New algorithm will help improve health care for people with type 1 diabetes
By Krista Lamb
Thanks to the work of Diabetes Action Canada researchers Dr. Alanna Weisman and Dr. Gillian Booth, it is now possible to distinguish type 1 diabetes from type 2 diabetes in Ontario’s electronic medical records and administrative databases.
This is an important step forward, as for years Ontario researchers had to take a ‘best guess’ approach to establishing the needs of people with type 1 diabetes in the province. “We’ll be able to learn a lot about type 1 diabetes in Canada, which we previously hadn’t been able to study,” says Weisman. “We didn’t even know basic things about type 1 diabetes, like how many people have a diagnosis of type 1 diabetes, are the rates increasing over time, decreasing over time, or are they stable?”
Having access to this type of data will allow researchers and policymakers to better understand the needs of those with type 1 and find ways to improve care.
Weisman, an endocrinologist at Mount Sinai Hospital, has focused her research on databases. She uses national and provincial sources to capture the health information of a population. Because type 1 diabetes is relatively rare compared to type 2—only about 5-10% of those with diabetes have type 1—it was challenging to find a way to extract information specific to the type 1 community.
“It’s important to understand that when we use these types of large databases that capture health information for a population, we don’t have the same level of detail available in the medical chart. We don’t actually have a simple coded variable that says what type of diabetes someone has,” Weisman explains. “If you don’t have a simple way of distinguishing that, it’s really hard to reliably identify those people who have type 1 diabetes because they’re such a small population relative to type 2 diabetes.”
The paper, “Validation of a type 1 diabetes algorithm using electronic medical records and administrative healthcare data to study the population incidence and prevalence of type 1 diabetes in Ontario, Canada,”was published in the journal BMJ Open Diabetes Research and Care. Weisman hopes that it may help researchers in other provinces find a reliable way to distinguish type 1 diabetes in their database systems. She cautions, however, that because each province has slightly different ways of collecting data, the algorithm may need to be adjusted in every case.
Next up, Weisman and her research team are working on ways to use this newfound data to learn more about how access to insulin pumps can have an impact on outcomes for those with type 1 diabetes. Across Canada, each province has different rules for pump funding, which means that outcomes could potentially differ greatly based on access.
“One of the first questions we’re looking at, since we have this opportunity for the first time to compare between provinces within Canada, is to look at whether this affects incidence of insulin pump use, and whether it affects who is able to use an insulin pump based on what funding is available in their province,” Weisman says. “It’s disheartening to think that the same individual with type 1 diabetes has access to an insulin pump in one province and not another. I think this can be used to advocate and drive change in those provinces where people don’t have that much access.”
Her findings could also influence how coverage for technologies like continuous glucose monitors, which are currently not covered in most provinces, are supported. As wearable technology improves, it will be important to know just how much impact these devices have on the overall health of those who use them in order to better understand the need for improved access and funding. This new research offers a step forward in that work.