Go to content

Low-income Ontario children with diabetes faring better than their Californian counterparts


Low-income children with Type 1 diabetes in Ontario are getting more of the recommended preventative care visits and have fewer hospitalizations than similar children in California, according to a new study from the Institute for Clinical Evaluative Sciences (ICES), The Hospital for Sick Children (SickKids) and the Centre for Policy, Outcomes, and Prevention, Stanford University.

In the study, published today in CMAJ Open, the researchers examined the health system models in Ontario and California to understand which system better serves the needs of low-income children with diabetes. The system in Ontario, with its organized provincial diabetes care network including generalists (e.g., family physicians and general pediatricians) was compared with that of California, an American model with targeted support services for children from low-income families.

The researchers found that more California children received their regular preventive care from sub-specialist pediatric endocrinologists, while most Ontario children received this care from generalists but visit rates were significantly different.

“We found that 76 per cent of low-income Ontario children were getting at least two preventive care visits per year, compared to only 65 per cent of low-income children in California. This may be because generalists were closer and more easily accessible than pediatric endocrinologists, who are in much shorter supply and tend to be located in big cities,” says Dr. Astrid Guttmann, senior author on the study, chief science officer at ICES and a pediatrician and senior associate scientist at SickKids.

International guidelines recommend children with diabetes have at least two to four preventive outpatient visits per year in order to closely monitor blood sugar control and to get needed screening tests. These visits help prevent the life-threatening complications of diabetes.

“We also found rates of life-threatening diabetes complications were slightly lower in low-income children in Ontario compared with California. This reassures us that generalists providing routine, preventive care for children with diabetes is likely a safe model of care when they are supported  by multi-disciplinary care teams and have backup from centers with subspecialist pediatric endocrinologists” says Dr. Suni Kaiser, author of the study and  assistant professor, University of California, in San Francisco.

But according to the researchers, there are gaps in the Ontario system. Low-income Ontario children are three times more likely than higher income Ontario children to be hospitalized for a complication related to their disease (seven versus 2.5 hospitalizations for every 100 children per year).

“While it’s reassuring that our low-income children are doing the same or better than low-income children in California, we do have concerns within our own system,” says Guttmann. “Our findings suggest that there is an important equity gap in terms of diabetes outcomes by socioeconomic status but unrelated to the healthcare system organization.”

“Healthcare for children with diabetes mellitus from low-income families in Ontario and California: a population-based cohort study,” was published today in CMAJ Open.

Author block: Sunitha V. Kaiser, Vandana Sundaram, Eyal Cohen, Rayzel Shulman, Jun Guan, Lee Sanders, and Astrid Guttmann.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized child and family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca. Follow us on Twitter (@SickKidsNews) and Instagram (@SickKidsToronto).


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996

Suzanne Gold
The Hospital for Sick Children (SickKids)
[email protected]
416-813-7654 ext 202059


Contributing ICES Scientists

Research Programs

Associated Sites

Read the Journal Article