IDF21-0214 COVID-19 & Diabetes in Canada: Two Global Pandemics Colliding & An Opportunity For Optimizing Data-Driven Diabetes Care Delivery & Outcomes in British Columbia (BC)

Abstract

Background: Diabetes is a key ambulatory care sensitive condition to measure the effectiveness of primary care. In Canada, diabetes is a serious, prevalent, complex & costly problem affecting the entire healthcare system spectrum. Global healthcare systems, including diabetes & primary care, have been sidelined by COVID-19 (SARS-CoV2 corona virus) after initial December 2019 reports from China & official mid-March 2020 pandemic declaration by WHO. In the province of British Columbia (BC) & throughout Canada, travel restrictions, home-isolation & other pandemic-safe strategies finally began mid-March 2020. By July-Oct 2020, COVID-19 resurgence & escalation were evident in BC, Canada & world-wide. By July 2021, there were contagious SARS-CoV2 variants globally, fuelled by delayed vaccinations & other factors. Worse COVID-19 prognosis & increased mortality have been associated with diabetes, advanced age and/or major co-morbidities. Purpose: The BC Provincial Diabetes Evaluation is a quality improvement environmental scan project (now in its Knowledge Translation Phase) to better understand BC's diabetes risk factors; major gaps, barriers & impact on diabetes care services; & best practice solutions for data-driven, diabetes care management redesign so that people with diabetes receive improved, timely, appropriate, cost-effective diabetes care that is locally/culturally/ethnically-sensitive, no matter where they live in BC; with emphasis now on the COVID-19 global pandemic as a driver for change. Methods: 1. Retrospective, open quantitative multi-source data analysis 2. Prospective, open qualitative data analysis 3. Diabetes performance measures; co-morbidities (CKD, CAD, CHF); major procedures/surgeries (renal dialysis, PCI, lower limb amputation) Results: BC has 5.02 million people, ethnic diversity & >70% rural/remote/isolated geography. Aboriginal, Chinese & South Asian people are at highest risk of diabetes & account for the highest rates of diabetes, diabetes complications, hospitalizations, major surgeries/procedures & premature mortality in BC. For over 40 years, intermittent efforts in BC & Canada to improve chronic disease & diabetes management had little positive effect, unfortunately. Ideally, healthcare services & planning should be driven by strong data & strong evidence. No provincial/centralized diabetes program/service/strategy exists for BC’s 470,000 diabetes people. Eighty-precent of diabetes care in BC is provided by family physicians (primary care). To assist with pandemic responses such as COVID-19, our BC Provincial Diabetes Evaluation innovative tools such as Diabetes Heat Maps, Diabetes Snapshot Reports & geographically-specific, multi-source, quantitative & qualitative data analysis could be useful for improving data-driven decisions & care delivery; plus accurately locating & profiling BC’s diabetes high COVID-19 risk populations:•Elderly, cardiac, renal disease: poor COVID-19 prognosis•By age groups, gender, health determinants & premature mortality•Insulin users•No onsite, reliable lab testing (e.g. HbA1c, SCr)•Insufficient physician & healthcare•By urban, rural/remote/isolated areas Conclusion: Without coordinated BC provincial diabetes care planning or services, a fragmented, non-standardized, patchwork system has resulted with negative health outcomes & high impact on the entire healthcare system in BC (similar across Canada). Our BC Provincial Diabetes Evaluation Knowledge Translation findings will help with diabetes care management redesign; & improve the trajectory of diabetes, diabetes outcomes & healthcare utilization in BC. The time is now for data-driven improvements in BC’s diabetes care, with COVID-19 as a driver for change.