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. 2022 Aug 23;10(3):E772-E780.
doi: 10.9778/cmajo.20210195. Print 2022 Jul-Sep.

Trends in glucose testing among individuals without diabetes in Ontario between 2010 and 2017: a population-based cohort study

Anna Chu  1 , Baiju R Shah  1 , Mohammed Rashid  1 , Gillian L Booth  1 , Ghazal S Fazli  1 , Karen Tu  1 , Louise Y Sun  1 , Husam Abdel-Qadir  1 , Catherine H Yu  1 , Sheojung Shin  1 , Kim A Connelly  1 , Sheldon Tobe  1 , Peter P Liu  1 , Douglas S Lee  2
Affiliations

Trends in glucose testing among individuals without diabetes in Ontario between 2010 and 2017: a population-based cohort study

Anna Chu et al. CMAJ Open. .

Abstract

Background: Early identification of people with diabetes or prediabetes enables greater opportunities for glycemic control and management strategies to prevent related complications. To identify gaps in screening for these conditions, we examined population trends in receipt of timely glucose testing overall and in specific clinical subgroups.

Methods: Using linked administrative databases, we conducted a retrospective cohort study of people aged 40 years and older without diabetes at baseline. Our primary outcome was up-to-date glucose testing, defined as having received testing at least once in the 3 years before each index year from 2010 to 2017, using linked administrative databases of people residing in Ontario, Canada. We calculated rates of up-to-date testing by age group, sex, ethnicity (South Asian, Chinese, general population) and comorbidities (hypertension, hyperlipidemia, cardiovascular disease).

Results: Over the 8-year study period, up-to-date glucose testing rates were stable at 67% for men and 77% for women (both relative risk 1.00 per year; 95% confidence interval 1.00-1.00). Testing rates were significantly lower in men than in women (all age groups p < 0.001) and lower in younger than older age groups (except those aged ≥ 80 yr). South Asian people had the highest testing rates, although among people aged 70 years or older, testing was highest in the general population (p < 0.001). Among people with hypertension, hyperlipidemia and cardiovascular disease, annual testing rates were also stable, but only 58% overall among people with hypertension.

Interpretation: We found lower glucose testing rates in younger men and people with hypertension. Our findings reinforce the need for initiatives to increase awareness of glycemic testing.

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Conflict of interest statement

Competing interests: Catherine Yu reports receiving research grants from the St. Michael’s Hospital Medical Services Association, St. Michael’s Hospital (Unity Health Toronto), the Ontario SPOR SUPPORT Unit and the Royal College of Physicians and Surgeons of Canada. Kim Connelly reports receiving research grants and payment for presentations from AstraZeneca, Servier, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk and Merck. Dr. Connelly also reports serving on a Data Safety Monitoring Board or Advisory Board for AstraZeneca, Servier, Boehringer Ingelheim, Eli Lilly, Novartis, Novo Nordisk and Merck. Gillian Booth reports receiving grants or contracts from the Canadian Institutes of Health Research (CIHR), Juvenile Diabetes Research Foundation and the Thistledown Foundation. Karen Tu reports receiving payments (to institutions) from CIHR, St. Michael’s Hospital Foundation, The College of Family Physicians of Canada, Foundation for Advancing Family Medicine, Canadian Medical Association Foundation, North York General Hospital, Heart and Stroke Foundation of Canada, Heart and Stroke Foundation of Ontario, Department of Defense (United States), University of Toronto (Department of Family and Community Medicine), MaRS Innovation Fund, Canadian Dermatology Foundation, Canadian Rheumatology Association (Canadian Initiative for Outcomes in Rheumatology Care), PSI Foundation, Cancer Care Ontario, Toronto Rehabilitation Institute Chair Fund, University of Toronto Practice-Based Research Network, Arthritis Society, MS Society of Canada, The Canadian Vascular Network and the Ontario SPOR SUPPORT Unit Targeted IMPACT Award. Sheldon Tobe reports receiving a KMH clinic unrestricted grant and in-kind support for the Zero to Five study, and consulting fees from AstraZeneca (all paid to Sunnybrook Research Institute). Dr. Tobe also reports receiving payment from Amgen, Astra-Zeneca, Bristol Myers Squibb, Bayer, Boehringer Ingelheim, Janssen, Lilly, Novartis, Novo Nordisk, Pfizer and Sanofi Genzyme for the CHEPPLUS education program. Dr. Tobe has worked on a volunteer basis with the American Hypertension Specialists Certification Program. No other competing interests were declared.

Figures

Figure 1:
Figure 1:
Up-to-date glucose testing rates among adults aged 40 years or older in Ontario, by age (years), 2010–2017. “Up to date” is defined as at least 1 glycosylated hemoglobin, plasma or serum glucose or oral glucose tolerance test in the previous 3 years, and excludes people who received a diabetes diagnosis before the study period.
Figure 2:
Figure 2:
Up-to-date glucose testing rates among (A) men and (B) women aged 40 years and older in Ontario, by ethnicity, 2010–2017. “Up to date” is defined as at least 1 glycosylated hemoglobin, plasma or serum glucose or oral glucose tolerance test in the previous 3 years, and excludes people who received a diabetes diagnosis before the study period. Groups are displayed in order of increasing overall rates of testing in 2017.
Figure 3:
Figure 3:
Annual glucose testing rates among high-risk populations in Ontario 2008–2017: (A) people with hypertension, (B) people with hyperlipidemia and (C) people with cardiovascular disease. “Glucose testing” is defined as at least 1 glycosylated hemoglobin, plasma or serum glucose or oral glucose tolerance test and excludes people who received a diabetes diagnosis before the study year or were admitted to hospital during the study year. “Cardiovascular disease” is defined as a history of hospital admission for myocardial infraction, stroke or heart failure, or previous percutaneous coronary intervention or coronary artery bypass graft surgery.
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