Type 1 diabetes is a chronic, metabolic disease in which the pancreas produces little or no insulin. It typically begins before age 25 years, but it can occur at any age. Type 1 diabetes has historically been, and continues to be, the most common type of diabetes in children and youth (although type 2 diabetes is increasingly being diagnosed in this population). In 2019, an estimated 1.5 million Ontarians, or 10% of the provincial population, were living with diabetes (type 1 and type 2 combined). Most health administrative data do not differentiate between type 1 and type 2 diabetes, but estimates suggest that 5% to 10% of these cases are type 1 diabetes. Type 1 diabetes is not preventable.
People with diabetes are at risk of developing serious, acute complications (e.g., severe hypoglycemia, ketoacidosis); long-term microvascular complications affecting the eyes, kidneys, and nerves; and cardiovascular disease. Frequent monitoring of glucose levels, lifelong insulin administration via injection or an insulin pump to keep blood glucose levels in the target range, and a healthy, balanced diet and physical activity are essential for managing type 1 diabetes and reducing the risk of acute and chronic complications.
Managing the condition and its complications has substantial personal and economic impacts for people with type 1 diabetes and their families and caregivers, and the economic burden to the Canadian health care system and society more broadly is considerable. The direct cost to the health care system of treating diabetes (all forms) and its complications is estimated be $1.5 billion. People with diabetes and their families have identified challenges affording out-of-pocket costs for medications, equipment, devices, and supplies required to treat their diabetes. Twenty-five percent of Canadians with diabetes report that these costs affect their adherence to their prescribed treatment regimens, which poses risks to their short- and long-term health.
Compared with the general population, people with diabetes (type 1 or type 2) are more than three times more likely to be hospitalized with cardiovascular disease, 12 times more likely to be hospitalized with end-stage kidney disease, and nearly 20 times more likely to be hospitalized with nontraumatic lower-limb amputations. The risk of blindness in people with diabetes is up to 25 times higher than in those without diabetes. More than 30% of people with diabetes experience significant depressive symptoms, and 11% of people with diabetes meet the diagnostic criteria for comorbid major depressive disorder—twice that of people without diabetes. Among children with type 1 diabetes, acute complications, such as diabetic ketoacidosis and severe hypoglycemia, are the leading cause of hospital admissions and emergency department visits. Further, young adults without medical follow-up during the transition from pediatric to adult diabetes services are more likely to experience hospitalization for diabetic ketoacidosis during this period.
There are also regional variations across Ontario in the rates of hospitalizations and emergency department visits attributable to type 1 diabetes. In 2017/18, there were nearly three times as many hospitalizations in the North West region (71.4 per 100,000 individuals) than in the Mississauga Halton region (25.5 per 100,000 individuals) (Discharge Abstract Database, 2017/18). That same year, the rate of emergency department visits per 100,000 people was 4.2 times higher in the South East region (274 per 100,000 individuals) than in the Mississauga Halton region (65 per 100,000 individuals) (National Ambulatory Care Reporting System, 2017/18). These varying rates of hospitalizations and emergency department visits may be linked to differences in the prevalence of type 1 diabetes across the regions and/or variations in care people with type 1 diabetes receive in the community.
Based on evidence and clinical expert consensus, the five quality statements that make up this quality standard provide guidance on high-quality health care in priority areas for people in Ontario with type 1 diabetes.