Diabetes-complications - Health Quality Ontario (HQO)

INDICATOR NAME

Name

Complications Among People Living with Diabetes

Alternate Name

Rate of serious complications in the last year among people living with diabetes

INDICATOR DESCRIPTION

Description

This indicator measures the rate of serious chronic complications (death; hospitalization for coronary artery disease, cerebrovascular disease, or peripheral vascular disease; dialysis for end-stage kidney disease) and death in the last year among people with diabetes aged 20 and older.

A lower rate is better.

Indicator Status

Active

HQO Reporting tool/product

Public reporting

Dimension

Effective

Type

Outcome

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Rate per 100 patients

Calculation Methods

Numerator divided by the denominator times 100

Numerator including inclusion/exclusion

Number of people with diabetes with any of the complications listed below:
1. Death (from RPDB)
2. Coronary artery disease hospitalization (e.g. AMI) - CIHI-DAD record with DXCODE or INCODE associated with AMI, PTCA, CABG, angina with most responsible diagnosis pre- or post-admission
- ICD-10 codes: I20, I21, I22, DXTYPE1 = M
- CCI codes : 1IJ50, 1IJ57, 1IJ76
3. Cerebral vascular disease (CVD) hospitalization (e.g. Stroke) with most responsible diagnosis
- ICD10 codes: I61, I63, I64, G45 DXTYPE1 = M

Exclude:
G45.4
- CCI codes: 1JE57
4. Peripheral vascular disease (PVD) hospitalization (i.e. Surgeries for peripheral vascular disease including amputations)
- CCI codes: 1VQ93, 1VC93, 1VG93, 1WA93, 1WE93, 1WI93, 1WJ93, 1WK93, 1WL93, 1WM93, 1WN93 - Exclude if one of the following ICD-10 codes, any DXTYPE, appears on the same record: C402, C403, C461, C472, C492, D162, D163, D212, S72 to S79, S82 to S89, S97, S98, T023, T025 to T029, T033 to T039, T043 to T049, T053 to T059, T07, T132 to T139, T142 to T149
5. Incident end stage renal disease (i.e. requiring dialysis)
At least two chronic dialysis OHIP fee code G860 to G866
6. Any complication: Calculated as the first occurrence of any of the above*
*For patients with more than one complication during the reported year, the first occurrence of the complication is selected for calculation of the overall complication rate.

Denominator including inclusion/exclusion

All cases of diabetes that are prevalent on April 1 of each fiscal year.
Exclude:
1. Invalid unique ICES key number
2. Non-Ontario resident
3. Invalid sex or birthdate
4. Death date before April 1st of given year

5.Age < 20 at the time of diagnosis

6. In Ontario Diabetes Database <1 year prior to April 1 of fiscal year of interest (i.e., were incident in year prior to fiscal year of interest)

7. Two or more dialysis OHIP fee codes (G860 to G866) present in previous year. (Use this exclusion for the incident renal disease outcome only. Keep these people in for other outcomes in a year)

Adjustment (risk, age/sex standardization)- detailed

Direct standardization using the fiscal year diabetes population (as of April 1st) in Ontario as a standard.
Standardized by:
Age groups: 20-34, 35-49, 50-64, 65+
Sex
Duration of diabetes: 0-4, 5-9, 10+ years

Data Source

Discharge Abstract Database (DAD), Ontario Diabetes Database (ODD), Ontario Health Insurance Plan (OHIP) Claims History Database, Postal Code Conversion File Plus (PCCF+), Registered Persons Database (RPDB)

Data provided to HQO by

Institute for Clinical Evaluative Sciences (ICES)

Reported Levels of comparability /stratifications (defined)

Age, Income, Region, Rurality, Sex, Time

RESULT UPDATES

Indicator Results

Click here to view Health Quality Ontario results for this indicator

OTHER RELEVANT INFORMATION

Caveats and Limitations

The indicator only measures serious complications of diabetes. Some outcomes may not be directly related to diabetes (such as death). The indicator is not adjusted for comorbidities. ODD doesn’t distinguish between type 1 and type 2 diabetes. Results for fiscal years 2020/21 and 2021/22 should be interpreted with caution as the COVID-19 pandemic may have affected the number of hospital admissions and deaths among people living with diabetes. We noted fewer hospitalizations and more deaths (the numerator) in the 2020/21 and 2021/22 fiscal years, which affected the rates for some types of diabetes complications.

Footnotes

i Public Health Agency of Canada. Diabetes in Canada: Facts and Figures From a Public Health Perspective. 2011. http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/ facts-figures-faits-chiffres-2011/pdf/facts-figures-faits-chiffreseng.pdf. ii Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. Lancet. July 1, 2006;368(9529):29-36. iii Hux J. E., Booth G.L., Slaughter P. M., and Laupacis A. Diabetes in Ontario: An ICES Practice Atlas. Institute for Clinical Evaluative Sciences; 2003. http://www.ices.on.ca/file/DM_Intro.pdf. Accessed July, 2012. iv Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212.