Study identifies care gap in diabetes management

Majority of Canadians living with diabetes do not receive all recommended clinical tests

OTTAWA, Dec. 3 /CNW Telbec/ - While most Canadian adults living with diabetes get regular care, they are not always getting all of the clinically recommended tests they require to prevent health complications. A new study released by the Canadian Institute for Health Information (CIHI) looked at the extent to which Canadians age 18 and older living with diabetes received four specific tests. Although many receive individual tests, such as blood glucose (HbA1c) tests, urine protein tests and dilated eye exams, and are having their feet checked for sores or irritations, the results found that fewer than one-third (32%) reported receiving all four of these clinically recommended tests from their health providers.

"This indicates there is room for improvement in the care Canadians living with diabetes are receiving," says Greg Webster, Director of Primary Health Care Information at CIHI. "Better management and control of diabetes can help prevent serious health complications and prolong life for people with diabetes."

More than 2 million Canadians have diabetes. It is the single largest cause of blindness in Canada and a leading cause of kidney failure, lower limb amputations and cardiovascular complications such as heart disease, according to a previous study by Statistics Canada. CIHI's analysis, Diabetes Care Gaps and Disparities in Canada, found that within the past 12 months

    -   81% of all Canadians with diabetes received an HbA1c test, which
        measures blood glucose levels over a period of time,
    -   74% received a urine protein test to measure kidney function and
    -   51% had their feet checked for sores or irritations.

In the past two years

    -   66% received a dilated eye exam.

When asked if they had received the HbA1c exam, urine protein test and foot check in the past year, as well as the dilated eye exam in the past two years, only 32% said yes to receiving all four tests. Adults with diabetes who used insulin-a group with greater disease severity-were more likely to receive all four care components than those who did not use insulin (50% versus 28%, respectively).

While it is clinically recommended to have these tests performed by a health care provider, Canadians living with diabetes can also practise some self-care preventive measures between visits to their doctors. The analysis found that half (50%) of adults with diabetes self-monitored their blood glucose levels on a daily basis and that just over half (58%) checked their feet for sores, or had a family member or friend check them, at least once a week.

Care varies by region, household income

CIHI's study found significant variations by province in the proportion of people with diabetes who reported they had received all four recommended tests within the study period. Results ranged from lows of 21% of adults with diabetes in Newfoundland and Labrador and 22% in Manitoba to highs of 39% of people with diabetes in British Columbia and 37% in Saskatchewan.

Large gaps were also found between people of different household income levels. The percent of adults with diabetes who received all four recommended care tests in the past two years was highest in the highest household income group (42%) and lowest in the lowest income group (21%).

"Diabetes control involves a complex combination of actions from both the patient and the health care provider," says Dr. Alan Katz, Research Director, Department of Family Medicine, and associate professor, departments of Family Medicine and Community Health Sciences, University of Manitoba. "In addition to taking the necessary medications and insulin, people living with this condition need to modify their lifestyles in order to avoid complications, such as blindness or limb amputations. It is imperative that all people living with diabetes receive self-management guidance from their health care providers and put together a personal plan that will help fend off associated health effects."

The report and the following figures are available from CIHI's website at

    Figure 1  Age-Standardized Percentage of Adults 18 and Older With
              Diabetes Who Received Recommended Care Components From a Health
              Care Professional, Canada, 2007 (Figure 3 in the report)

    Figure 2  Age-Standardized Percentage of Adults 18 and Older With
              Diabetes Who Received a Dilated Eye Exam in the Past Two Years,
              for Canada and by Province/Territory, 2007 (Figure 7 in the

    Figure 3  Age-Standardized Percentage of Adults 18 and Older With
              Diabetes Who Received Recommended Care Components, by Household
              Income, Canada, 2007 (Figure 10 in the report)

SOURCE Canadian Institute for Health Information

For further information: For further information: Media contacts: Angela Baker, (416) 549-5402, Cell: (416) 459-6855,; Tonya Johnson, (613) 694-6610, Cell: (613) 296-2580,

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