Time trends and geographic disparities in acute complications of diabetes in Ontario, Canada.
OBJECTIVE
This study examines whether acute diabetes complication rates have fallen in recent years and whether geographic factors influence these trends.


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 approximately 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.
Booth
Gillian L
GL
Division of Endocrinology and Metabolism, St. Michael's Hospital, 61 Queen St. East, 6-147, Toronto, Ontario, Canada M5C 2T2. boothg@smh.toronto.on.ca
Hux
Janet E
JE
Fang
Jiming
J
Chan
Benjamin T B
BT
D000208:Acute Disease; D048909:Diabetes Complications / Q000453:epidemiology* / Q000628:therapy; D004632:Emergency Medical Services / Q000706:statistics & numerical data* / Q000639:trends*; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000628:therapy; D007003:Hypoglycemia / Q000453:epidemiology / Q000628:therapy; D007198:Indians, North American / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data