TORONTO - A variety of routine clinical tests should be the norm for Canadians who are living with diabetes, but a new study indicates not everyone is getting these tests and checkups by their health-care providers.
All four specific recommended clinical tests are being done for fewer than one-third of patients, says the research released Thursday by the Canadian Institute for Health Information.
"It's a wake-up call," says Dr. Alan Katz, research director in the department of family medicine at the University of Manitoba.
"It's pointing out that we're not doing a good enough job for our diabetic patients. And it challenges us as physicians and health system planners and decision-makers to say `how can we improve this?"' he said in an interview from Winnipeg.
Greg Webster, director of primary health-care information at CIHI, said better control of diabetes can help prevent serious health complications and prolong life for people with the disease.
"These tests can provide signals to the patients and their health-care providers in terms of the need for intervention to better manage their condition," he said.
"And that's important because if they don't do that, they're at much greater risk of developing complications such as blindness, lower limb amputations, kidney failure and heart disease."
The study is mostly based on 2007 data from Statistics Canada's Canadian Community Health Survey, but CIHI provided funding to ensure that all provinces would be included in the analysis.
The figures show that 81 per cent of Canadians with diabetes received a hemoglobin A1c test in the previous year. The test is used to measure blood glucose levels over a period of time.
Seventy-four per cent had received a urine protein test to measure kidney function in the year prior to the survey, and 51 per cent had their feet checked for sores or irritations.
And 66 per cent had received a dilated eye exam in the two-year period prior to the data being collected.
But overall, only 32 per cent of diabetics surveyed had all four clinical tests in the recommended period of time. Those who used insulin were more likely to have had all four tests.
Katz said it mirrors the findings of similar work he has done in Manitoba.
"Canadians are not getting as good quality care for their diabetes as we would like," he said. "Bottom line is care needs to improve."
The prevalence of diabetes was highest among adults with a household income of less than $20,000, at eight per cent, and lower among adults with incomes of $60,000 and over, at four per cent, the report said.
People with higher household incomes were more likely to receive the four clinical tests.
Katz said people living in poverty often struggle to attend appointments and keep to their diets.
"If you can't commit to coming on a regular basis to get your tests done because you have challenges with transportation and things like that, then it becomes much more challenging to provide that kind of care," he said.
Electronic record systems can help by providing reminders when patients are due for testing, Katz said.
As well, he said some places have introduced a pay-for-performance model, whereby physicians who look after patients with chronic conditions such as diabetes receive extra remuneration for recording results of tests, and sending them in.
Webster said British Columbia and Saskatchewan had the highest rates for people getting all four tests, at about 40 per cent. Newfoundland and Labrador was below the average, at just over 20 per cent, he said.
The report says 5.1 per cent of Canadians 12 and over reported a diagnosis of diabetes in 2007. More than two million Canadians have the disease, and the number is expected to grow as the population ages, Webster said.
The Canadian Diabetes Association will release a report Monday that introduces a new cost model and details the economic burden of diabetes -- to the individual and society as a whole.
