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Diabetes is a serious chronic disease that affects the body's ability to produce or properly use insulin.¹ It can lead to various disabling and life-threatening complications such as heart disease and stroke, high blood pressure, and premature death.² In Canada, diabetes is the single largest cause of blindness, and a leading cause of kidney failure and lower limb amputations.³ Diabetes is the seventh leading cause of death and accounts for 25,000 person-years of life lost before age 75.²

In 2005, 1.3 million Canadians aged 12 or older, or 4.9% of the population in this age group, reported that they were living with diabetes (Chart 1). This estimate, which reflects self-reports of physician-diagnosed diabetes, is based on recent national data from the Canadian Community Health Survey (CCHS) (see Data source). Prevalence was higher than the national average in all four Atlantic provinces: 6.0% in New Brunswick, 6.3% in Prince Edward Island, 6.7% in Nova Scotia, and 6.8% in Newfoundland and Labrador. In Alberta and the Northwest Territories, rates were significantly lower than the national average, at 3.9% and 3.4%, respectively.

Males aged 12 or older were slightly more likely (5.4%) than females (4.4%) to report having diabetes (Table 1). People younger than 45 were much less likely to have diabetes than were those aged 45 or older. Overall, in 2005, about one in five (19.9%) individuals with diabetes reported using insulin (data not shown).

Diabetes care in selected regions

Appropriate care is critical to managing diabetes and to preventing serious complications. In 2003, the Canadian Diabetes Association published the Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.⁴ These guidelines recommend the type of care that should be provided to individuals with diabetes.

While some information about the quality of care for diabetes in Canada is available,^1, 5 it has been based on small studies that do not always represent the overall Canadian population. The 2005 CCHS included a set of questions on diabetes care. Developed by Statistics Canada in collaboration with the Public Health Agency of Canada, these questions were designed to collect information about the care practices of people with diabetes, including glucose testing and foot and eye examinations (see The data).

The following information on hemoglobin A1C testing, foot care and eye exams is based on the "diabetes care module" of the 2005 CCHS and reflects results from the following provinces and territories: Newfoundland and Labrador, Prince Edward Island, New Brunswick, Ontario, Manitoba and Yukon Territory.

Hemoglobin testing

Management of glycemic levels is a critical part of diabetes care. Glycemic control, as measured by hemoglobin A1C, is associated with a reduced risk of developing long-term complications. The Clinical Practice Guidelines recommend that a physician measure this indicator every three months to ensure that glycemic goals are being met or maintained.

 In 2005, almost three-quarters (74%) of diabetic respondents aged 18 or older reported having had their hemoglobin A1C checked by a health care professional at least once in the year before the survey (Table 2). Diabetic respondents who had been tested were tested an average of 3.4 times during the 12-month period, or about once every three and a half months (data not shown). Rates were similar for men and women aged 18 or older, as well as across age groups. Diabetics who used insulin were more likely to have been tested (83%) than those not using insulin (74%).

Among the diabetic population, half (49.8%) reported that they, or a family member had checked their glucose level every day (Table 3).

Foot care

Individuals with diabetes often experience foot problems such as ulcers, lesions and infections. Without appropriate care, these may lead to more serious health conditions such as gangrene and the need for amputation. To reduce the risk of serious complications and to improve quality of life, the Clinical Practice Guidelines recommend annual foot examinations for all people with diabetes, and more frequent exams for those at high risk. The Guidelines also recommend that high-risk individuals receive instruction for appropriate self-care.

In 2005, almost half (48%) of the diabetic population aged 18 or older (in Newfoundland and Labrador, Prince Edward Island, New Brunswick, Ontario, Manitoba and Yukon Territory) reported having had their feet checked by a health care professional at least once during the previous 12 months (Table 3). On average, these individuals had had their feet checked 3.7 times over a 12-month period. The participation rates were similar for males and females, and across age groups and socio-economic status. Individuals using insulin were more likely to have had their feet checked (68%), compared with those who were not using insulin (45%). After adjusting for other factors, diabetic respondents using insulin were 2.7 times more likely to have had their feet examined by a health care professional in the previous year, compared with those not using insulin.

Respondents were also asked about foot care provided by themselves or a family member or friend. The majority of respondents (65%) indicated that they, or a family member or friend, had checked their feet for sores or irritations at least once in the previous 12 months; 37% checked daily and 17% checked weekly (Table 3). Almost one third of respondents indicated that they had never checked their feet.

Eye exams

People with diabetes are at risk of developing diabetic retinopathy—a disease of the blood vessels of the eye. High blood sugar levels cause the blood vessels in the eye to weaken and leak tiny amounts of blood or fluid, causing swelling of the retina. Vision may become blurred and, in some cases, blindness will result. The Clinical Practice Guidelines recommend that all people with diabetes be screened and examined for retinopathy when diabetes is first diagnosed.

Most of those responding to the questions on diabetes care (68%) indicated that, at least once, they had had an eye test where their pupils were dilated. Diabetics aged 18 to 44 were less likely to have had a dilation eye exam in the past 12 months, compared with older diabetic respondents (Table 2). As with other types of care, those using insulin were more likely to have had an eye exam (82%), compared with those not using insulin (66%). After adjusting for other factors, diabetic respondents taking insulin were 2.7 times more likely to have received an eye dilation examination compared with those not taking insulin.

Among all those who reported having had an eye examination, 14% reported having had it within the last month, 58% between one month and one year ago; and 17%, one to two years ago (Table 4).

Meeting the CPG requirements?

Information from the 2005 CCHS diabetes care module provides insight into care practices for and of diabetic patients in the participating regions of Canada. Overall, the proportion of diabetic respondents meeting the Clinical Practice Guidelines varied by the type of care. Most diabetic patients (74%) had had their hemoglobin A1C checked by a health care professional at least once in the year before the survey, and, on average, those who had received the test were close to meeting the recommended frequency of every three months. The majority of diabetic respondents were also meeting the recommendation for eye examinations (dilation of pupils), but only half had the recommended annual foot examinations. The Canadian rates for eye examinations were slightly higher than those reported in the United States; in 2001, only 66% of the US respondents indicated that they had had an eye examination.⁷ For foot examinations, though, the Canadian rates were lower than those in the United States, where approximately 60% of diabetics received annual foot examinations.

The results indicate that diabetics who were using insulin were more likely to receive diabetes care, compared with those not using insulin. In some cases, insulin use may be a marker for a more progressed or advanced disease or may reflect poor glycemic control.

Based on data from six of the provinces/territories, this article presents a first look at the health care practices for diabetics—information needed to better understand this aspect of the disease and the factors that affect the receipt of appropriate care.

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An electronic version of this article entitled "Diabetes care" was released on June 13, 2006 in the online publication Smoking and Diabetes Care: Results from the CCHS Cycle 3.1, 2005, part of the Your Community, Your Health: Findings from the Canadian Community Health Survey (CCHS) series, catalogue no. 82-621-XWE2006002.