ICES 306 This report represents an important first step toward examining patterns of diabetes Conclusion prevalence, health outcomes and service availability in Ontario communities. The findings we present will enable local policymakers and health planners to examine the performance of key measures relevant to diabetes care in a given region or community. This information, in turn, can be used to set regional priorities for program planning and development and can help with the development of regional indicators to measure and guide improvement. LESSONS LEARNED Diabetes prevalence rates were highest in the Greater Toronto Area and in Ontario’s First Nations communities. The last decade has seen a dramatic rise in the prevalence of diabetes in Ontario, affecting all segments of the population and all regions. However, ethnic groups that have a greater predisposition for developing diabetes (those of First Nations, South Asian, African and Hispanic descent) continue to experience the greatest burden of diabetes in terms of disease prevalence and incidence. Our findings call for comprehensive, culturally appropriate diabetes prevention programs targeting high-risk communities, in addition to broader-scale policies aimed at curbing the ongoing rise in obesity and diabetes. Conclusion ICES 307 Diabetes complication rates were highest in findings underscore the need for patient- The distribution of endocrinologists was northern and rural areas of the province— centred models of chronic disease limited largely to major centres. As the where access to care is more challenging— management that address multiple conditions majority of individuals with diabetes live in or and lowest in urban areas. Further research concurrently. More complex patients may close to a major centre, the geographical is needed to fully understand the factors benefit from primary care models that have location of these specialists may not be an driving these disparities and how they can be access to team members from other impediment for them. Those living in remote addressed. Outcomes may be narrowed in disciplines, such as social workers, mental settings, however, are likely to experience part by greater access to care; however, health workers and case managers, and from substantial barriers to accessing care from variations in risk across populations related specialist diabetes programs, such as the specialists. If so, a variety of means may be to ethnicity and the social determinants of newly developed Complex Diabetes Care necessary to remedy this gap, including health may also play a role. Measures to Centres and other specialist models. capitalizing on existing telemedicine improve the health of high-risk populations initiatives. The Ministry of Health and Long- Access to diabetes programs and services will need to address the geographic barriers Term Care has a well-established mobile was greatest in urban centres. However, given to accessing care experienced by those living retinal screening program that serves the high burden of diabetes in urban in remote settings, as well as non-geographic northern communities where access to eye communities, existing service capacity in barriers (e.g., language, poverty, medication care specialists is more limited. However, these regions may still be insufficient. costs, access to affordable and healthy foods, there are a number of areas in the province Diabetes programs and their satellites appear and opportunities for physical activity). While where ophthalmologists are lacking. Access to be well distributed throughout the province, complication rates were generally lowest in to optometrists was much greater, potentially but we did not have information on the urban communities, the number of people filling an important gap in access to eye care number of employees at each site, the experiencing these complications was for the diabetic population. Our data sources services offered or clients seen (including greatest in such areas, which has an lacked information on wait times for volumes, demographics, comorbidities or enormous impact on health service provision specialists and other non-geographic barriers details on diabetes control). Such information and planning. to accessing these services. is essential for understanding the extent to Concomitant medical and mental health which existing services are meeting the needs problems were common among people living of local populations with diabetes and the with diabetes in Ontario. For practitioners, efficiency with which these services are being competing medical and social issues may utilized. Enhanced programs and services detract from diabetes care; for patients, designed for those living in poverty, recent coexisting conditions such as depression and immigrants and First Nations populations arthritis can impede one’s ability to make could help reduce the burden of diabetes in changes in diet or activity levels, to lose these high-risk groups. weight, or to adhere to therapies. These Conclusion ICES 308 NEXT STEPS designed to serve as a common electronic Optimizing care for the growing population medical record for people with diabetes with diabetes will continue to challenge the ICES and its collaborators will continue to where clinical information, such as blood Ontario health care system in the years measure and report on patterns of health pressure readings, will be entered in a ahead. This report is designed to provide care and health-system use at the provincial standardized way that facilitates data recall Ontarians with an impartial visual level in key areas related to diabetes. The and comparison. representation of the current state of diabetes measures presented in the report are those in the province. Further research will be that could be readily identified with existing Components of the Ontario Diabetes Strategy essential for ongoing evaluations of diabetes provincial data holdings at ICES. However, (ODS) were implemented, in part, to reduce care in Ontario. some information needs could not be regional variations in diabetes care and addressed by the data sources available to us. improve health outcomes for all populations For instance, we were unable to assess many with diabetes. The results of our analyses are aspects of diabetes care and management in available for Diabetes Regional Coordination the outpatient setting. We measured fairly Centres, Local Health Integration Networks advanced complications of diabetes including and other organizations to use for priority hospitalization for heart disease or stroke, setting, planning and quality improvement dialysis for end-stage renal disease or the activities. By implementing interventions at need for amputation. However, our data the population and practice levels, it will be sources lacked the ability to capture less possible to expedite progress and achieve advanced complications, such as maximal impact. Findings from this report microalbuminuria or mild reductions in provide baseline data for ongoing surveillance kidney function or whether target levels of activities related to diabetes incidence, glucose, blood pressure or cholesterol are prevalence and disease outcomes. Our being met. These limitations may, in part, be findings, together with data from the ODS Key addressed through implementation of the Performance Measures and other sources, Ontario Diabetes Registry, which will give will aid in the evaluation of diabetes service health care providers dates and results of key programs and care delivery models currently laboratory tests, such as A1C and cholesterol, underway or in development. and will enable providers to compare their practice results to regional and provincial averages. In addition, the Diabetes Registry is ICES 309 1 Manuel DG, Rosella LCA, Tuna M, Bennett C. How Many Canadians Will Be Diagnosed References with Diabetes Between 2007 and 2017? Assessing Population Risk. Toronto: Institute for Clinical Evaluative Sciences; 2010. Accessed February 28, 2012 at http://www.ices.on.ca/file/Diabetes%20 Risks%20June%2016%202010.pdf. 2 Lipscombe LL, Hux JE. 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