Medically complex patients with Type 2 diabetes could benefit from seeing a specialist soon
Patients with Type 2 diabetes who are not as medically complex did
well when managed solely by primary care providers - a finding the
researchers called optimistic.
"This study showed that Ontario's primary care system is functioning
as it should by providing good care for the majority of newly diagnosed
patients with Type 2 diabetes," said Dr. Gillian Booth, an
endocrinologist at St. Michael's Hospital and researcher at the
Institute for Clinical Evaluative Sciences.
"With more than a million people living with diabetes in Ontario,
endocrinologists don't expect, or necessarily need, to see every
patient. We really wanted to look at who would stand to benefit from
early specialist care and should be referred as soon as possible."
The study, published online today in Diabetic Medicine,
found medically complex patients with newly diagnosed diabetes receiving
early endocrinologist care had 10 to 20 per cent lower risk of
cardiovascular events (heart attack, stroke and death from coronary
heart disease); those with at least three or more visits had 30 per cent
The study used Ontario health data examining almost 80,000 adults 30
and older diagnosed with Type 2 diabetes between April 1, 1998, and
March 3, 2006.
There are no specific guidelines in Canada for referring patients
with Type 2 diabetes for specialist care. Often, primary care providers
(doctors, together with nurses and dieticians) will solely manage the
care of patients with Type 2 diabetes. But Type 2 diabetes can be a
complicated condition to manage, involving a combination of diet,
physical activity and medications to control blood sugar, blood pressure
and cholesterol levels. When a patient's care becomes complex,
endocrinologists often step in. Endocrinologists are doctors who
specialize in the diagnosis and treatment of medical conditions caused
by hormone imbalances.
"The earlier we can help provide targeted care to these patients, the better," said Dr. Booth.
"Our research will hopefully contribute to the efficiency of our
health-care system, ensuring people with diabetes are living healthy
lives, as long as possible."
It's estimated 360 million people worldwide live with Type 2
diabetes, in which the pancreas does not produce sufficient insulin, or
doesn't properly use the insulin it produces. This leads to a buildup of
glucose in blood, instead of energy use.
Diabetes rates in Ontario have doubled in the last 12 years, with
one in 10 adults now living with the disease; this number rises to one
in four adults over the age of 65. The Canadian Diabetes Association
forecasts that with the aging population and dramatic rise in obesity,
one in three Canadians will live with diabetes by 2020.
the Canadian Diabetes Association and by the University of Toronto
About St. Michael's Hospital
St. Michael's Hospital provides compassionate care to all who
enter its doors. The hospital also provides outstanding medical
education to future health care professionals in 27 academic
disciplines. Critical care and trauma, heart disease, neurosurgery,
diabetes, cancer care, cares of the homeless and global health are among
the hospital's recognized areas of expertise. Through the Keenan
Research Centre and the Li Ka Shing International Healthcare Education
Centre, which make up the Li Ka Shing Knowledge Institute, research and
education at St. Michael's Hospital are recognized and make an impact
around the world. Founded in 1892, the hospital is fully affiliated with
the University of Toronto.
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For more information, or to arrange an interview with Dr. Booth, please contact:
Melissa Di Costanzo
Adviser, Media Relations, St. Michael's Hospital
416-864-6060 ext. 6537
Media Advisor, ICES