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Time Trends and Geographic Disparities in Acute Complications of Diabetes in Ontario, Canada

¹ Department of Medicine, University of Toronto, Ontario, Canada
² St. Michael’s Hospital, Toronto, Ontario, Canada
³ Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
⁴ Department of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
⁵ Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada
⁶ Department of Family and Community Medicine, University of Toronto, Ontario, Canada
⁷ Health Quality Council, Saskatoon, Saskatchewan, Canada

Address correspondence and reprint requests to Gillian L. Booth, MD, Division of Endocrinology and Metabolism, St. Michael’s Hospital, 61 Queen St. East, 6-147, Toronto, Ontario, Canada M5C 2T2. E-mail: boothg{at}smh.toronto.on.ca

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 = 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 6% 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.

Abbreviations: GEE, generalized estimating equation • ODD, Ontario Diabetes Database.

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