Resources and population served: a description of the Ontario Paediatric Diabetes Network

Shulman, Rayzel; Miller, Fiona A.; Stukel, Thérèse A.; Daneman, Denis; Guttmann, Astrid

doi:10.9778/cmajo.20150006

Cited by 20 publications

(26 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 Furthermore, we assumed that most of the other children in Ontario with diabetes have type 1 because we have previously shown that almost all (94.8%) children in Ontario with diabetes have type 1. 16…”

Section: Setting and Data Sourcesmentioning

confidence: 99%

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study

Shulman¹,

Slater

Khan

et al. 2020

cmajo

View full text Add to dashboard Cite

he prevalence of type 2 diabetes in children is increasing worldwide. 1-3 In 2006-2008, the incidence of childhood-onset type 2 diabetes in Canada was estimated at 1.54 per 100 000 per year, with the highest incidence in Manitoba (12.45 per 100 000 per year); in Ontario, the incidence was 1.7 per 100 000 per year. 4 First Nations children in Canada have the highest incidence of type 2 diabetes, at 23.2 per 100 000 per year. 4 In Manitoba and northwestern Ontario, 87% of children with type 2 diabetes have First Nations heritage. 5 First Nations status and exposure to diabetes in utero are independently associated with an increased risk of type 2 diabetes in the first 30 years of life. 6,7 This is especially concerning because youth with type 2 diabetes experience complications sooner than youth with type 1 diabetes. 8,9 The prevalence, incidence and outcomes of diabetes among First Nations children in Ontario are not known. It is important for First Nations communities to have these data to inform population approaches to prevent and manage diabetes

show abstract

Section: Setting and Data Sourcesmentioning

confidence: 99%

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study

Shulman¹,

Slater

Khan

et al. 2020

cmajo

View full text Add to dashboard Cite

show abstract

“…38,39 Using health administrative databases, we could not distinguish between T1D and T2D; nevertheless, approximately 95% of children younger than 18 years of age with diabetes have T1D. 40 Given that DKA can occur in both forms of diabetes, our finding of increasing trends of DKA at diagnosis is a concerning observation irrespective of the type of diabetes the child has, highlighting the importance of determining the underlying drivers.…”

Section: Limitationsmentioning

confidence: 88%

Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study

Robinson

Rahme³

et al. 2019

cmajo

View full text Add to dashboard Cite

Background: Diabetic ketoacidosis at type 1 diabetes diagnosis is a preventable life-threatening complication. Canadian data on the temporal trends of the prevalence of diabetic ketoacidosis at the onset of type 1 diabetes in children are unknown. We aimed to determine the temporal changes in diabetic ketoacidosis prevalence at diabetes diagnosis in Quebec. Methods: We conducted a population-based cohort study of children (aged 1-17 yr) living in Quebec who were diagnosed with diabetes between 2001 and 2014, using multiple health administrative linked databases available at the Institut national de santé publique du Québec through the Quebec Integrated Chronic Surveillance System. We used multivariate Poisson regression analysis with robust error variance to determine trends in the prevalence of diabetic ketoacidosis. Results: We found that 25.6% (1471/5741) of children presented with diabetic ketoacidosis at diabetes diagnosis. The incidence of diabetes was stable at 30 cases per 100 000 children per year during the study period. The age-and sex-standardized rates of diabetic ketoacidosis increased from 22% (95% confidence interval [CI] 17%-26%) in 2001 to 30% (95% CI 24%-36%) in 2014. The relative increase of diabetic ketoacidosis prevalence at diabetes diagnosis over the study period was 2.0% per year (rate ratio 1.02; 95% CI 1.01-1.03). Interpretation: Despite a stable incidence of type 1 diabetes, we found that the prevalence of diabetic ketoacidosis at diabetes onset increased between 2001 and 2014. Our findings are concerning and demonstrate a need to continue to campaign to recognize type 1 diabetes before diabetic ketoacidosis supervenes.

show abstract

“…16 The database does not distinguish between type 1 and type 2 diabetes; however, Canadian studies have shown that most people under age 20 years with diabetes have type 1 diabetes. 15,17 Once cases enter the database, they remain until the patient dies or migrates out of Ontario. Using a unique encoded identifier, we linked records to the Registered Persons Database (demographic information), the Ontario Health Insurance Plan database (physicians' billing claims) and the Canadian Institute for Health Information Discharge Abstract Database (hospital admissions).…”

Section: Participants and Data Sourcesmentioning

confidence: 99%

“…Each centre provides, at a minimum, access to a team consisting of physicians, nurses, dietitians and social workers with training in diabetes care. 15 The workforce in these centres varies from generalists (family physicians, pediatricians) to pediatric endocrinologists (at academic centres), and all of the community centres are affiliated with 1 of the 5 academic pediatric centres. 15 The overall goal of the network is to promote linkages among the centres, assist with the development and dissemination of resources and guidelines, and provide support and infrastructure for implementing evidence-based care and for coordinating services, while promoting consistency in standards of practice through professional development.…”

mentioning

confidence: 99%

Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis

et al. 2017

View full text Add to dashboard Cite

Background:The Network of Ontario Pediatric Diabetes Programs was implemented in 2001. The objective of this study was to determine whether implementation of the network was associated with a decrease in the risk of acute diabetes-related complications and a reduction in the socioeconomic and geographic disparities in these outcomes. Methods:We conducted a population-based time trend analysis of children (< 18 yr) with diabetes using health administrative databases in Ontario from 1996 to 2011. We determined the relation between network implementation and diabetes-related emergency department visits and hospital admissions using linear mixed-effects models with a Poisson link function.Results: Data for 13 806 children with established diabetes were analyzed. After the network was implemented, there was a significant decrease in the rate per 100 children of emergency department visits (17.0 in 2001 v. 10.00 in 2011, p < 0.001) and hospital admissions (8.8 v. 5.0, p < 0.001). The decrease was most significant for those in the lowest socioeconomic quintile and in urban areas. After network implementation, children in the lowest socioeconomic quintile remained at higher risk than those in the highest socioeconomic quintile for emergency department visits (adjusted rate ratio [RR after ] 1.77 [95% confidence interval (CI) 1.55 to 2.03]) and hospital admissions (RR after 2.11 [95% CI 1.77 to 2.52]). However, the yearly decrease in rates of emergency department visits and hospital admissions for the lowest compared to the highest socioeconomic quintile shifted toward a decreasing disparity after network implementation (p < 0.05). Before the network was implemented, geographic location was not associated with outcomes. After implementation, the risk of emergency department visits among patients from urban areas was significantly lower than that among patients from rural areas. Interpretation:The establishment of a pediatric diabetes network was associated with better health outcomes, particularly for patients of lower socioeconomic status. Further work is needed to address the health care needs of those in rural areas. Abstract Researchof Health and Long-Term Care, consists of 35 specialized pediatric diabetes centres. Each centre provides, at a minimum, access to a team consisting of physicians, nurses, dietitians and social workers with training in diabetes care. 15 The workforce in these centres varies from generalists (family physicians, pediatricians) to pediatric endocrinologists (at academic centres), and all of the community centres are affiliated with 1 of the 5 academic pediatric centres. 15 The overall goal of the network is to promote linkages among the centres, assist with the development and dissemination of resources and guidelines, and provide support and infrastructure for implementing evidence-based care and for coordinating services, while promoting consistency in standards of practice through professional development. To date, accountability measures for the network have not included patient outcomes...

show abstract

Resources and population served: a description of the Ontario Paediatric Diabetes Network

Cited by 20 publications

References 21 publications

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study

Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study

Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study

Outcomes associated with a pediatric clinical diabetes network in Ontario: a population-based time-trend analysis

Contact Info

Product

Resources

About