The purpose of this study was to assess changes in diabetes management and healthcare utilisation among First Nations with diabetes in Alberta before and during the COVID-19 pandemic.

This analysis used a retrospective cohort in a case–control design. Individual-level administrative health datasets (1 April 2018 to 31 March 2022) were linked and data were formatted as a segmented interrupted time series.

This study took place in Alberta, Canada using administrative data.

Adult First Nations and non-First Nations (matched 1:1) with diabetes and living in Alberta were included (n=28 101; 53% female, 47% male).

The primary outcome was the change in incidence rate of general practitioner (GP) visits, emergency department (ED) visits, hospitalisations and diabetes-related drug dispenses during-COVID-19 versus pre-COVID-19, quantified using generalised linear regressions. The secondary outcome was to report the reasons for non-drug outcomes pre-COVID-19 and during-COVID-19, based on primary diagnosis International Statistical Classification of Diseases and Related Health Problems codes.

Pre-COVID-19, baseline rates of GP visits, ED visits, hospitalisations and drug dispenses were significantly higher among First Nations compared with non-First Nations (rate differences 398.32 (391.97–404.67), 100.58 (98.32–102.84), 14.49 (13.56–15.43), 876.98 (868.72–885.24) per 100 person-years (PY); p

Healthcare utilisation was substantially elevated among First Nations compared with non-First Nations peoples before and during COVID-19. While the generalisability of our findings to other health systems and populations may be limited, our findings are clinically applicable among First Nations across Alberta in order to help direct public health programming post-COVID-19.

To describe the association between place of residence in Alberta, Canada, and cardiovascular event risk among adults newly treated with metformin for type 2 diabetes.

Retrospective cohort study.

Administrative data from Alberta, Canada between 2008 and 2023.

Adult new metformin users, categorised by residence (rural, urban, metropolitan) from postal codes 1 year before metformin.

Cause-specific hazard models were constructed for the primary composite outcome (cardiovascular mortality, hospitalisation for an acute coronary syndrome or stroke) and each of the secondary outcomes (components of the primary outcome and all-cause mortality). Models were adjusted for baseline demographics, healthcare utilisation and diabetes complications.

A total of 236 005 adult new metformin users were identified and distributed across the rural-urban continuum (66% metropolitan, 10% urban, 24% rural). Mean age was 55 years, 55% were men, and mean follow-up time was 5.7 years. There were 19 059 primary composite outcome events, and rural residents were more likely to experience the outcome, adjusted HR (aHR): 1.09 (95% CI 1.06 to 1.13), compared with metropolitan. A significant interaction between residence and cardiovascular event history was identified. When stratified, risk of the primary outcome among those without cardiovascular history and living in a rural area was aHR: 1.16 (95% CI 1.11 to 1.20). Among rural residents with cardiovascular history, the risk was aHR: 0.84 (95% CI 0.78 to 0.91).

Quantifying the association between residence and risk of cardiovascular events may focus the allocation of healthcare resources. Development of targeted intervention programmes should focus on primary prevention in rural areas and secondary prevention in metropolitan areas.