Diabetes and early and late diagnosis in Newfoundland and Labrador

Roche, Madonna Margaret (2015) Diabetes and early and late diagnosis in Newfoundland and Labrador. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

The primary objective of this research was to examine diabetes with a focus on the timing of its diagnosis, the factors associated with diabetes, risk of mortality and hospitalization outcomes, and the diagnosis, treatment and management in Newfoundland and Labrador. Administrative data were used to develop definitions of early and late diabetes diagnosis based on when various complications and comorbidities developed. This dissertation is comprised of three studies. The first study aimed to describe factors associated with diabetes, a late diabetes diagnosis, and whether these factors are different for males and females. The second study compared risk of mortality and hospitalizations for males and females with and without diabetes and those diagnosed early and late with diabetes. The third study aimed to describe how family physicians diagnose, treat and manage type 2 diabetes and to identify if there were any differences in how male and female family physicians diagnose, treat and manage those with type 2 diabetes. The findings indicate that different factors are associated with a diabetes diagnosis and its timing in males and females. Females living in a rural area, receiving social assistance, having poor self perceived health and considering most days stressful appear to have the greatest risk for developing diabetes. Females with lower education levels are less likely to be diagnosed late with diabetes compared to females with a higher level of education. Females with diabetes have a greater risk of mortality than males with diabetes and cardiovascular disease has a greater negative impact on females with diabetes than on males, especially when females are diagnosed at a later stage. Finally, the majority of family physicians in this province have patients with complications present when diagnosed with diabetes. Even though family physicians have positive attitudes toward diabetes management, risk factors for diabetes complications are not monitored optimally. Male and female family physicians were similar in their diagnosis, treatment and management practices and in their attitudes toward diabetes. In conclusion, certain risk factors appear to impact males and females differently and more research is needed on the timing of diagnosis and how males and females develop diabetes. Different management strategies could be considered for males and females and those diagnosed at different stages with diabetes. Family physicians should monitor risk factors for diabetes complications more closely in an attempt to manage progression of the disease.

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