Diabetes
Care in the U.S. Vs. Canada
Can
the differences in the way healthcare is delivered in the U.S. and
Canada make a difference in the outcomes?
The
study compared the glycemic control of patients with type 1
diabetes treated in the U.S. and Canada.
A
large multicenter randomized clinical trial conducted in
the U.S. and Canada was analyzed. Patients with type 1
diabetes, screened from 1983 to 1989 for enrollment in the
Diabetes Control and Complications Trial (DCCT), were
categorized as treated in the U.S. (n = 2,604) or Canada (n
= 245). HbA1c levels were compared between U.S. and
Canadian patients, both before and after adjustment for
predictors of HbA1c.
In
general, volunteers screened for the DCCT were highly
educated and following healthy lifestyles. Canadians were
somewhat younger (25 vs. 27 years of age, P = 0.002), less
likely to be college educated (62 vs. 71%, P = 0.002),
more likely to receive care through a family doctor (41 vs.
28%, P = 0.001), and had a higher frequency of
out-patient visits (4 vs. 3 per year, P = 0.004).
Despite these differences in health care delivery, the mean
HbA1c at baseline was identical in the two
countries (8.9 vs. 9.0, P = 0.40). Adjustment for demographic,
lifestyle, and clinical predictors of HbA1c yielded similar
findings (9.0 vs. 9.2, P = 0.15). Equal percentages of
American and Canadian patients who were screened ultimately entered
the trial (21 vs. 19%, P = 0.20), and those randomized to
conventional care achieved similar mean HbA1c levels (9.1
vs. 9.2, P = 0.50).
There was no winner, differences in care delivery patterns do
not yield large differences in glycemic control for
patients with type 1 diabetes who were recruited in the
U.S. and Canada for a large randomized trial.
Diabetes
Care 2002 25: 1149-1153.
Did
You Know?
The
CDC's Diabetes Program have been tremendously effective in reducing
both the complications and the health care costs associated with
diabetes. --Maine's
Diabetes Program has resulted in a 43 percent reduction in
hospitalizations related to diabetes, a 36 percent reduction in
emergency room visits, and a 31 percent reduction in illness-related
physician visits. --In New York, the rate of hospitalizations of
people with diabetes has been reduced by over 35 percent.
