A recent study published in February 2025 sheds new light on the quality of diabetes care in Ontario, Canada. Despite accounting for socioeconomic marginalization, significant disparities persist between immigrants and non-immigrants, highlighting the need for targeted interventions to ensure equitable healthcare access.
The Immigrant's Numbers Tell a Story
The study analyzed a staggering 1,449,589 individuals with diabetes, of whom 22.6% (328,077 people) were immigrants.
The findings reveal concerning trends:
✅ Eye exams: Only 64.4% of immigrants received an eye examination compared to 72.8% of non-immigrants—a notable 8.4 percentage point difference.
✅ HbA1c testing: a crucial marker for blood sugar control, was less frequent among immigrants.
✅ Immigrants were less likely to reach recommended targets for HbA1c (≤7.0%) and LDL cholesterol (≤2.0 mmol/L)—both critical markers for diabetes management.
"There were statistically significant differences in virtually all diabetes care indicators between immigrants and non-immigrants... Notably, although most of the process and outcome indicators were significantly different between immigrants and non-immigrants, the absolute differences between groups were generally small, with the largest absolute difference being for eye examinations (64.4% among immigrants, 72.8% among non-immigrants)."
Yet, paradoxically, immigrants had higher rates of LDL-cholesterol and urine ACR testing and were more likely to achieve urine ACR targets. This suggests potential differences in screening priorities, healthcare utilization patterns, or provider recommendations within immigrant communities.
Marginalization Quintiles: A Complex Picture
A major strength of the study is its analysis of marginalization factors—material deprivation, residential instability, and dependency—providing a nuanced look at healthcare disparities.
Even among the least marginalized individuals, immigrants consistently received lower rates of HbA1c testing and eye examinations than their non-immigrant counterparts. This suggests that disparities in care go beyond socioeconomic status.
Interestingly, in the most marginalized quintiles, the quality of care declined more sharply for non-immigrants than for immigrants.
This raises important questions:
Are immigrant communities relying more on alternative support systems?
Does the immigrant experience shape different healthcare-seeking behaviors?
Could healthcare navigation challenges be leveling out disparities across marginalization levels?
These findings point to a complex interplay of social, cultural, and systemic factors influencing healthcare access and outcomes.
Beyond the Numbers: The Urgency of System-Wide Improvements
The study underscores a broader issue: diabetes care in Ontario is falling short for everyone, regardless of immigration status.
👉 Less than 50% of individuals with diabetes (immigrant and non-immigrant) met target HbA1c levels.
👉 Only about a quarter achieved recommended urine ACR targets, highlighting potential gaps in kidney disease management.
👉 Process measures were alarmingly low, with one-quarter to one-half of all patients missing key screenings, exams, and preventive treatments.
"Among both immigrants and non-immigrants, less than half of people with diabetes achieved HbA1c targets, and only about a quarter had urine ACR in target. Even process indicators had poor performance, with between one-quarter and one-half of people with diabetes in both groups failing to receive appropriate laboratory testing, eye examinations or preventative medications."
📢 Key takeaway: While disparities between groups are concerning, the overall quality of diabetes care in Ontario needs urgent attention.
Building an Equitable Diabetes Care System
This study provides valuable insights that should guide policy and practice to improve diabetes care for all, particularly immigrants.
Addressing the root causes of disparities requires:
✅ Breaking Language Barriers: Providing interpreter services and multilingual health resources to ensure patients fully understand their care.
✅ Culturally Responsive Care: Training healthcare providers to recognize diverse health beliefs and practices that influence treatment adherence.
✅ Tackling Systemic Bias: Addressing implicit biases in the healthcare system to ensure equal treatment for all patients.
✅ Simplifying Healthcare Navigation: Streamlining processes so newcomers can more easily access specialists, screenings, and treatments.
🚀 It’s time for policymakers, healthcare professionals, and communities to work together to close these gaps and improve diabetes outcomes for everyone.
Let's continue this important conversation and explore potential solutions in the comments below! 👇
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