Effective management of diabetes is a public health priority, with about 537 million adults estimated to be living with the condition worldwide. The significance of prevention and management of diabetes was also highlighted during the COVID‑19 pandemic, as the infection is associated with high risks of hospitalisation and mortality among people with diabetes. Deaths due to diabetes continue to increase globally, reaching 6.7 million deaths in 2021. It is projected that by 2045 approximately 783 million adults will have the condition, and taking into account the impact of COVID‑19, the burden of diabetes is likely to become even higher (IDF, 2021[1]).
Diabetes is a leading cause of cardiovascular disease, blindness, kidney failure and lower limb amputation, and ongoing control of diabetes usually involves a considerable amount of self-management; therefore, patient-centred care instruction and education are central to primary care of people with diabetes (OECD, 2020[2]). In most cases, hospital admissions for diabetes can be avoided through high quality primary care. In particular, 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. Management of key risk factors such as smoking, blood pressure and lipid levels is also important in reducing complications.
Figure 6.11 shows that in 2021 there was a more than 20‑fold variation in hospital admissions for diabetes across OECD countries. Japan, Iceland and Italy reported the lowest rates, while the United States reported rates more than twice the OECD average. Prevalence of diabetes, general access to hospital care may explain some of this variation. As seen for other chronic conditions (see section on “Avoidable hospital admissions”), admissions for diabetes fell in nearly all countries both before and during the pandemic. The average decreases across OECD countries were 19% between 2011 and 2019, and 17% between 2019 and 2021. During the pandemic, the reduction was largest in Mexico and Poland, potentially reflecting reduced use of healthcare services across multiple settings.
In individuals living with diabetes and hypertension, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are recommended in most national guidelines as first-line medications to reduce blood pressure. Figure 6.12 reveals broad consistency in the proportion of patients with diabetes on recommended antihypertensive medications, although Türkiye, the Netherlands and Iceland had rates lower than 80%. Changes in the proportion have remained stable over recent years, and the pandemic also did not seem to have much impact on prescribing patterns for individual living with diabetes, possibly due to expanded use of e‑prescriptions (OECD, 2023[3]).
High-quality primary care can reduce the risk of amputations among diabetes patients, and the rate of hospital admissions for major lower extremity amputation reflects the long-term quality of diabetes care. Figure 6.13 shows large international variation in rates of amputation among adults with diabetes, with Iceland, Italy and Korea reporting rates lower than 3 per 100 000 population, while the United States reported a rate higher than 30 per 100 000. Admissions for amputation have decreased in recent years; the average decline was about 10% between 2011 and 2019, while it was smaller – at around 6% – during the pandemic.
The relationship between the nature, frequency and duration of primary care provided for diabetes and the rate of admissions to hospital for related complications is complex, and warrants further research. The OECD’s international survey of patients with chronic conditions including diabetes (www.oecd.org/health/paris.htm), is likely to uncover differences in primary care performance and outcomes of diabetes care across countries.
