetes and/or their caregivers

• Ask your healthcare provider what screening tests you need to help prevent complications. That way, you can follow the ABCDESSS of staying healthy with diabetes.

With the upcoming tabling of a comprehensive diabetes framework by the federal government, we hope that with the framework’s implementation, the challenges highlighted in this study can be addressed.

^{Source: IQVIA Canadian Primary Care EMR Database (Ontario), January 2018-December 2019. All IQVIA database content is based exclusively on anonymized information sourced from participating health clinics. The data in question was subjected to robust anonymization measures prior to its delivery to IQVIA, and was independently assessed against risks of re-identification to ensure an optimal protection of patient privacy.}