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

https://doi.org/10.1016/j.diabres.2013.11.022Get rights and content

Abstract

Aims

This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs).

Methods

We used data from the 2011 Survey on Living with Chronic Diseases in Canada – Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received.

Results

We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control.

Conclusion

Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.

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.

References (35)

  • S.B. Harris et al.

    Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study)

    Diabetes Res Clin Pract

    (2005)
  • M. Braga et al.

    Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada

    Can J Cardiol

    (2010)
  • L. Guariguata et al.

    Global estimates of the prevalence of hyperglycaemia in pregnancy for 2013 for the IDF Diabetes Atlas

    Diabetes Res Clin Pract

    (Nov 23, 2013)
  • Public Health Agency of Canada

    Diabetes in Canada: facts and figures from a health perspective

    (2011)
  • Public Health Agency of Canada Steering Committee on Health-Adjusted Life Expectancy

    Health-adjusted life expectancy in Canada: 2012 report by the Public Health Agency of Canada

    (2012)
  • UK Prospective Diabetes Study Group

    Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes: UKPDS 34

    Lancet

    (1998)
  • UK Prospective Diabetes Study Group

    Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38

    BMJ

    (1998)
  • C.J. McCabe et al.

    Evaluation of a diabetic foot screening and protection programme

    Diabetic Med

    (1998)
  • CDC Diabetes Cost-effectiveness Group

    Cost-effectiveness of intensive glycemic control, intensified hypertension control, and serum cholesterol level reduction for type 2 diabetes

    JAMA

    (2002)
  • P. Gaede et al.

    Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes

    N Engl J Med

    (2003)
  • R. Collins et al.

    MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial

    Lancet

    (2003)
  • P. Gaede et al.

    Effect of a multifactorial intervention on mortality in type 2 diabetes

    N Engl J Med

    (2008)
  • P. Gaede et al.

    Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study

    Diabetes Care

    (2008)
  • Look AHEAD Research Group

    Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial

    Arch Intern Med

    (2010)
  • C. Pimouguet et al.

    Effectiveness of disease-management programs for improving diabetes care: a meta-analysis

    CMAJ

    (2011)
  • T.A. Wadden et al.

    Four-year weight losses in the look AHEAD study: factors associated with long-term success

    Obesity (Silver Spring)

    (2011)
  • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

    Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada

    Can J Diabetes

    (2008)
  • Cited by (9)

    • Care Endpoints in Adults With Type 2 Diabetes: Screening and Therapeutic Targets at a Canadian Tertiary Diabetes Care Centre

      2023, Canadian Journal of Diabetes
      Citation Excerpt :

      Achievement of targets was encoded in a binary fashion. As assessment of therapeutic levels and timely screening are discrete variables, chi-square analysis was done to compare our targets with other pertinent studies in Canada, which include results from the CIHI, the 2011 SLCDC, the DM-SCAN and Aronson et al (13–15,17). p<0.05 was considered significant.

    • A Scoping Review of Foot Screening in Adults With Diabetes Mellitus Across Canada

      2022, Canadian Journal of Diabetes
      Citation Excerpt :

      The approach to screening was poorly characterized and variably reported across studies (Table 2). Eighteen studies specified that foot examination was conducted by either the participants themselves or by a health-care provider (13–22,24–27,29,31–33). No article reported the use of a specific screening tool.

    View all citing articles on Scopus
    View full text