Profile of adults with type 2 diabetes and uptake of clinical care best practices: Results from the 2011 Survey on Living with Chronic Diseases in Canada – Diabetes component
Introduction
Diabetes is reaching epidemic levels worldwide [1], and Canada is no exception. In 2008/2009, the prevalence rate of diagnosed diabetes was 8.7% among Canadian adults, and its overall prevalence increased by 70% over the last decade [2]. Diabetes may cause many long term complications, such as cardiovascular disease, nephropathy, neuropathy or retinopathy, and is associated with shorter life expectancy and health adjusted life expectancy [3]. Considerable resources are dedicated to diabetes treatment and care at the national level, and needs are expected to increase, in part due to the projected rise in diabetes rates in Canada [1].
Studies have shown an improvement in diabetes control and a reduction in complications after appropriate cost-effective interventions, including clinical treatment of associated risk factors and complications, and lifestyle management [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. This type of evidence was foundational for the development of the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs) for the prevention and management of diabetes in Canada [15], a compilation of evidence-based clinical recommendations that helps health professionals provide optimal treatment and care. However, population-based studies have reported gaps in the adherence of health professionals to recommended care for Canadian diabetic adults [16], [17], [18], [19], [20], [21]. Information about the uptake of diabetes clinical care best practices, and ultimately the quality of clinical care delivered, can inform the development of better health policies, programs and services aimed at improving the health of Canadians living with this disease. Since about 90% of Canadian diabetic adults have type 2 diabetes (T2D) [22], and as clinical monitoring and management differ by type, this study focuses on the latter only.
Using data from the 2011 Survey on Living with Chronic Diseases in Canada – Diabetes component (SLCDC-D) and CDA CPGs as indicators of optimal care, the purpose of this study was to (1) describe the profile of adults with T2D in Canada and (2) assess the uptake of clinical care best practices looking specifically at clinical monitoring, as well as recommendations on self-monitoring and lifestyle management provided by health professionals.
Section snippets
Data source and study population
The 2011 SLCDC-D is a cross-sectional survey developed by the Public Health Agency of Canada (PHAC) and administered by Statistics Canada that collected diabetes management and outcome information. Computer-assisted telephone interviews were conducted in 2010 and 2011. Respondents selected the language of their choice for the interview, including English, French, or any other preferred language. Respondents’ personal information and confidentiality were protected by the Statistics Act [23], and
Profile of Canadians with type 2 diabetes
Among SLCDC-D respondents who knew their diabetes type (89.0%, 95% CI: 87.1–90.8), 2335 (90.1%, 95% CI: 88.1–92.0) reported having T2D diagnosed by a health professional other than during pregnancy. Study participants’ mean age was 62.9 years (95% CI: 62.1–63.7). The majority were male, white, with a post-secondary diploma, a total household income over 40,000 dollars, and living in an urban area (Table 1). The mean time since diagnosis was 10.6 years (95% CI: 10.1–11.2). Detailed information
Discussion
These results highlight the high prevalence of self-reported complications/comorbidities and prescription medication use among Canadian adults with T2D. Although the majority of participants met five clinical monitoring indicators or more over the six selected, only about two-thirds met the HbA1C monitoring indicator, and less than half met the foot monitoring indicator. Lifestyle management recommendations provided by health professionals to Canadian T2D patients were also identified as an
Grant support
Marie-France Langlois is recipient of a National researcher award from the Fonds de la recherche du Québec Santé (FRQS). The Étienne-LeBel Clinical Research Center is an FRQS funded research center. Jeffrey Johnson is a Senior Scholar with Alberta Innovates-Health Solutions and a Centennial Professor at the University of Alberta.
Disclaimer
The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Public Health Agency of Canada or the Centers for Disease Control and Prevention.
Conflict of interest statement
None declared.
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