OBJECTIVE -This study examines whether acute diabetes complication rates have fallen in recent years and whether geographic factors influence these trends. RESEARCH DESIGN AND METHODS -A population-based time-trend analysis of acute complications of diabetes was conducted using linked administrative and census data from Ontario, Canada. The study population included all adults identified through a province-wide electronic diabetes registry between 1994 and 1999 (n ϭ 577,659). The primary outcome was hospitalizations for hyper-and hypoglycemia and emergency department visits for diabetes. RESULTS -Between 1994 and 1999, rates of hospitalization for hyper-and hypoglycemic emergencies decreased by 32.5 and 76.9%, respectively; emergency department visits for diabetes fell by 23.9%. On multivariate analysis, fiscal year was an independent predictor of acute diabetes complications, with individuals in our cohort experiencing a decline in risk of ϳ6% per year for either being hospitalized with hyper-or hypoglycemia or requiring an emergency department visit for diabetes. After accounting for variation in physician service use, diabetic individuals living in rural areas or Aboriginal communities were nearly twice as likely to have an acute complication, whereas those residing in remote areas of the province were nearly three times as likely to experience an event. CONCLUSIONS -Although our findings suggest an overall improvement in diabetes care in Ontario, certain subgroups of the population continue to experience higher rates of complications that are potentially preventable through good ambulatory care. Measures to improve access to timely and effective outpatient care may further reduce rates of acute complications among the diabetic population. R esults of randomized trials published over the past decade have proven the importance of tight glycemic control in preventing chronic complications of diabetes (1,2). However, despite these advances in knowledge, there remains a considerable gap between the level of care recommended by evidence-based guidelines and actual practice (3,4). A broad range of provider factors have been identified as barriers to adopting evidence into practice (5,6). Reduced access to health services can also impede the optimal delivery of care, contributing to gaps between outcomes in the general population and those achieved in clinical trials. Because hospitalizations for acute diabetic emergencies should be largely avoidable, these episodes provide one measure of the quality of diabetes care provided in the ambulatory setting. The translation of evidence regarding tight glycemic control into clinical practice could result in lower rates of hospitalizations for hyperglycemia but might also lead to a rise in the use of acute care services to manage severe hypoglycemia. Studies from several countries have failed to identify a decline in acute hyperglycemic admissions on a per capita basis. However, such trends might have been masked by a concomitant rise in the prevalence of diabetes (7,8), or increasing barriers to accessing timely and effective outpatient care. In Canada, both outpatient and in-hospital medical services are universally covered through provincial health insurance plans. However, variations in health outcomes related to diabetes have been observed across geographic regions, favoring urban over rural areas (9 -11). Disparities in access to outpatient services could explain these findings. Increasing physician supply shortages over the past decade may have created further constraints to providing care to patients with diabetes and other chronic diseases in rural areas of the country (12). We conducted a population-based time-trend analysis of avoidable hospitalizations and emergency department visits related to hyper-or hypoglycemia in Ontario, Canada between 1994 and 1999 -a period during which a number of studies were published regarding the benefit of tight glycemic control. The primary purpose of this study was to examine whether the quality of diabetes care, as
In Ontario, between the years 1994-1999, acute complications of diabetes decreased by roughly 6% per year REF .
Time Trends and Geographic Disparities in Acute Complications of Diabetes in Ontario, Canada
Diabetes care
Diabetes care
Medicine