Effective management of diabetes remains a public health priority, with over 425 million people living with the condition worldwide. Diabetes is a chronic disease that occurs when the body’s ability to regulate excessive glucose levels in the blood is diminished. It is a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation. Diabetes caused 4 million deaths in 2017, and it is projected that by 2045 over 629 million adults will have the condition (IDF, 2017[1]).
Ongoing management of diabetes usually involves a considerable amount of self-care; therefore, advice and education are central to the primary care of people with diabetes (OECD, 2019[2]). Effective control of blood glucose levels through routine monitoring, dietary modification and regular exercise can reduce the onset of serious complications and the need for hospitalisation (Wolters, Braspenning and Wensing, 2017[3]). Management of other key risk factors such as smoking, blood pressure and lipid levels is also important in reducing complications of diabetes.
Figure 6.12 shows avoidable hospital admissions for diabetes. While admissions have fallen in many countries over time, a more than 5-fold variation in the rates is still evident across countries. Iceland, Italy and Spain report the lowest rates, with Mexico and Korea reporting rates nearly twice the OECD average. Prevalence of diabetes may explain some of this variation. A positive relationship can be demonstrated between overall hospital admissions and admissions for diabetes, providing some indication that access to hospital care can also play a role in explaining international variation (OECD, 2015[4]).
In diabetic individuals with hypertension, angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) are recommended in most national guidelines as first-line medications to reduce blood pressure. Figure 6.13 reveals broad consistency in the proportion of diabetic patients on recommended antihypertensive medications: only Finland, Belgium and Korea have rates lower than 80%.
Hospital admissions for major lower extremity amputation reflect the long-term quality of diabetes care. Figure 6.14 shows the rates of amputations among adults with diabetes. The international variation is over 20-fold, with Iceland, Italy, Korea and the United Kingdom reporting rates lower than 3 per 100 000 general population and Costa Rica, Israel, Mexico and Austria reporting rates above 13 per 100 000.
The relationship between the nature, frequency and duration of primary care for diabetes and the rate of admissions to hospital for related complications is complex and still not well understood. In its ongoing attempts to contribute to reductions in knowledge gaps, the OECD is working to establish an international survey of patients with chronic conditions, including diabetes, to capture their self-reported health outcomes and better understand their primary care context. This survey is central to the Patient-Reported Indicators Surveys (PaRIS) initiative (https://www.oecd.org/health/paris.htm).
