Diabetes care

Effective management of diabetes is a public health priority, with over 463 million people living with the condition worldwide. Diabetes is a chronic disease that occurs when the body’s ability to regulate excessive glucose levels in the blood is diminished. Diabetes caused 4.2 million deaths in 2019, and it is projected that by 2045 up to 700 million adults will have the condition (International Diabetes Federation, 2020[18]). It is a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation.

More recently, diabetes has been found to be an important risk factor for hospitalisation and death due to COVID-19 (Muniyappa and Gubbi, 2020[19]; Singh et al., 2020[20]), and several studies have found that potential complications of COVID-19 infection include development of diabetes and kidney failure (Collins, 2021[21]). In addition, measures put in place to respond to the COVID-19 pandemic have disrupted routine management of diabetes (Chudasama et al., 2020[22])

Ongoing control of diabetes usually involves a considerable amount of self-management; therefore, patient-centred care instruction and education are central to the primary care of people with diabetes (OECD, 2020[14]). Effective control of blood glucose levels through routine monitoring, dietary modification and regular exercise can reduce the onset of serious complications and the need for hospitalisation. Management of key risk factors such as smoking, blood pressure and lipid levels are also important in reducing complications.

Figure 6.12 shows avoidable hospital admissions for diabetes. While admissions have fallen in many countries over time, a more than 6-fold variation in the rates still occurs across countries. In 2019, Iceland, Italy and Spain reported the lowest rates, with Lithuania, the United States and Korea reporting rates nearly twice the OECD average. Prevalence of diabetes and general access to hospital care may explain some of this variation (OECD, 2015[23]). During the COVID-19 crisis, diabetes hospital admission rates decreased in most countries that were able to report 2020 data. The reduction was largest in Lithuania, potentially reflecting reduced use of health care services across multiple settings. Austria, the Czech Republic, Ireland, Portugal and Latvia also reduced the proportion, although the extent of the reduction was limited.

In diabetic individuals with hypertension, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are recommended in most national guidelines as first-line medications to reduce blood pressure. Figure 6.13 reveals broad consistency in the proportion of diabetic patients on recommended antihypertensive medications: only Finland, Belgium and Korea had rates lower than 80%.

High-quality primary care can reduce the risk of amputations, and hospital admissions for major lower extremity amputation reflect the long-term quality of diabetes care. Figure 6.14 shows the rates of amputation among adults with diabetes. The international variation is over 25-fold. Iceland, Korea and Italy reported rates lower than 3 per 100 000 general population, while the United States reported a rate higher than 30 per 100 000, followed by Israel, Mexico and Costa Rica reporting rates between 13 and 18 per 100 000. In 2020, the rates were not significantly different from 2019 in all countries that reported 2020 data.

The relationship between the nature, frequency and duration of primary care for diabetes and the rate of admissions to hospital for related complications is complex and warrants further research. The OECD is conducting an international survey of patients with chronic conditions, including diabetes, to capture their self-reported health outcomes and better understand their primary care context. This survey is central to the OECD’s PaRIS initiative (https://www.oecd.org/health/paris.htm).

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