The effectiveness and efficiency of diabetes screening in Ontario, Canada: a population-based cohort studyReport as inadecuate

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BMC Public Health

, 10:506

First Online: 20 August 2010Received: 13 January 2010Accepted: 20 August 2010DOI: 10.1186-1471-2458-10-506

Cite this article as: Wilson, S.E., Rosella, L.C., Lipscombe, L.L. et al. BMC Public Health 2010 10: 506. doi:10.1186-1471-2458-10-506


BackgroundLittle is known about the efficiency and effectiveness of the current level of diabetes screening activity in Ontario where there is universal access to health services. Our study aims were to: i determine how often Ontarians are screened for diabetes; ii estimate screening efficiency based on the number needed to screen NNS to diagnosis one diabetes case; iii examine the population effectiveness of screening as estimated by the number of undiagnosed diabetes cases.

MethodsOntario respondents of the Canadian Community Health Survey who agreed to have their responses linked to health care data n = 37,400 provided the cohort. The five-year probabilities of glucose testing and diabetes diagnoses were estimated using a Cox Proportional Hazards Model. We defined NNS as the ratio of diabetes tests to number of diabetes diagnoses over the study period. We estimated the number of undiagnosed diabetes by dividing the number not tested at the end of study period by the NNS.

Results80% of women and 66% of men had a blood glucose test within 5 years. The efficiency of screening was estimated by a NNS of 14 among men and 22 among women. 127,100 cases of undiagnosed diabetes were estimated, representing 1.4% of the Ontario adult population. Increasing age, hypertension, immigrant and non-white ethnicity, and number of general practitioner visits were associated with an increased likelihood of having a glucose test LR χ2 p < 0.001. Low income men were less likely to be tested.

ConclusionsDiabetes screening was high in this population-based cohort of Ontarians. Screening efficiency varied considerably in the population. Undiagnosed diabetes continues to be prevalent and remains concentrated in the highest risk groups for diabetes, especially among men.

AbbreviationsBMIBody mass index

CCHSCanadian Community Health Survey

CDACanadian Diabetes Association

FPGFasting plasma glucose

HbA1cHemoglobin A1c

ODDOntario Diabetes Database

OGTTOral glucose tolerance test

OHIPOntario Health Insurance Plan

RPDBRegistered Persons Database

SBGSerum blood glucose.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-506 contains supplementary material, which is available to authorized users.

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Author: Sarah E Wilson - Laura C Rosella - Lorraine L Lipscombe - Douglas G Manuel


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