Disparities in adherence to diabetes screening guidelines among males and females in a universal care setting: A population-based study of 1,380,697 adults

Padma Kaul; Luan Manh Chu; Douglas C Dover; Roseanne O Yeung; Dean T Eurich; Sonia Butalia

doi:10.1016/j.lana.2022.100320

Disparities in adherence to diabetes screening guidelines among males and females in a universal care setting: A population-based study of 1,380,697 adults

Lancet Reg Health Am. 2022 Jul 13:14:100320. doi: 10.1016/j.lana.2022.100320. eCollection 2022 Oct.

Authors

Padma Kaul^{1

2

3}, Luan Manh Chu⁴, Douglas C Dover¹, Roseanne O Yeung², Dean T Eurich³, Sonia Butalia^{5

6

7

8}

Affiliations

¹ Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
² Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
³ School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
⁴ Alberta SPOR Support Unit, Alberta Health Services, Canada.
⁵ Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁶ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁷ O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁸ Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Abstract

Background: National guidelines recommend that all adults over the age of 40 years undergo screening for diabetes at least once every 3-years. We examined the adherence to these guidelines among males and females after accounting for age, urban/rural residence, and material deprivation. We also examined the incidence of prediabetes and diabetes in adherent and non-adherent individuals.

Methods: Our study is based on a retrospective population-level inception cohort of adults aged 40-79 years without pre-existing diabetes or cardiovascular disease on April 1, 2013. Adherence during a 3-year screening period (2013-2016) and prediabetes and diabetes during a 4-year follow-up period were examined. Multivariate logistic regression was used to examine the adjusted association between sex and adherence.

Findings: Among 1,380,697 individuals (49·2% male, 50·8% female) adherence rates were 69·9% in males and 79·8% in females. Sex-differences in adherence were largest in younger individuals (58·0% and 72·6% and in males and females aged 40-44 years, respectively) and consistent across rural/urban residence and material deprivation. Females were more adherent (adjusted odds ratio 1·92; 95% confidence interval 1·89 to 1·95) than males. Prediabetes and diabetes rates among individuals who adhered to screening guidelines were 15·7% and 2·6% among males and 13·4% and 1·5% among females. During the follow-up period, an additional 3·2% and 1·9% of adherent males and females had diabetes. Incidence rates of prediabetes and diabetes during the follow-up period among individuals who did not adhere to screening guidelines were 8·8% and 2·1% among males and 7·3% and 1·3% among females.

Interpretation: Adherence to diabetes screening guidelines is sub-optimal, especially among young males. Despite lower rates of adherence to screening, males have higher rates of prediabetes and diabetes compared to females. There is a need for education campaigns to improve diabetes screening rates in young adults, especially males.

Funding: This study was funded by the Canadian Institutes of Health Research Sex and Gender Science Chair (Recipient: Kaul).

Keywords: Adherence; Diabetes; Pre-diabetes; Screening.