Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data

OBJECTIVES

Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM.

METHODS

We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008-2009 and 2018-2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014-2015 to 2018-2019. Individuals with newly identified T2DM, ascertained between 2010-2011 and 2017-2018 with a lookback period between 2008-2009 and 2009-2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age.

RESULTS

The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions.

CONCLUSIONS

We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.

[Nephrologist-IPA collaboration for better patient management]

Chronic kidney disease, the extreme consequence of which is dialysis or transplantation, requires a highly structured care pathway, marked by precise care and treatment recommendations. Given the aging of the population, the increase in the number of patients is inevitable. Synergy between nephrologists and advanced practice nurses allows the implementation of organization protocols in fields of competence including consultations and prescriptions.

[The ANFIPA in practice: the example of the chronic kidney disease, dialysis, transplant college]

The French association of advanced practice nurses (anfipa) is actively participating in setting up advanced practice across the country. Colleges are places of interaction and work for advanced practice nurses and students. Highlighting missions of this college enables us to create places of discussion and exchanges in the field, and to take part in the rollout of this new profession.

[The advanced practice nurse and chronic renal patients]

In the course of his life, a patient with chronic kidney disease will have to hear the announcement of a diagnosis, live with a pathology for which there is no hope of cure, undergo a multitude of tests and, finally, choose a mode of substitution (dialysis and/or transplantation). The advanced practice nurse has a role to play in bringing added value to these patients. In this function lies a constant questioning of his practices, a development of his intellectual curiosity in the service of patients.

[The future of kidney failure treatments]

The future of nephrology lies in the miniaturisation of renal replacement techniques, the development of the use of stem cells and xenotransplants. Moreover, medicine must be personalised, from screening and throughout the care pathway of the patient with chronic kidney failure. Thereby, the risk of morbidity can be reduced and the quality of life improved, with the help of connected tools. The role of the patients themselves and all healthcare professionals is essential.