Diabetes Care in the U.S. and Canada

OBJECTIVE — To compare the glycemic control of patients with type 1 diabetes treated in the U.S. and Canada. RESEARCH DESIGN AND METHODS — A large multicenter randomized clinical trial conducted in the U.S. and Canada was analyzed. Patients with type 1 diabetes, screened from 1983 to 1989 for enrollment in the Diabetes Control and Complications Trial (DCCT), were categorized as treated in the U.S. (n 2,604) or Canada (n 245). HbA1c levels were compared between U.S. and Canadian patients, both before and after adjustment for predictors of HbA1c. RESULTS — In general, volunteers screened for the DCCT were highly educated and follow-ing healthy lifestyles. Canadians were somewhat younger (25 vs. 27 years of age, P 0.002), less likely to be college educated (62 vs. 71%, P 0.002), more likely to receive care through a family doctor (41 vs. 28%, P 0.001), and had a higher frequency of out-patient visits (4 vs. 3 per year, P 0.004). Despite these differences in health care delivery, the mean HbA1c at baseline was identical in the two countries (8.9 vs. 9.0, P 0.40). Adjustment for demographic, lifestyle, and clinical predictors of HbA1c yielded similar findings (9.0 vs. 9.2, P 0.15). Equal percentages of American and Canadian patients who were screened ultimately entered the trial (21 vs. 19%,