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Medically complex patients with Type 2 diabetes have less heart disease, lower death rates if they see a specialist soon after diagnosis; healthier patients do well with family doctors


People recently diagnosed with Type 2 diabetes and who have other serious chronic health issues have less heart disease and lower death rates if they see an endocrinologist within one year of diagnosis, new research suggests.

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 lower rates.

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.

Dr. Booth’s work was funded by an Applied Health Research Grant from the Canadian Diabetes Association and by the University of Toronto Dean’s Fund.

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 healthcare 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.

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.

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