Racial Disparities in BC’s Diabetes Care Cascade

The Opportunity

Diabetes affects hundreds of thousands of people across British Columbia. The South Asian population — people who have ancestry from countries like Pakistan, India, Bangladesh, Bhutan, Maldives, Fiji, and Sri Lanka — are one of the fastest growing visible minority groups in BC, and are twice as likely to develop diabetes than other populations, often at younger ages and with lower body mass index. They are also more likely to develop serious health problems from diabetes like heart disease, kidney disease, and eye damage. Not only does this population experience a disproportionately high burden of type 2 diabetes, but they may also face barriers to care due to language, health literacy, cultural norms, income, employment conditions, immigration experiences, lack of access to culturally appropriate healthcare services, and systemic challenges within the healthcare system. In this case, ethnicity itself can act as a determinant of health, particularly when it intersects with social, economic, cultural, and systemic factors that impact how this group accesses, and continues to receive, care for chronic illnesses like diabetes.

Without proper treatment, diabetes can lead to serious complications that are painful, life-threatening, and in some cases fatal, and with such a large population of people impacted, very costly to the healthcare system. In 2024, diabetes cost the BC healthcare system $642 million, with anticipated costs rising to $747 million by 2033.

According to Diabetes Canada, a diagnosis of type 2 diabetes reduces a person’s lifespan by 5 to 15 years. It is the leading cause of blindness in Canada, and contributes to:

• 30% of strokes,
• 40% of heart attacks,
• 50% of kidney failure requiring dialysis; and,
• 70% of all non-traumatic leg and foot amputations.

Despite its significant impact on individuals, families, and the healthcare system, there is currently limited data available to fully understand disease patterns, outcomes, and gaps in care. What can we do to ensure South Asian people in BC have better access to diabetes screening, diagnosis, and culturally safe care, and prevent complications among people living with diabetes? We are supporting a project conducted by our partners at the BC Centre for Disease Control (BCCDC), who are developing a new tool to compile the health information of South Asian patients in BC together in one interactive dashboard. This tool will strengthen diabetes data collection and analysis to generate the evidence needed to support earlier diagnosis and treatment, identify inequities, and deliver timely, more culturally responsive and effective care. This tool will also facilitate personalized care by identifying patients with specific needs, such as those with pre-existing conditions or requiring better diabetes management, and aligning targeted supports to promote early intervention and prevent complications. By creating a stronger foundation of knowledge, we can help provide primary care doctors, researchers, and policy makers with the data they need to offer better diabetes care and support in our province.

The Solution

Using linked health administrative data covering the entire province’s population, researchers will use a name recognition software to identify South Asian patients, as ethnicity data is not routinely collected in clinical settings, like a doctor’s office or the hospital. They will then develop an interactive dashboard that will identify South Asian patients with diabetes who have gaps in care, such as inadequate medications or missed screening of diabetes-related complications, that put them at high risk of adverse health in relation to their illness.

By providing this information to doctors who are working directly with patients, this program will serve as an early warning system, notifying them of patients who are not accessing the care they need, and allowing them to connect with these patients before their symptoms become unmanageable.

Dr Geoffrey McKee, a Public Health Physician and Medical Director at the BCCDC, highlights the importance of gathering this data to also determine the programs and policy changes that can help those with type 2 diabetes in the province. “If we want to support evidence-based care, we want decisions to be made on the best evidence and data available, but at the moment, that evidence isn’t there. Most people would be surprised at how little data on diabetes is available to inform the response to such a major population health burden right now.”

The Impact

This project uses an upstream approach to diabetes care by gathering the information necessary to provide better and personalized patient care and inform policy to help prevent diabetes in the South Asian community. By allowing for early intervention, this work has the potential to improve and save lives, while saving millions of dollars for our healthcare system.

According to Dr Jia Hu, Public Health Physician & Interim Medical Director at the BCCDC, “this (project) creates an ‘atlas’ of diabetes care in BC. Until we really understand the situation, it’s hard to solve the problem. This is your one stop comprehensive shop of how diabetes care is actually delivered across the province.