Less than one-third of people with diabetes are routinely undergoing the four basic tests used for monitoring disease progression
Fewer than one-third of people with diabetes are routinely undergoing the four basic tests used for monitoring disease progression and essential to preventing complications such as blindness and amputation, a new study reveals.
“This indicates there is room for improvement in the care Canadians living with diabetes are receiving,” said Greg Webster, director of primary health-care information at the Canadian Institute for Health Information.
The CIHI report, entitled “Diabetes Care Gaps and Disparities in Canada,” found that:
81 per cent of diabetics had an HbA1c test, a blood test that measures glucose levels over time;
74 per cent did a urine protein test to measure kidney function;
51 per cent had their feet checked for sores or irritations;
66 per cent had undergone a dilated eye exam.
The first three tests are done annually, while the latter test is done every two years. Only 32 per cent underwent the gamut of testing that is recommended. About two million Canadians suffer from diabetes.
Alan Katz, research director for the department of family medicine at the University of Manitoba in Winnipeg, said the four tests are important measures of the consequences of diabetes. Used properly to initiate treatment and lifestyle changes, they are key to keeping diabetes in check, he said.
“The ultimate consequence of lack of disease control is more blindness, more amputation, more kidney disease and more heart disease,” Dr. Katz said.
The poor record for testing and monitoring of diabetics should not be an indictment of physicians, he said, but rather a reminder that people with chronic illnesses need to be cared for systematically and that systems must be put in place to facilitate that care.
“With these tests, there needs to be a simple reminder system,” Dr. Katz said. Such systems are an integral part of electronic medical records.
Dr. Katz said the tests would also be done more routinely if there were incentives to do so (as there are in some provinces) and if there was a more team-based approach to primary care. “You don’t need a doctor to do these tests,” he said.
The CIHI study showed, in fact, that there are wide disparities in testing of diabetics based on a patient’s home province, income and severity of illness.
Fifty per cent of adults with diabetes who used insulin receive all four tests (HbA1c exam, urine protein test, foot check and dilated eye exam) compared with 28 per cent of those who did not use insulin. Insulin use is an indicator of severity.
In British Columbia – a province that offers incentives and where group practices are more common – 59 per cent of people with diabetes routinely underwent all four tests. At the other end of the spectrum (and the country) in Newfoundland and Labrador, only 21 per cent underwent all four tests.
Similarly, the research showed that only 21 per cent of diabetics with household incomes of less than $20,000 received the battery of four tests, compared with 42 per cent of those whose household income was above $60,000.
There are three distinct forms of diabetes: gestational diabetes is a temporary condition that occurs during pregnancy; Type 1 diabetes, usually diagnosed in children, occurs when the pancreas is unable to produce insulin; Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body does not effectively use the insulin it produces.
About 90 per cent of diabetics have type 2 disease, which is usually a consequence of obesity, inactivity, poor diet and aging.
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