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Manji A, Basiri R, Harton F, Rommens K, Manji K. Effectiveness of a Multidisciplinary Limb Preservation Program in Reducing Regional Hospitalization Rates for Patients With Diabetes-Related Foot Complications. INT J LOW EXTR WOUND 2024:15347346241238458. [PMID: 38504634 DOI: 10.1177/15347346241238458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE This study evaluated the toe and flow model (TFM), a limb preservation program led by podiatric surgeons in Alberta, Canada, for its impact on hospitalization rates and length of stay (LOS) in patients with diabetic foot complication (DFC). Diabetes, a leading cause of non-traumatic lower extremity amputations (LEAs) in Canada, often results in diabetic foot ulcers (DFUs), a major cause of infection, amputation, and hospitalization. TFM has reportedly reduced amputation rates by 39% to 56%. METHODS The study analyzed Alberta's health database from 2007 to 2017, focusing on diabetes patients aged 20 and above. It included patients with various DFCs and compared outcomes in regions using TFM and standard of care (SOC). The study also examined data from two major cities, one with TFM and the other without, including rural referrals to Calgary and Edmonton. The data were normalized for the diabetic population and analyzed using a standard Student's t-test. RESULTS TFM regions showed significantly lower hospitalization rates (p = 1.22E-12) than SOC regions. Over 11 years, TFM maintained lower average and median LOS by 0.13 and 0.26 days, respectively. TFM access reduced hospitalization risk by up to 30%, and patients in TFM regions had a 21% shorter LOS compared to SOC regions. CONCLUSION Despite similar demographics and healthcare systems, the TFM region benefited from a dedicated multidisciplinary program and comprehensive limb preservation services. The study shows that TFM effectively reduces hospitalizations and LOS for DFCs, with significantly better outcomes in the TFM region than in SOC regions.
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Affiliation(s)
- Ali Manji
- Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reza Basiri
- Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada
- Institute of Biomedical Engineering, University of Toronto, Ontario, Canada
| | - Francois Harton
- Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenton Rommens
- Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karim Manji
- Zivot Limb Preservation Centre, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Zhou C, Zhou S, Wang J, Xie L, Lv Z, Zhao Y, Wang L, Luo H, Xie D, Shao F. Safety, tolerability, pharmacokinetics and pharmacokinetic-pharmacodynamic modeling of cetagliptin in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1359407. [PMID: 38529396 PMCID: PMC10961402 DOI: 10.3389/fendo.2024.1359407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
Aims To evaluate the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of cetagliptin (CAS number:2243737-33-7) in Chinese patients with type 2 diabetes mellitus (T2DM). A population PK/PD model was developed to quantify the PK and PD characteristics of cetagliptin in patients. Materials and methods 32 Chinese adults with T2DM were enrolled in this study. The subjects were randomly assigned to receive either cetagliptin (50 mg or 100 mg), placebo, or sitagliptin (100 mg) once daily for 14 days. Blood samples were collected for PK and PD analysis. Effects on glucose, insulin, C-peptide, and glucagon were evaluated following an oral glucose tolerance test (OGTT) (day15). Effects on HbA1c and glycated albumin (GA), and safety assessments were also conducted. Meanwhile, a population PK/PD model was developed by a sequential two-step analysis approach using Phoenix. Results Following multiple oral doses, cetagliptin was rapidly absorbed and the mean half-life were 34.9-41.9 h. Steady-state conditions were achieved after 1 week of daily dosing and the accumulation was modest. The intensity and duration of DPP-4 inhibition induced by 50 mg cetagliptin were comparable with those induced by sitagliptin, and 100 mg cetagliptin showed a much longer sustained DPP-4 inhibition (≥80%) than sitagliptin. Compared with placebo group, plasma active GLP-1 AUEC0-24h increased by 2.20- and 3.36-fold in the 50 mg and 100 mg cetagliptin groups. A decrease of plasma glucose and increase of insulin and C-peptide were observed following OGTT in cetagliptin groups. Meanwhile, a tendency of reduced GA was observed, whereas no decreasing trend was observed in HbA1c. All adverse events related to cetagliptin and sitagliptin were assessed as mild. A population PK/PD model was successfully established. The two-compartment model and Sigmoid-Emax model could fit the observed data well. Total bilirubin (TBIL) was a covariate of volume of peripheral compartment distribution (V2), and V2 increased with the increase of TBIL. Conclusions Cetagliptin was well tolerated, inhibited plasma DPP-4 activity, increased plasma active GLP-1 levels, and exhibited a certain trend of glucose-lowering effect in patients with T2DM. The established population PK/PD model adequately described the PK and PD characteristics of cetagliptin.
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Affiliation(s)
- Chen Zhou
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Sufeng Zhou
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacology, Pharmacy College, Nanjing Medical University, Nanjing, China
| | - Jie Wang
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacy, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Lijun Xie
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zhanhui Lv
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacology, Pharmacy College, Nanjing Medical University, Nanjing, China
| | - Yuqing Zhao
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lu Wang
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Huan Luo
- Clinical Development Department, Beijing Sun-novo Pharmaceutical Research Co., Ltd, Beijing, China
| | - Daosheng Xie
- Clinical Development Department, Beijing Sun-novo Pharmaceutical Research Co., Ltd, Beijing, China
- Clinical Development Department, Beijing Noahpharm Medical Technology Co., Ltd, Beijing, China
| | - Feng Shao
- Phase I Clinical Trial Unit, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- Department of Clinical Pharmacology, Pharmacy College, Nanjing Medical University, Nanjing, China
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Cohen NM, Lifshitz A, Jaschek R, Rinott E, Balicer R, Shlush LI, Barbash GI, Tanay A. Longitudinal machine learning uncouples healthy aging factors from chronic disease risks. NATURE AGING 2024; 4:129-144. [PMID: 38062254 DOI: 10.1038/s43587-023-00536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/02/2023] [Indexed: 01/21/2024]
Abstract
To understand human longevity, inherent aging processes must be distinguished from known etiologies leading to age-related chronic diseases. Such deconvolution is difficult to achieve because it requires tracking patients throughout their entire lives. Here, we used machine learning to infer health trajectories over the entire adulthood age range using extrapolation from electronic medical records with partial longitudinal coverage. Using this approach, our model tracked the state of patients who were healthy and free from known chronic disease risk and distinguished individuals with higher or lower longevity potential using a multivariate score. We showed that the model and the markers it uses performed consistently on data from Israeli, British and US populations. For example, mildly low neutrophil counts and alkaline phosphatase levels serve as early indicators of healthy aging that are independent of risk for major chronic diseases. We characterize the heritability and genetic associations of our longevity score and demonstrate at least 1 year of extended lifespan for parents of high-scoring patients compared to matched controls. Longitudinal modeling of healthy individuals is thereby established as a tool for understanding healthy aging and longevity.
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Affiliation(s)
- Netta Mendelson Cohen
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Aviezer Lifshitz
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Rami Jaschek
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Ehud Rinott
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Ran Balicer
- Clalit Research Institute, Ramat Gan, Israel
| | - Liran I Shlush
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
| | - Gabriel I Barbash
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel.
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
| | - Amos Tanay
- Department of Computer Science and Applied Math, Weizmann Institute of Science, Rehovot, Israel.
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel.
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Blanchette V, Patry J, Brousseau-Foley M, Todkar S, Libier S, Leclerc AM, Armstrong DG, Tremblay MC. Diabetic foot complications among Indigenous peoples in Canada: a scoping review through the PROGRESS-PLUS equity lens. Front Endocrinol (Lausanne) 2023; 14:1177020. [PMID: 37645408 PMCID: PMC10461566 DOI: 10.3389/fendo.2023.1177020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/18/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens. Methods A scoping review was conducted based on Arksey and O'Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR). Results Of 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA. Discussion This study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare. Conclusion Efforts have been made to manage DRFC, but continued attention and support are necessary to address this population's needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting. Systematic review registration Open Science Framework https://osf.io/j9pu7, identifier j9pu7.
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Affiliation(s)
- Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jérôme Patry
- Centre de Recherche du Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
| | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
- Faculty of Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec Affiliated with Université de Montréal, Trois-Rivières Family Medicine University Clinic, Trois-Rivières, QC, Canada
| | - Shweta Todkar
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Solène Libier
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anne-Marie Leclerc
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Marie-Claude Tremblay
- VITAM-Centre de Recherche en Santé Durable, Québec, QC, Canada
- Faculty of Medicine, Family and Emergency Medicine Department, Université Laval, Québec, QC, Canada
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Williams A, Bissinger R, Shamaa H, Patel S, Bourne L, Artunc F, Qadri SM. Pathophysiology of Red Blood Cell Dysfunction in Diabetes and Its Complications. PATHOPHYSIOLOGY 2023; 30:327-345. [PMID: 37606388 PMCID: PMC10443300 DOI: 10.3390/pathophysiology30030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
Diabetes Mellitus (DM) is a complex metabolic disorder associated with multiple microvascular complications leading to nephropathy, retinopathy, and neuropathy. Mounting evidence suggests that red blood cell (RBC) alterations are both a cause and consequence of disturbances related to DM-associated complications. Importantly, a significant proportion of DM patients develop varying degrees of anemia of confounding etiology, leading to increased morbidity. In chronic hyperglycemia, RBCs display morphological, enzymatic, and biophysical changes, which in turn prime them for swift phagocytic clearance from circulation. A multitude of endogenous factors, such as oxidative and dicarbonyl stress, uremic toxins, extracellular hypertonicity, sorbitol accumulation, and deranged nitric oxide metabolism, have been implicated in pathological RBC changes in DM. This review collates clinical laboratory findings of changes in hematology indices in DM patients and discusses recent reports on the putative mechanisms underpinning shortened RBC survival and disturbed cell membrane architecture within the diabetic milieu. Specifically, RBC cell death signaling, RBC metabolism, procoagulant RBC phenotype, RBC-triggered endothelial cell dysfunction, and changes in RBC deformability and aggregation in the context of DM are discussed. Understanding the mechanisms of RBC alterations in DM provides valuable insights into the clinical significance of the crosstalk between RBCs and microangiopathy in DM.
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Affiliation(s)
- Alyssa Williams
- Faculty of Science, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4M1, Canada
| | - Rosi Bissinger
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Hala Shamaa
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Shivani Patel
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Lavern Bourne
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Ferruh Artunc
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research at the University of Tübingen, 72076 Tübingen, Germany
| | - Syed M. Qadri
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
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Cheran K, Murthy C, Bornemann EA, Kamma HK, Alabbas M, Elashahab M, Abid N, Manaye S, Venugopal S. The Growing Epidemic of Diabetes Among the Indigenous Population of Canada: A Systematic Review. Cureus 2023; 15:e36173. [PMID: 37065334 PMCID: PMC10103803 DOI: 10.7759/cureus.36173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Diabetes is one of the most well-known and well-researched non-communicable diseases known to humankind. The goal of this article is to show that the prevalence of diabetes is constantly increasing among indigenous people, a major population subgroup in Canada. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this systematic review, and the databases used were PubMed and Google Scholar. Studies that were published in the last 15 years (2007-2022) were selected for this review, and after applying the inclusion and exclusion criteria, screening, and removing duplicates, 10 articles were selected for the final review - three qualitative studies, three observational studies, and four studies without a specified methodology. We used the JBI (Joanna Briggs Institute) checklist, NOS (Newcastle-Ottawa Scale) checklist, and SANRA (Scale for the Assessment of Narrative Review) checklist for quality assessment. We found that all the articles showed that the prevalence of diabetes is increasing in all the Aboriginal communities despite all the interventional programs already in place. Rigorous health plans, health education, and wellness clinics for primary prevention can all be effective in reducing the potential risks of diabetes. More studies exploring the prevalence, effects, and outcomes of diabetes in the indigenous population of Canada are needed to effectively understand the disease and its complications in this group.
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7
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Emmanuel R, Read UM, Grande AJ, Harding S. Acceptability and Feasibility of Community Gardening Interventions for the Prevention of Non-Communicable Diseases among Indigenous Populations: A Scoping Review. Nutrients 2023; 15:791. [PMID: 36771495 PMCID: PMC9921708 DOI: 10.3390/nu15030791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Compared with non-Indigenous populations, Indigenous populations experience worse health across many outcomes, including non-communicable diseases, and they are three times more likely to live in extreme poverty. The objectives were to identify (1) the content, implementation, and duration of the intervention; (2) the evaluation designs used; (3) the outcomes reported; and (4) the enablers and the challenges. Using the PRISMA-ScR guidelines, a search of research databases and grey literature was conducted. Seven studies met the inclusion criteria. Papers reported on acceptability, nutrition knowledge, fruit and vegetable intake, self-efficacy, motivation, and preference concerning fruit and vegetable, diet, and gardening. No study measured all outcomes. All papers reported on acceptability, whether implicitly or explicitly. The evaluation used mostly pre- and post-intervention assessments. The effect of gardening on nutrition and gardening knowledge and fruit and vegetable intake was inconclusive, and was related to a general lack of robust evaluations. Applying the He Pikinga Waiora Framework, however, revealed strong evidence for community engagement, cultural centeredness, integrated knowledge translation and systems thinking in increasing the acceptability and feasibility of gardening in Indigenous communities. Despite environmental challenges, the evidence signaled that gardening was an acceptable intervention for the Indigenous communities.
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Affiliation(s)
- Rosana Emmanuel
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London SE1 1UL, UK
| | - Ursula M Read
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London SE1 1UL, UK
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Antonio Jose Grande
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London SE1 1UL, UK
- Department of Medicine, Universidade Estadual de Mato Grosso do Sul-(UEMS), P.O. Box 351, Dourados 79804-970, Brazil
| | - Seeromanie Harding
- Department of Population Health Sciences, School of Life Course & Population Sciences, King's College London, London SE1 1UL, UK
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Mavragani A, Sherifali D, Dragonetti R, Ashfaq I, Veldhuizen S, Naeem F, Agarwal SM, Melamed OC, Crawford A, Gerretsen P, Hahn M, Hill S, Kidd S, Mulsant B, Serhal E, Tackaberry-Giddens L, Whitmore C, Marttila J, Tang F, Ramdass S, Lourido G, Sockalingam S, Selby P. Technology-Enabled Collaborative Care for Concurrent Diabetes and Distress Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Feasibility Study. JMIR Res Protoc 2023; 12:e39724. [PMID: 36649068 PMCID: PMC9890354 DOI: 10.2196/39724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/09/2022] [Accepted: 11/28/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted the delivery of diabetes care and worsened mental health among many patients with type 2 diabetes (T2D). This disruption puts patients with T2D at risk for poor diabetes outcomes, especially those who experience social disadvantage due to socioeconomic class, rurality, or ethnicity. The appropriate use of communication technology could reduce these gaps in diabetes care created by the pandemic and also provide support for psychological distress. OBJECTIVE The purpose of this study is to test the feasibility of an innovative co-designed Technology-Enabled Collaborative Care (TECC) model for diabetes management and mental health support among adults with T2D. METHODS We will recruit 30 adults with T2D residing in Ontario, Canada, to participate in our sequential explanatory mixed methods study. They will participate in 8 weekly web-based health coaching sessions with a registered nurse, who is a certified diabetes educator, who will be supported by a digital care team (ie, a peer mentor, an addictions specialist, a dietitian, a psychiatrist, and a psychotherapist). Assessments will be completed at baseline, 4 weeks, and 8 weeks, with a 12-week follow-up. Our primary outcome is the feasibility and acceptability of the intervention, as evident by the participant recruitment and retention rates. Key secondary outcomes include assessment completion and delivery of the intervention. Exploratory outcomes consist of changes in mental health, substance use, and physical health behaviors. Stakeholder experience and satisfaction will be explored through a qualitative descriptive study using one-on-one interviews. RESULTS This paper describes the protocol of the study. The recruitment commenced in June 2021. This study was registered on October 29, 2020, on ClinicalTrials.gov (Registry ID: NCT04607915). As of June 2022, all participants have been recruited. It is anticipated that data analysis will be complete by the end of 2022, with study findings available by the end of 2023. CONCLUSIONS The development of an innovative, technology-enabled model will provide necessary support for individuals living with T2D and mental health challenges. This TECC program will determine the feasibility of TECC for patients with T2D and mental health issues. TRIAL REGISTRATION ClinicalTrials.gov NCT04607915; https://clinicaltrials.gov/ct2/show/NCT04607915. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39724.
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Affiliation(s)
| | - Diana Sherifali
- Addictions Research Program, Clinical Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Farooq Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Osnat C Melamed
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Philip Gerretsen
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret Hahn
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean Hill
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada.,Vector Institute for Artificial Intelligence, Toronto, ON, Canada.,Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada.,École polytechnique fédérale de Lausanne, Lausanne, Switzerland
| | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Benoit Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Eva Serhal
- Department of Virtual Mental Health, Outreach and Project ECHO, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Leah Tackaberry-Giddens
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Carly Whitmore
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Frank Tang
- Diabetes Action Canada, Toronto, ON, Canada.,Aging, Community and Health Research Unit, McMaster University, Hamilton, ON, Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto, ON, Canada.,Office of Social Accountability and Community Engagement, McGill University, Montreal, QC, Canada.,The Association of Faculties of Medicine of Canada, Ottawa, ON, Canada.,Conseil Pour La Protection Des Malades, Montreal, QC, Canada.,Montreal Children's Hospital, Montreal, ON, Canada
| | | | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Bariatric Surgery Program, University Health Network, Toronto, ON, Canada
| | - Peter Selby
- Nicotine Dependence Service, Addictions Program, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Addictions Research Program, Clinical Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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9
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Torti JMI, Szafran O, Kennett SL, Bell NR. Interprofessional care of patients with type 2 diabetes mellitus in primary care: family physicians’ perspectives. BMC PRIMARY CARE 2022; 23:74. [PMID: 35395729 PMCID: PMC8990268 DOI: 10.1186/s12875-022-01688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022]
Abstract
Background There is a lack of understanding of the team processes and factors that influence teamwork and medication management practices in the care of patients with type 2 diabetes mellitus (T2DM). The purpose of the study was to explore physicians’ perspectives of barriers and facilitators to interprofessional care of patients with T2DM within team-based family practice settings. Methods This was a qualitative, descriptive study. Participants included physicians affiliated with a primary care network providing care to patients with T2DM in an interprofessional team-based primary care setting in Edmonton, Alberta, Canada. Participants’ contact information was obtained from the publicly available College of Physicians and Surgeons of Alberta and respective primary care network websites. Interview questions addressed physicians’ perspectives on factors or processes that facilitated and hindered the care and medication management of adult patients with T2DM in primary care team-based clinical practice. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis and a constant comparative approach. Results A total of 15 family physicians participated in individual interviews. Family physicians identified facilitators of interprofessional team-based care and medication management of patients with T2DM in three theme areas—access to team members and programs, knowledgeable and skilled health professionals, and provision of patient education by other health professionals. Two themes emerged as barriers to interprofessional care – lack of provider continuity and the loss of skills from delegation of tasks. Conclusion Family physicians perceive both benefits and risks to interprofessional team-based care in caring for patients with T2DM. Successful functioning of team-based care in family practice will require overcoming traditional professional roles.
Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01688-w.
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10
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Turner LV, MacDonald MJ, Riddell MC, Voth J, Hawke TJ. Decreased Diastolic Blood Pressure and Average Grip Strength in Adults With Type 1 Diabetes Compared With Controls: An Analysis of Data From the Canadian Longitudinal Study on Aging. Can J Diabetes 2022; 46:789-796. [PMID: 35835668 DOI: 10.1016/j.jcjd.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Our aim in this study was to determine whether aging individuals with type 1 diabetes (T1D) have differences in cardiovascular health, assessed by blood pressure, and skeletal muscle function, assessed by grip strength, compared with matched nondiabetic controls (CON). METHODS This investigation was a retrospective cohort analysis using baseline and 3-year follow-up data from the Canadian Longitudinal Study on Aging. Bivariate and multivariate regression analyses were used to examine the association between sociodemographic, health, behavioural and T1D-specific variables on blood pressure and grip strength in T1D and CON groups. Generalized estimating equations were used to model the average population changes in blood pressure and grip strength from baseline to follow up. RESULTS The sample included 126 individuals (63 T1D and 63 CON). Systolic blood pressure was not significantly different between groups at baseline or follow up (p>0.05). However, compared with CON, diastolic blood pressure was significantly lower at both time-points in the T1D group (p<0.001). Grip strength was consistently lower among persons with T1D (p=0.03). In the multivariate regression model, body mass index, age and sex were significantly associated with diastolic blood pressure and grip strength in both groups. In the T1D group, disease duration accounted for a large proportion of the variance in diastolic blood pressure and grip strength (17% and 9%, respectively). The rate of decline in diastolic blood pressure and grip strength did not differ between groups (p>0.05). CONCLUSIONS Diastolic blood pressure and grip strength appear to be consistently lower and differentially regulated in individuals with T1D vs CON. Aging individuals with T1D may be at risk of premature morbidity and mortality.
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Affiliation(s)
- Lauren V Turner
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | | | - Michael C Riddell
- School of Kinesiology and Health Science, Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Jennifer Voth
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Thomas J Hawke
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
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11
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Eberle C, Stichling S. Environmental health influences in pregnancy and risk of gestational diabetes mellitus: a systematic review. BMC Public Health 2022; 22:1572. [PMID: 35982427 PMCID: PMC9389831 DOI: 10.1186/s12889-022-13965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications globally. Environmental risk factors may lead to increased glucose levels and GDM, which in turn may affect not only the health of the mother but assuming hypotheses of "fetal programming", also the health of the offspring. In addition to traditional GDM risk factors, the evidence is growing that environmental influences might affect the development of GDM. We conducted a systematic review analyzing the association between several environmental health risk factors in pregnancy, including climate factors, chemicals and metals, and GDM. Methods We performed a systematic literature search in Medline (PubMed), EMBASE, CINAHL, Cochrane Library and Web of Science Core Collection databases for research articles published until March 2021. Epidemiological human and animal model studies that examined GDM as an outcome and / or glycemic outcomes and at least one environmental risk factor for GDM were included. Results Of n = 91 studies, we classified n = 28 air pollution, n = 18 persistent organic pollutants (POP), n = 11 arsenic, n = 9 phthalate n = 8 bisphenol A (BPA), n = 8 seasonality, n = 6 cadmium and n = 5 ambient temperature studies. In total, we identified two animal model studies. Whilst we found clear evidence for an association between GDM and air pollution, ambient temperature, season, cadmium, arsenic, POPs and phthalates, the findings regarding phenols were rather inconsistent. There were clear associations between adverse glycemic outcomes and air pollution, ambient temperature, season, POPs, phenols, and phthalates. Findings regarding cadmium and arsenic were heterogeneous (n = 2 publications in each case). Conclusions Environmental risk factors are important to consider in the management and prevention of GDM. In view of mechanisms of fetal programming, the environmental risk factors investigated may impair the health of mother and offspring in the short and long term. Further research is needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13965-5.
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Affiliation(s)
- Claudia Eberle
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda, University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany.
| | - Stefanie Stichling
- Medicine With Specialization in Internal Medicine and General Medicine, Hochschule Fulda, University of Applied Sciences, Leipziger Strasse 123, 36037, Fulda, Germany
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12
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Blanchette V, Patry J, Brousseau-Foley M. Adequacy Between Canadian Clinical Guidelines and Recommendations Compared With International Guidelines for the Management of Diabetic Foot Ulcers. Can J Diabetes 2021; 45:761-767.e12. [PMID: 34052133 DOI: 10.1016/j.jcjd.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/21/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Although quality of care in the prevention and management of diabetic foot ulceration (DFU) has improved with the use of comprehensive evidence-based clinical practice guidelines, disparities between national and international guidelines have been demonstrated in one study conducted in Western Pacific regions. Although there are challenges of systematic implementation of evidence-based care in some clinical settings, their applications have demonstrated positive outcomes on DFU-associated burdens in many countries. The aim of this study was to review and evaluate 3 Canadian clinical practice guidelines and recommendations (CPGRs) in comparison with the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines. METHODS Extraction of all 85 recommendations from the IWGDF guidelines was performed and 3 independent investigators used a rating recommendations adequacy method with descriptive statistics. The Appraisal of Guidelines REsearch & Evaluation (AGREE) II instrument was used for quality appraisal and reliability scores were noted using intraclass correlation coefficients. RESULTS The Wounds Canada CPGR had the higher adequacy with the IWGDF guidelines. However, its development method was poor to fair. The Registered Nurses' Association of Ontario CPGR was superior for its development and implementation strategies, but major gaps were found in all chapters. The Diabetes Canada CPGR obtained a good quality appraisal evaluation, but was not dedicated exclusively to DFU and some important recommendations were absent. Reliability scores of AGREE II were good between investigators (p<0.0001). Some disparities were noted between Canadian and international recommendations. CONCLUSIONS Some disparities were noted, future orientations for development should include various health-care professionals involved in the team approach, patient-oriented research, recommendations published along with their level of evidence and strength of recommendations (such as with the Grading of Recommendations, Assessment, Development and Evaluations system) and implementation strategies to enhance evidence-based practice in Canada.
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Affiliation(s)
- Virginie Blanchette
- Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada.
| | - Jérôme Patry
- Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada; Faculty of Medicine, Family Medicine and Emergency Medicine Department, Université Laval, Québec, Canada
| | - Magali Brousseau-Foley
- Department of Physical Activity Sciences and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada; Faculty of Medicine, Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec affiliated with Université de Montréal, Trois-Rivières Family Medicine University Clinic, Trois-Rivières, Québec, Canada
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13
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Bean C, Dineen T, Locke SR, Bouvier B, Jung ME. An Evaluation of the Reach and Effectiveness of a Diabetes Prevention Behaviour Change Program Situated in a Community Site. Can J Diabetes 2020; 45:360-368. [PMID: 33323314 DOI: 10.1016/j.jcjd.2020.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 02/05/2023]
Abstract
More than 350 million people are living with prediabetes. Preventing type 2 diabetes (T2D) progression can reduce morbidity, mortality and health-care costs. Interventions can support people with diet and physical activity behaviour changes; however, many interventions are university-based, posing barriers (e.g. accessibility, limited reach and maintenance), which highlight the need for community intervention. Limited research has comprehensively evaluated programs in community contexts. The purpose of this study was to pragmatically examine the reach and effectiveness of a diabetes prevention behaviour change program in the community using the RE-AIM framework. Demographic and outcome data were collected through telephone screening and survey data, and analyzed using descriptive and multivariate analyses. Over 2 years, 9,954 individuals were identified by a medical laboratory as living with prediabetes. Information letters were sent by the laboratory to individuals upon physician approval (N=2,241, 22.5%) as a main form of recruitment. From this, 271 individuals and an additional 160 individuals via other recruitment methods contacted the research team (N=431). Two hundred thirteen adults with prediabetes were enrolled (87.4% Caucasian, 69.7% female; 95% program completion). Analyses of 6-month follow-up data revealed significant maintenance of reductions in weight and waist circumference and improvements in physical function, self-reported physical activity and all-food frequency items except fruit intake (N=121, d=0.21 to 0.68, p <0.05 to 0.001). The program demonstrated diabetes risk-reducing benefits for enrolled individuals. Future work is needed to increase physician referral and participant response rates and to explore program expansion through digitization to reach more individuals at risk of developing T2D.
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Affiliation(s)
- Corliss Bean
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Tineke Dineen
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Sean R Locke
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Brooklyn Bouvier
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary E Jung
- Faculty of Health and Social Development, The University of British Columbia, Kelowna, British Columbia, Canada.
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14
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Li Y, Pan Q, Gao M, Guo L, Yan H, Li S. Secular trends and rural-urban differences in endocrine and metabolic disease mortality in China: an age-period-cohort modeling of National Data. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00803-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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15
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Decker KM, Lambert P, Demers A, Kliewer EV, Musto G, Biswanger N, Elias B, Turner D. Examining the Impact of First Nations Status on the Relationship Between Diabetes and Cancer. Health Equity 2020; 4:211-217. [PMID: 32440618 PMCID: PMC7241056 DOI: 10.1089/heq.2019.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose: This population-based study examined the relationship between diabetes and cancer and determined if this relationship was influenced by First Nations (FN) status. Methods: In a matched case–cohort study, individuals 30–74 years of age diagnosed with diabetes during 1984–2008 in the province of Manitoba, Canada, with no cancer diagnosis before their diabetes diagnosis were matched to one diabetes-free control by age, sex, FN status, and residence. Flexible competing risk and Royston–Parmar regression models were used to compare cancer rates. Results: Overall, 72,715 individuals diagnosed with diabetes were matched to controls. In all age groups, diabetes was related to an increased risk of cancer. The relationship between diabetes and any type of cancer was not influenced by FN status (i.e., there was no interaction between the diagnosis of diabetes and people's FN status for any age group). The only significant interaction between diabetes and FN status was for kidney cancer for individuals 60–74 years of age; diabetes increased the risk of kidney cancer for all other Manitobans (AOMs) but not for FN. Conclusions: Diabetes increased the risk of cancer. The association was not modified by FN status except for kidney cancer where diabetes increased the risk for AOMs but not for FN.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Research Institute in Oncology and Hematology, CancerCare Manitoba, Winnipeg, Canada.,Department of Epidemiology, CancerCare Manitoba, Winnipeg, Canada
| | - Pascal Lambert
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, Canada
| | | | | | - Grace Musto
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, Canada
| | | | - Brenda Elias
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Donna Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Epidemiology, CancerCare Manitoba, Winnipeg, Canada
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16
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Brousseau-Foley M, Blanchette V. Multidisciplinary Management of Diabetic Foot Ulcers in Primary Cares in Quebec: Can We Do Better? J Multidiscip Healthc 2020; 13:381-385. [PMID: 32368075 PMCID: PMC7173947 DOI: 10.2147/jmdh.s251236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
A growing body of evidence supports the presence of integrated foot care based on multidisciplinary and interdisciplinary teams in the management and prevention of diabetic foot ulcer (DFU) worldwide. This model of care is however rare in the clinical setting in Quebec, Canada. Many best practice gaps are identified as well as probable causal hypothesis are listed in this commentary. We support our opinions with a pilot audit conducted as part of a continuous quality improvement process in managing patients with DFU in our area and on Canadian facts and data. Our pilot study (n = 27 hospitalized patients) included a typical DFU population with neuropathy, peripheral arterial disease and previous amputation. It highlights underachievement of best practice recommendations implementation such as multidisciplinary DFU management and offloading interventions in our establishment. Due the high morbidity and mortality associated with DFU patients, four died during the studied hospitalization episode. Several barriers were encountered in the pilot audit justifying that no robust conclusion can be raised. However, our observations are concerning. Even though data accessibility was limited, our observations are sadly coherent with what is found in the literature. Economic data of what this means for our health system is put forward in the overall discussion. We are preoccupied by the trends outlined by some facts and observations, and this commentary was written with this in mind. In the face of the diabetes crisis that is arising, a plea is made to reassess care pathway for this vulnerable population as we emphasize the importance of teamwork in managing DFU.
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Affiliation(s)
- Magali Brousseau-Foley
- University Family Medicine Group, Faculty of Medicine Affiliated to Université De Montréal, Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
- Department of Sciences of Physical Activity and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Virginie Blanchette
- Department of Sciences of Physical Activity and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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17
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Campbell RJ, Sutherland R, Khan S, Doliszny KM, Hooper PL, Slater M, Frymire E, Shah BR, Walker JD, Green ME. Diabetes-induced eye disease among First Nations people in Ontario: a longitudinal, population-based cohort study. CMAJ Open 2020; 8:E282-E288. [PMID: 32303520 PMCID: PMC7207040 DOI: 10.9778/cmajo.20200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Canada, First Nations populations experience a higher incidence of diabetes and diabetes-related complications than other people. Given the paucity of information on use of preventive eye examinations and the need for interventional care for severe retinopathy among First Nations people, we carried out a population-based study to compare rates of eye examinations and interventional therapies to treat vision-threatening stages of diabetic retinopathy among First Nations people and other people with diabetes in Ontario. METHODS In collaboration with the Chiefs of Ontario, we carried out a population-based study to identify cohorts of First Nations people and other people with diabetes in Ontario from 1995/96 to 2014/15. We used linked health administrative databases to evaluate rates of eye examination (2005/06-2014/15) and severe diabetic retinopathy treatment and compared them between the 2 populations, and between First Nations people living in and outside of First Nations communities. RESULTS We identified 23 013 First Nations people and 1 364 222 other people diagnosed with diabetes from 1995/96 to 2014/15, of whom 49.8% (95% confidence interval [CI] 48.9%-50.7%) and 53.8% (95% CI 53.7%-54.0%), respectively, received an eye examination in 2014/15. Eye examination rates were similar for First Nations people regardless of whether they lived in or outside a First Nations community. First Nations people developed severe diabetic retinopathy at a faster rate than other people (hazard ratio 1.19, 95% CI 1.02-1.38). The gap between First Nations people and other people in the proportion requiring therapy for severe diabetic retinopathy was especially prominent among younger people. There were no significant differences in rates of diabetic retinopathy treatment in First Nations people stratified by place of residence. INTERPRETATION Eye examination rates remain suboptimal among people with diabetes in Ontario and were lower among First Nations people. This is particularly concerning in light of our other findings showing an increased risk of requiring treatment for advanced diabetic retinopathy and the accelerated rate of diabetic retinopathy progression among First Nations people with diabetes.
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Affiliation(s)
- Robert J Campbell
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
| | - Roseanne Sutherland
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Shahriar Khan
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Katharine M Doliszny
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Philip L Hooper
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Morgan Slater
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Eliot Frymire
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Baiju R Shah
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Jennifer D Walker
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
| | - Michael E Green
- Department of Ophthalmology (Campbell, Doliszny), Queen's University and Kingston Health Sciences Centre; ICES Queen's (Campbell, Khan, Frymire, Walker, Green), Kingston, Ont.; Chiefs of Ontario (Sutherland), Toronto, Ont.; Department of Ophthalmology (Hooper), Western University and St. Joseph's Hospital, London, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; ICES Central (Shah); Department of Medicine (Shah), University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont
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Abstract
BackgroundAlthough many studies explore the experiences of persons with type 1 diabetes, most examine the experience of children, adolescents, or persons in transition to adulthood. Few studies focus on the person living long term with type 1 diabetes.PurposeThe purpose of this study was to explore the facilitators and barriers for people living well with type 1 diabetes over the long term.MethodsAn inductive interpretive description approach was used to explore living with type 1 diabetes for a duration of 40 years or more. Qualitative semistructured interviews with a convenience sample (n = 8) were conducted.ResultsFour dialectic themes were identified: accommodating and battling the disease, convenience and constraint of technology and treatment, self-reliance and reliance on others, and external and personal knowledge.ConclusionsRecommendations for the health-care team emphasize person-centered care with acknowledgment of the person as expert and as more than their condition. Further research with this population would strengthen the implications for practice. Specifically, research is needed on diabetes distress, losses experienced due to diabetes, how to meet their educational needs, and how to tap into their expertise for the benefit of those with type 1 following them.
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Affiliation(s)
- Donna Epp
- Faculty of Health Studies, Brandon University, Brandon, Manitoba, Canada
| | - Sonya Grypma
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
| | - Barbara Astle
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
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19
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Azzi JL, Azzi S, Lavigne-Robichaud M, Vermeer A, Barresi T, Blaine S, Giroux I. Participant Evaluation of a Prediabetes Intervention Program Designed for Rural Adults. CAN J DIET PRACT RES 2019; 81:80-85. [PMID: 31736334 DOI: 10.3148/cjdpr-2019-033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The type 2 diabetes epidemic is a global crisis threatening the health and economies of many nations. This study aimed to evaluate a prediabetes intervention program designed for rural adults in southwestern Ontario based on the feedback of participants. Rural adults with prediabetes were referred by physicians to an intervention program developed to assist with unique barriers rural adults face related to the built environment and socioeconomic status when adopting a healthy lifestyle. After 6 monthly education sessions offered by a dietitian and a nurse, participants completed a questionnaire to share their program experience. In addition, 6 focus groups consisting of 5-9 participants were conducted to assess program acceptability, feasibility, and practicality. Of 49 enrolled, 35 participants aged 60.8 ± 7.1 (mean ± SD) evaluated the program. Participants reported finding the program to be acceptable, feasible, and practical due to the interactive nature of the sessions, the group setting and the availability of health professionals. This prediabetes lifestyle intervention program was perceived as successfully addressing rural adults' needs in terms of adopting a healthy lifestyle. Feedback received through program evaluation, which included a participant experience survey and focus groups has helped improve this program and may benefit other prediabetes education intervention programs.
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Affiliation(s)
- Jayson L Azzi
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Sarita Azzi
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
| | | | | | | | | | - Isabelle Giroux
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON
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Ramzan S, Timmins P, Hasan SS, Babar ZUD. Trends in global prescribing of antidiabetic medicines in primary care: A systematic review of literature between 2000-2018. Prim Care Diabetes 2019; 13:409-421. [PMID: 31213359 DOI: 10.1016/j.pcd.2019.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/18/2019] [Accepted: 05/23/2019] [Indexed: 12/28/2022]
Abstract
The aim of this review was to examine changes in the use of diabetes medicines prescribed to treat type 2 diabetes in the primary care setting. Five electronic databases were searched using strict inclusion/exclusion criteria. The quality of eligible studies was appraised using the Newcastle-Ottawa Scale. Findings show the trend has been away from using sulfonylurea and towards the use of metformin. The introduction of newer drugs has not shifted treatment outcomes and glycaemic control. It was not possible to determine how clinicians make choices about the medicines they prescribe for T2DM, or what influences those choices.
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Affiliation(s)
- Sara Ramzan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom.
| | - Peter Timmins
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom.
| | - Syed Shahzad Hasan
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom.
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom.
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21
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Nash DM, Dirk JS, McArthur E, Green ME, Shah BR, Walker JD, Beaucage M, Jones CR, Garg AX. Kidney disease and care among First Nations people with diabetes in Ontario: a population-based cohort study. CMAJ Open 2019; 7:E706-E712. [PMID: 31822501 PMCID: PMC7015672 DOI: 10.9778/cmajo.20190164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND End-stage kidney disease is a serious complication of diabetes. We describe the prevalence of chronic kidney disease, prevalence and incidence of end-stage kidney disease and quality of care of early-stage chronic kidney disease for First Nations people with diabetes compared to other Ontarians with diabetes. METHODS We conducted a retrospective cohort study in Ontario using linked administrative data at ICES. We included adults with incident diabetes between 1994 and 2014, and used laboratory values to identify kidney disease and quality indicators for care for early-stage disease. We compared measures in First Nations people to those in other people in Ontario, and used direct age and sex standardization. We used Cox proportional hazards regression to compare the incidence of end-stage kidney disease between groups. RESULTS Our study included 21 968 First Nations people with diabetes. The age- and sex-standardized prevalence of chronic kidney disease was higher for First Nations people than for other Ontarians (20.7% v. 18.4%), as was the prevalence of end-stage kidney disease (2.9% v. 1.0%). The incidence of end-stage kidney disease was higher among First Nations people than among other people in Ontario (9.3 v. 4.7 events per 10 000 person-years; age- and sex-adjusted hazard ratio 2.23, 95% confidence interval 1.72-2.89). The 2 groups were similarly likely to receive recommended medications, but First Nations people were less likely to receive laboratory tests for their kidney disease. INTERPRETATION Despite receiving similar quality of care for early-stage kidney disease, First Nations people with diabetes had higher rates of end-stage kidney disease than other Ontarians. Further research is needed to better understand contributing factors to help inform future interventions.
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Affiliation(s)
- Danielle M Nash
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont.
| | - Jade S Dirk
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Eric McArthur
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Michael E Green
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Baiju R Shah
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Jennifer D Walker
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Mary Beaucage
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Carmen R Jones
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
| | - Amit X Garg
- ICES Western (Nash, Dirk, McArthur, Garg); Department of Epidemiology and Biostatistics (Nash), Western University, London Ont.; ICES Central (Shah, Walker), Toronto, Ont.; Department of Infectious Diseases (Dirk), Nova Scotia Health Authority, Halifax, NS; ICES Queen's (Green); Department of Family Medicine (Green), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto, Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Patient and Family Advisory Council (Beaucage), Ontario Renal Network; the Chiefs of Ontario (Jones), Toronto, Ont.; Department of Medicine (Garg), Western University, London, Ont
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22
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Secrest MH, Azoulay L, Dahl M, Clemens KK, Durand M, Hu N, Targownik L, Turin TC, Dormuth CR, Filion KB. A population-based analysis of antidiabetic medications in four Canadian provinces: Secular trends and prescribing patterns. Pharmacoepidemiol Drug Saf 2019; 29 Suppl 1:86-92. [PMID: 31464069 DOI: 10.1002/pds.4878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/14/2019] [Accepted: 07/09/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE To use the Canadian Network for Observational Drug Effect Studies (CNODES) to describe drug utilization of antidiabetic medications in four Canadian provinces. METHODS With the use of data from CNODES, we constructed cohorts of patients with type 2 diabetes in four Canadian provinces (Manitoba, Ontario, Quebec, and Saskatchewan) who received their first-ever prescription for a noninsulin antidiabetic medication during the study period, defined as the earliest date of data availability in each province (range: 1993-1998) to the latest date of the data extraction in each province (range: 2013-2014). Prescriptions rates were calculated for all prescriptions by class and described over time. RESULTS Across provinces, we identified 650 830 patients who initiated antidiabetic medications during the study period. In most provinces, the overall prescription rate of antidiabetic medications increased during the last two decades. Metformin particularly increased in popularity, surpassing sulfonylureas in all provinces as the most widely prescribed antidiabetic medication by the early 2000s. Thiazolidinediones grew in popularity from the onset of their availability until 2006 to 2007, at which point they rapidly declined. Dipeptidyl peptidase-4 inhibitors saw substantial growth in several provinces following their addition to provincial formularies in 2008 to 2012, while glucagon-like peptide-1 agonists experienced modest growth. Insulin prescription rates remained constant or steadily increased over the last two decades. CONCLUSIONS CNODES can be used for cross-jurisdictional drug utilization studies. In Canada, trends in antidiabetic medication prescriptions followed changing guidelines reflecting up-to-date knowledge of drug effectiveness and safety.
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Affiliation(s)
- Matthew H Secrest
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Laurent Azoulay
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Matthew Dahl
- Department of Community Health Sciences, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada
| | - Kristin K Clemens
- Department of Medicine, and Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Madeleine Durand
- Internal Medicine Service, Centre Hospitalier Universitaire de Montreal (CHUM), Montreal, Quebec, Canada
| | - Nianping Hu
- The Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Laura Targownik
- Department of Community Health Sciences, Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada.,Section of Gastroenterology, Division of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tanvir C Turin
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin R Dormuth
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
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Yiallourou SR, Maguire GP, Eades S, Hamilton GS, Quach J, Carrington MJ. Sleep influences on cardio-metabolic health in Indigenous populations. Sleep Med 2019; 59:78-87. [DOI: 10.1016/j.sleep.2018.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/26/2018] [Accepted: 10/17/2018] [Indexed: 12/27/2022]
Affiliation(s)
- S R Yiallourou
- Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - G P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - S Eades
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - G S Hamilton
- Department of Lung and Sleep Medicine at Monash Health, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - J Quach
- Policy, Equity and Translation, Murdoch Children's Research Institute Melbourne, Graduate School of Education, The University of Melbourne, Australia
| | - M J Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
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24
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Relationship between body image and physical functioning following rehabilitation for lower-limb amputation. Int J Rehabil Res 2019; 42:85-88. [PMID: 30531338 DOI: 10.1097/mrr.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of the present study was to evaluate change in body image and the association between body image at discharge and mobility 4 months after rehabilitation. A prospective cohort comprising adults older than or equal to 50 years of age undergoing rehabilitation for first major lower-limb amputation at an inpatient prosthetic rehabilitation program were assessed at discharge and 4 months after rehabilitation. Paired t-tests compared total Amputee Body Image Scale (ABIS), gait velocity, and L-test scores between discharge (T1) and 4 months (T2). Multivariable linear regression assessed relationship between ABIS scores and mobility. Nineteen participants completed assessments (mean±SD age=60.86±6.85 years; 63.20% male patients). Body image changed from T1 (43.58±7.83) to T2 (48.26±12.21), but was not statistically significant (P=0.063). Mobility significantly improved at T2. ABIS scores at T1 were not associated with mobility at T2. Mobility improved after discharge but was not related to body image at T1. Additional research on the impact of body image perception on patient outcomes after rehabilitation is needed.
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25
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Chen SC, Chiu HW, Chen CC, Woung LC, Lo CM. A Novel Machine Learning Algorithm to Automatically Predict Visual Outcomes in Intravitreal Ranibizumab-Treated Patients with Diabetic Macular Edema. J Clin Med 2018; 7:jcm7120475. [PMID: 30477203 PMCID: PMC6306861 DOI: 10.3390/jcm7120475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose: Artificial neural networks (ANNs) are one type of artificial intelligence. Here, we use an ANN-based machine learning algorithm to automatically predict visual outcomes after ranibizumab treatment in diabetic macular edema. Methods: Patient data were used to optimize ANNs for regression calculation. The target was established as the final visual acuity at 52, 78, or 104 weeks. The input baseline variables were sex, age, diabetes type or condition, systemic diseases, eye status and treatment time tables. Three groups were randomly devised to build, test and demonstrate the accuracy of the algorithms. Results: At 52, 78 and 104 weeks, 512, 483 and 464 eyes were included, respectively. For the training group, testing group and validation group, the respective correlation coefficients were 0.75, 0.77 and 0.70 (52 weeks); 0.79, 0.80 and 0.55 (78 weeks); and 0.83, 0.47 and 0.81 (104 weeks), while the mean standard errors of final visual acuity were 6.50, 6.11 and 6.40 (52 weeks); 5.91, 5.83 and 7.59; (78 weeks); and 5.39, 8.70 and 6.81 (104 weeks). Conclusions: Machine learning had good correlation coefficients for predicating prognosis with ranibizumab with just baseline characteristics. These models could be the useful clinical tools for prediction of success of the treatments.
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Affiliation(s)
- Shao-Chun Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Hung-Wen Chiu
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Lin-Chung Woung
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
| | - Chung-Ming Lo
- Department of Ophthalmology, Taipei City Hospital, Taipei 10632, Taiwan.
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Adam L, O'Connor C, Garcia AC. Evaluating the Impact of Diabetes Self-Management Education Methods on Knowledge, Attitudes and Behaviours of Adult Patients With Type 2 Diabetes Mellitus. Can J Diabetes 2018; 42:470-477.e2. [DOI: 10.1016/j.jcjd.2017.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/27/2017] [Accepted: 11/15/2017] [Indexed: 12/23/2022]
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27
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Seafood consumption patterns, their nutritional benefits and associated sociodemographic and lifestyle factors among First Nations in British Columbia, Canada. Public Health Nutr 2018; 21:3223-3236. [DOI: 10.1017/s136898001800215x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjectiveTo describe seafood consumption patterns in First Nations (FN) in British Columbia (BC) and examine lifestyle characteristics associated with seafood consumption; to identify the top ten most consumed seafood species and their contributions to EPA and DHA intake; and to estimate dietary exposure to methylmercury, polychlorinated biphenyls and dichlorodiphenyldichloroethylene.DesignDietary and lifestyle data from the First Nations Food Nutrition and Environment Study, a cross-sectional study of 1103 FN living in twenty-one communities across eight ecozones in BC, Canada, were analysed. Seafood consumption was estimated using a traditional FFQ. Seafood samples were analysed for contaminant contents.ResultsSeafood consumption patterns varied significantly across BC ecozones reflecting geographical diversity of seafood species. The top ten most consumed species represented 64 % of total seafood consumption by weight and contributed 69 % to the total EPA+DHA intake. Mean EPA+DHA intake was 660·5 mg/d in males, 404·3 mg/d in females; and 28 % of FN met the Recommended Intake (RI) of 500 mg/d. Salmon was the most preferred species. Seafood consumption was associated with higher fruit and vegetable consumption, lower smoking rate and increased physical activity. Dietary exposure to selected contaminants from seafood was negligible.ConclusionsIn FN in BC, seafood continues to be an essential part of the contemporary diet. Seafood contributed significantly to reaching the RI for EPA+DHA and was associated with a healthier lifestyle. Given numerous health benefits, seafood should be promoted in FN. Efforts towards sustainability of fishing should be directed to maintain and improve access to fisheries for FN.
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Diabetic Myopathy: current molecular understanding of this novel neuromuscular disorder. Curr Opin Neurol 2018; 30:545-552. [PMID: 28665810 DOI: 10.1097/wco.0000000000000479] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Here we summarize the evidence from human studies of the impairments to the structural, functional, and metabolic capacities in skeletal muscle in those with type 1 diabetes (T1D) - a condition known as diabetic myopathy. Given the importance of skeletal muscle for blood lipid and glucose management, the development and progression of diabetic myopathy would not only lead to increased insulin resistance, but also impact the ability to mitigate dysglycemic/dyslipidemic burdens. RECENT FINDINGS Despite the importance of skeletal muscle in whole-body metabolic control, studies investigating diabetic myopathy are startling limited. Recent findings have demonstrated that those with T1D exhibit decreased force production, increased fatigability, loss of muscle stem cells, and a greater reliance on glycolytic metabolism, as a result of reduced mitochondrial capacity. SUMMARY We propose a mechanistic model for the development of diabetic myopathy based on the human findings to date. This model suggests that repeated insulin injections in those with T1D leads to recurrent periods of intracellular hyperglycemia in myofibers. Resultant reductions in mitochondrial function lead to greater reliance on glycolytic metabolism and a concomitant shift in fiber type composition. Studies defining the scope and magnitude of diabetic myopathy and testing the veracity of this model are urgently needed in order to develop appropriate therapeutic strategies to maximize muscle health in those with T1D.
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Kumar V, Sharma K, Ahmed B, Al-Abbasi FA, Anwar F, Verma A. Deconvoluting the dual hypoglycemic effect of wedelolactone isolated fromWedelia calendulacea: investigationviaexperimental validation and molecular docking. RSC Adv 2018; 8:18180-18196. [PMID: 35542112 PMCID: PMC9080591 DOI: 10.1039/c7ra12568b] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 04/02/2018] [Indexed: 01/10/2023] Open
Abstract
Wedelia calendulacea has a long history of use in the Indian Ayurvedic System of Medicine for the treatment, prevention, and cure of a diverse range of human diseases such as diabetes obesity, and other metabolic diseases. A wide range of chemical constituents, such as triterpenoid saponin, kauren diterpene, and coumestans, has been isolated from the plant. Conversely, no published literature is available in relation to the isolation of wedelolactone (WEL) for its anti-diabetic effect. The aim of the present study was to isolate the bioactive phyto-constituent from Wedelia calendulacea and to scrutinize the antidiabetic effect with its possible mechanism of action. The structure of the isolated compound was elucidated by different spectroscopy techniques. Proteins, such as dipeptidyl peptidase-4 (DPPIV), glucose transporter 1 (GLUT1), and peroxisome proliferator-activated receptors-γ (PPARγ), were also subjected to in silico docking. Later, this isolated compound was scrutinized against α-glucosidase and α-amylase enzyme activity along with an oral glucose tolerance test (OGTT) for estimation of glucose utilization. Streptozotocin (STZ) was used for the induction of type II diabetes mellitus (DM) in Wistar rats. The rats were divided into different groups and received the WEL (5, 10, and 20 mg kg−1, b.w.) and glibenclamide (2.5 mg kg−1, b.w.) for 28 days. The blood glucose level (BGL), plasma insulin, and body weight were determined at regular time intervals. The serum lipid profile hypolipidemic effect for the different antioxidant markers and hepatic tissue markers were scrutinized along with an inflammatory mediator to deduce the possible mechanism. With the help of spectroscopy techniques, the isolated compound was identified as wedelolactone. In the docking study, WEL showed docking scores of −6.17, −9.43, and −7.66 against DPP4, GLUTI, and PRARY, respectively. WEL showed the inhibition of α-glucosidase (80.65%) and α-amylase (93.83%) and suggested an effect on postprandial hyperglycemia. In the OGTT, WEL significantly (P < 0.001) downregulated the BGL, a marker for better utilization of drugs. In the diabetes model, WEL reduced the BGL and enhanced the plasma insulin and body weight. It also significantly (P < 0.001) modulated the lipid profile; this suggested an anti-hyperlipidemia effect. WEL significantly (P < 0.001) distorted the hepatic tissue, acting as an antioxidant marker in a dose-dependent manner. WEL significantly (P < 0.001) downregulated the C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) level. On the basis of the available results, we can conclude that WEL can be an alternative drug for the treatment of type II DM either by inhibiting the production of inflammatory mediator or by the downregulation of oxidative stress. Wedelia calendulacea has a long history of use in the Indian Ayurvedic System of Medicine for the treatment, prevention, and cure of a diverse range of human diseases such as diabetes obesity, and other metabolic diseases.![]()
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Affiliation(s)
- Vikas Kumar
- Natural Product Drug Discovery Laboratory
- Department of Pharmaceutical Sciences
- Faculty of Health Sciences
- Sam Higginbottom Institute of Agriculture, Technology & Sciences
- Allahabad
| | - Kalicharan Sharma
- Department of Pharmaceutical Chemistry
- SPER
- Jamia Hamdard
- New Delhi-110062
- India
| | - Bahar Ahmed
- Department of Pharmaceutical Chemistry
- SPER
- Jamia Hamdard
- New Delhi-110062
- India
| | - F. A. Al-Abbasi
- Department of Biochemistry
- King Abdulaziz University
- Jeddah-21589
- Kingdom of Saudi Arabia
| | - Firoz Anwar
- Department of Biochemistry
- King Abdulaziz University
- Jeddah-21589
- Kingdom of Saudi Arabia
| | - Amita Verma
- Bioorganic & Medicinal Chemistry Research Laboratory
- Department of Pharmaceutical Sciences
- Faculty of Health Sciences
- Sam Higginbottom University of Agriculture, Technology & Sciences
- Allahabad-211007
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30
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Verweel L, Gionfriddo MR, MacCallum L, Dolovich L, Rosenberg-Yunger ZRS. Community Pharmacists' Perspectives of a Decision Aid for Managing Type 2 Diabetes in Ontario. Can J Diabetes 2017; 41:587-595. [PMID: 29224635 DOI: 10.1016/j.jcjd.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Decision aids are tools designed to help patients make choices about their health care. We explored pharmacists' perceptions of an evidence-based diabetes decision aid developed by the Mayo Clinic, Diabetes Medication Choice (DMC). Using DMC as a reference, we aimed to explore pharmacists' perspectives on decision aids, their place in a community pharmacy setting and the implementing of a decision aid, such as DMC, in Ontario. METHODS We used semistructured interviews with a convenience sample of community pharmacists from Ontario. We applied a thematic analysis to the data. RESULTS We conducted 16 interviews with pharmacists, of whom 9 were certified diabetes educators, and 10 were female. Three themes emerged from the data: pharmacists' knowledge and awareness of decision aids; pharmacists' perceptions of the DMC decision aids, and implementation of the DMC decision aids in Ontario pharmacies. Participants discussed their limited experience with and training in the use of decision aids. Although many participants agreed that the DMC decision aids may contribute to patient-centred care, all agreed that significant changes were needed to be made to implement this tool in practice. CONCLUSIONS Pharmacists felt that the use of decision aids in community pharmacies in Ontario may improve patient-centred care. Modifications, however, are needed to improve the applicability to their context and fit into their workflow. Empirical data concerning the impact of decision aids in community pharmacy is needed.
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Affiliation(s)
- Lee Verweel
- Ontario Pharmacists Association, Toronto, Ontario, Canada.
| | - Michael R Gionfriddo
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, Forty Fort, Pennsylvania
| | - Lori MacCallum
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Banting & Best Diabetes Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Zahava R S Rosenberg-Yunger
- Ontario Pharmacists Association, Toronto, Ontario, Canada; Ted Rogers School of Management, Health Services Management, Ryerson University, Toronto, Ontario, Canada
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Marushka L, Batal M, Sharp D, Schwartz H, Ing A, Fediuk K, Black A, Tikhonov C, Chan HM. Fish consumption is inversely associated with type 2 diabetes in Manitoba First Nations communities. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Consumption of fish and n-3 fatty acids (n-3 FAs) has been postulated to prevent type 2 diabetes (T2D).Objective: To explore the association between self-reported T2D and fish consumption, dietary n-3 FAs, and persistent organic pollutants (POP) intake in a regionally representative sample of First Nations (FNs) in Manitoba.Design: Data from the cross-sectional First Nations Food, Nutrition and Environment Study (FNFNES) collected from 706 members of 8 Manitoba FNs in 2010 were used. Household interviews were used to collect social and lifestyle data. The consumption of fish was estimated using a traditional food frequency questionnaire. Fish samples were analyzed for the presence of POP. Multiple logistic regression models adjusted for potential risk factors for T2D were developed.Results: A negative, dose–response relationship was found between fish intake and self-reported T2D. Fish consumptions of 2–3 portions per month and ≥1/week were inversely associated with T2D with odds ratio (OR) values of 0.51 (95% CI: 0.28–0.91) and 0.40 (95% CI: 0.19–0.82), respectively, compared with no fish intake. Similarly, intake of n-3 FAs was negatively associated with T2D (OR = 0.48 (95% CI: 0.30–0.77). Dietary POP intake was not associated with T2D.Conclusion: These findings suggest that the consumption of traditionally harvested fish may have a beneficial effect on T2D in Manitoba FNs.
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Affiliation(s)
- Lesya Marushka
- Biology Department, University of Ottawa, 180 Gendron Hall, 30 Marie Curie, Ottawa, ON K1N 6N5, Canada
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, Université de Montréal, Pavillon Liliane de Stewart, 2405 Côte-Sainte-Catherine Street, Montreal, QC H3T 1A8, Canada
| | - Donald Sharp
- Assembly of First Nations, 55 Metcalfe St #1600, Ottawa, ON K1P 6L5, Canada
| | - Harold Schwartz
- Health Canada, Environmental Public Health Division, First Nations and Inuit Health Branch (FNIHB), Room 2000A Jeanne Mance Bldg. AL 1920A, Tunney’s Pasture, Ottawa, ON K1A 0K9, Canada
| | - Amy Ing
- Nutrition Department, Faculty of Medicine, Université de Montréal, Pavillon Liliane de Stewart, 2405 Côte-Sainte-Catherine Street, Montreal, QC H3T 1A8, Canada
| | - Karen Fediuk
- Dietitian and Nutrition Researcher, Ladysmith, BC, Canada
| | - Andrew Black
- Assembly of First Nations, 55 Metcalfe St #1600, Ottawa, ON K1P 6L5, Canada
| | - Constantine Tikhonov
- Health Canada, Environmental Public Health Division, First Nations and Inuit Health Branch (FNIHB), Room 2000A Jeanne Mance Bldg. AL 1920A, Tunney’s Pasture, Ottawa, ON K1A 0K9, Canada
| | - Hing Man Chan
- Biology Department, University of Ottawa, 180 Gendron Hall, 30 Marie Curie, Ottawa, ON K1N 6N5, Canada
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Diet quality indices in relation to metabolic syndrome in an Indigenous Cree (Eeyouch) population in northern Québec, Canada. Public Health Nutr 2017; 21:172-180. [DOI: 10.1017/s136898001700115x] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractObjectiveTo assess associations between three diet quality indices and metabolic syndrome (MetS) in the Cree (Eeyouch) of northern Québec, Canada, as well as to evaluate their pertinence in this Indigenous context.DesignThe alternative-Healthy Eating Index 2010 (aHEI-2010), the Food Quality Score (FQS) and the contribution of ultra-processed products (UPP) to total daily dietary energy intake using the NOVA classification were calculated from 24 h food recalls. MetS was determined with the latest harmonized definition. Logistic regressions assessed the relationship between quintiles of dietary quality scores with MetS and its components.SettingStudy sample from the 2005–2009 cross-sectional Nituuchischaayihititaau Aschii Environment-and-Health Study.SubjectsEeyouch (n 811) from seven James Bay communities (≥18 years old).ResultsMetS prevalence was 56·6 % with 95·4 % abdominal adiposity, 50·1 % elevated fasting plasma glucose, 43·4 % hypertension, 38·6 % elevated TAG and 44·5 % reduced HDL cholesterol. Comparing highest and lowest quintiles of scores, adjusted OR (95 % CI) of MetS was 0·70 (0·39, 1·08; P-trend=0·05) for aHEI-2010, 1·06 (0·63, 1·76; P-trend=0·87) for FQS and 1·90 (1·14, 3·17; P-trend=0·04) for the contribution of UPP to total daily dietary energy intake.ConclusionsAlthough diet quality indices have been associated with cardiometabolic risk, only the dietary intake of UPP was significantly associated with MetS in the Eeyouch. Indices tailored to the food environment of northern communities are essential to further understand the impact of diet quality in this context.
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Marushka L, Batal M, David W, Schwartz H, Ing A, Fediuk K, Sharp D, Black A, Tikhonov C, Chan HM. Association between fish consumption, dietary omega-3 fatty acids and persistent organic pollutants intake, and type 2 diabetes in 18 First Nations in Ontario, Canada. ENVIRONMENTAL RESEARCH 2017; 156:725-737. [PMID: 28482294 DOI: 10.1016/j.envres.2017.04.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/07/2017] [Accepted: 04/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND First Nations (FNs) populations in Canada experience a disproportionally higher rate of obesity and type 2 diabetes (T2D) compared to the general population. Recent data suggest that a high consumption of fish may help prevent T2D. On the other hand, fish might also be a potential source of environmental contaminants which could potentially be a risk factor for T2D. OBJECTIVE To investigate the potential associations between self-reported T2D and consumption of locally-harvested fish, dietary long-chain omega-3 fatty acids (n-3FAs) and persistent organic pollutants intake among adult FNs living on reserve in Ontario. DESIGN Data from the First Nations Food Nutrition and Environment Study, which included a cross-sectional study of 1429 Ontario FNs adults living in 18 communities across 4 ecozones in 2012 were analyzed. Social and lifestyle data were collected using household interviews. The consumption of locally-harvested fish was estimated using a traditional food frequency questionnaire along with portion size information obtained from 24hr recalls. Fish samples were analyzed for the presence of contaminants including dichlorodiphenyldichloroethylene (DDE) and polychlorinated biphenyls (PCBs). Dietary intakes of DDE and PCBs were estimated using community-specific levels of DDE/PCBs in fish species. Multiple logistic regression models adjusted for potential covariates including age, gender, body mass index, physical activity, total energy intake, smoking, and education were developed. RESULTS The prevalence of T2D in Ontario FNs was 24.4%. A significant positive association between fish consumption of one portion per week and more and T2D compared to no fish consumption was found (OR=2.5 (95% CI: 1.38-4.58). Dietary DDE and PCBs intake was positively associated with T2D (OR=1.09 (95%CI: 1.05-1.75) for DDE and OR=1.07 (95%CI: 1.004-1.27) for PCBs) per unit increase in DDE/PCBs while n-3-FAs intake, adjusted for DDE/PCBs intake, showed an inverse effect against T2D among older individuals (OR=0.86 (95% CI: 0.46-0.99). CONCLUSION Our results support previous findings that exposure to DDE and PCBs may increase the risk of T2D. Elevated levels of contaminants in fish may counteract with potentially beneficial effects of n-3FAs from fish consumption. However, the overall health benefits of high consumption of fish with a high n-3 FAs content may outweigh the adverse effect of contaminants.
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Affiliation(s)
| | | | | | - Harold Schwartz
- Health Canada, Environmental Public Health Division, First Nations and Inuit Health Branch (FNIHB), Canada
| | - Amy Ing
- Université de Montréal, Canada
| | - Karen Fediuk
- Dietitian and Nutrition Researcher, British Columbia, Canada
| | | | | | - Constantine Tikhonov
- Health Canada, Environmental Public Health Division, First Nations and Inuit Health Branch (FNIHB), Canada
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Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring. Obstet Gynecol 2017; 128:1095-1104. [PMID: 27741196 DOI: 10.1097/aog.0000000000001689] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To examine associations between breastfeeding initiation and subsequent diabetes among First Nations (indigenous people in Canada who are not Métis or Inuit) and non-First Nations mothers and their offspring with and without gestational diabetes mellitus (GDM). METHODS This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases. Information of breastfeeding initiation before hospital discharge was obtained from hospital abstracts recorded by nurses in postpartum wards. Cox proportional hazard models were applied to examine the association between breastfeeding initiation and risk of diabetes in mothers and their offspring. RESULTS Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001). Breastfeeding initiation was associated with a reduced risk of incident (later developed) diabetes in non-First Nations mothers without GDM (hazard ratio [HR] 0.73 [or -27% of risk], 95% confidence interval [CI] 0.68-0.79), non-First Nations mothers with GDM (HR 0.78 or -22% of risk, CI 0.69-0.89), First Nations mothers without GDM (HR 0.89 or -11% of risk, CI 0.81-0.98), and First Nations mothers with GDM (HR 0.82 or -18% of risk, CI 0.73-0.92) with 24 years of follow-up or less. With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038). The association between breastfeeding initiation and subsequent diabetes in mothers and offspring was independent of family income, rural residence, First Nations status, GDM, parity, gestational hypertension, and age of the mother. CONCLUSION Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.
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Ekwaru JP, Ohinmaa A, Tran BX, Setayeshgar S, Johnson JA, Veugelers PJ. Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach. PLoS One 2017; 12:e0177848. [PMID: 28542399 PMCID: PMC5436822 DOI: 10.1371/journal.pone.0177848] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/04/2017] [Indexed: 12/31/2022] Open
Abstract
Background The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a “best practice” in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project’s cost-effectiveness following a life-course approach. Methods We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system’s cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. Results The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICER<CA$50,000, and more than 93% of the time when using a threshold of ICER<CA$100,000. Conclusion School-based health promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.
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Affiliation(s)
- John Paul Ekwaru
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Solmaz Setayeshgar
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A. Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Paul J. Veugelers
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
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Olfactory and gustatory functions in patients with non-complicated type 1 diabetes mellitus. Eur Arch Otorhinolaryngol 2017; 274:2621-2627. [PMID: 28258376 DOI: 10.1007/s00405-017-4497-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 02/04/2017] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate any possible relationship between diabetic state and olfactory and gustatory functions in patients with non-complicated diabetes mellitus type 1 (T1D), and also to present evidence of the association between olfactory and gustatory scores and HbA1c values and disease durations. The study included 39 patients with non-complicated T1D and 31 healthy controls. Clinical characteristics such as age, gender, duration of disease, education levels and biochemical analyses (fasting blood glucose, urea, creatinine, total cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein (HDL-C), triglyceride, HbA1c, C-peptide, postprandial blood glucose) were measured. Subjective olfactory and gustatory tests were performed for all participants. There were no significant differences in olfactory tests between the two groups (odor thresholds 8.63 ± 0.91 vs. 8.55 ± 0.57, p = 0.66; odor discrimination 12.97 ± 0.80 vs. 12.74 ± 0.79, p = 0.24; odor identification 13.81 ± 0.98 vs. 13.72 ± 0.89, p = 0.69; TDI score 35.34 ± 1.94 vs. 34.97 ± 1.4, p = 0.37). There were also no significant differences in gustatory tests between the two groups (bitter 3.45 ± 0.51 vs. 3.44 ± 0.50, p = 0.90; sweet 3.32 ± 0.48 vs. 3.38 ± 0.49, p = 0.60; salty 3.13 ± 0.72 vs. 3.10 ± 0.72, p = 0.88; total score of taste 13.16 ± 1.61 vs. 13.13 ± 1.22, p = 0.92). Comparison of gustatory and olfactory scores according to disease duration of type 1 diabetes mellitus patients revealed that there were no differences between groups (all p > 0.05). T1D without complications may not be associated with olfactory and gustatory dysfunction according to subjective testing. We also found that gustatory and olfactory functions may not be related with HbA1c values and disease duration in non-complicated T1D.
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Pauley T, Gargaro J, Chenard G, Cavanagh H, McKay SM. Home-based diabetes self-management coaching delivered by paraprofessionals: A randomized controlled trial. Home Health Care Serv Q 2016; 35:137-154. [DOI: 10.1080/01621424.2016.1264339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Tim Pauley
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Judith Gargaro
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Glen Chenard
- Chronic Disease Management, Saint Elizabeth, Markham, Ontario, Canada
| | - Helen Cavanagh
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
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Nonalcoholic fatty liver disease diagnosed by transient elastography with controlled attenuation parameter in unselected HIV monoinfected patients. AIDS 2016; 30:2635-2643. [PMID: 27603289 DOI: 10.1097/qad.0000000000001241] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in Western countries. HIV-infected persons without viral hepatitis are at increased risk of NAFLD. Nevertheless, data on NAFLD in HIV monoinfection are scarce. DESIGN/METHODS We prospectively investigated prevalence and predictors of NAFLD and liver fibrosis by transient elastography and associated controlled attenuation parameter (CAP) in unselected HIV-infected adults without significant alcohol intake or viral hepatitis coinfection. NAFLD was defined as CAP at least 238 dB/m. Significant liver fibrosis and cirrhosis were defined as transient elastography measurement at least 7.1 and 13 kPa, respectively. Predictors of NAFLD and significant liver fibrosis were determined using logistic regression analysis. RESULTS A total of 300 consecutive patients (mean age 50 years, 77% men; mean CD4 cell count 570 cells/μl, 90% on antiretrovirals) were included as a part of a routine screening program. Transient elastography with CAP identified NAFLD and significant liver fibrosis in 48 and 15% of cases, respectively. NAFLD was independently associated with BMI more than 25 kg/m [adjusted odds ratio (aOR) 4.86, 95% confidence interval (CI) 2.55-9.26] and elevated alanine aminotransferase (ALT) (aOR 3.17, 95% CI 1.43-7.03). Independent predictors of significant liver fibrosis were diabetes (aOR 5.84, 95% CI 1.91-17.85), elevated ALT (aOR 3.30, 95% CI 1.27-8.59) and current use of protease inhibitors (aOR 3.96, 95% CI 1.64-9.54). CONCLUSION NAFLD and significant liver fibrosis diagnosed by transient elastography with CAP are major comorbidities in unselected HIV monoinfected persons on antiretroviral therapy, particularly if metabolic conditions and elevated ALT coexist. Noninvasive screening for NAFLD should be implemented in this population to establish early interventions and prevent complications.
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Manousaki D, Kent JW, Haack K, Zhou S, Xie P, Greenwood CM, Brassard P, Newman DE, Cole S, Umans JG, Rouleau G, Comuzzie AG, Richards JB. Toward Precision Medicine: TBC1D4 Disruption Is Common Among the Inuit and Leads to Underdiagnosis of Type 2 Diabetes. Diabetes Care 2016; 39:1889-1895. [PMID: 27561922 DOI: 10.2337/dc16-0769] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/09/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE A common nonsense mutation in TBC1D4 was recently found to substantially increase the odds of type 2 diabetes in Greenlandic Inuit, leading to exclusively increased postprandial glucose. We investigated the frequency and effect of the TBC1D4 mutation on glucose metabolism and type 2 diabetes diagnosis among Canadian and Alaskan Inuit. RESEARCH DESIGN AND METHODS Exome sequencing of the TBC1D4 variant was performed in 114 Inuit from Nunavik, Canada, and Sanger sequencing was undertaken in 1,027 Alaskan Inuit from the Genetics of Coronary Artery Disease in Alaskan Natives (GOCADAN) Study. Association testing evaluated the effect of the TBC1D4 variant on diabetes-related metabolic traits and diagnosis. RESULTS The TBC1D4 mutation was present in 27% of Canadian and Alaskan Inuit. It was strongly associated with higher glucose (effect size +3.3 mmol/L; P = 2.5 x 10-6) and insulin (effect size +175 pmol/L; P = 0.04) 2 h after an oral glucose load in homozygote carriers. TBC1D4 carriers with prediabetes and type 2 diabetes had an increased risk of remaining undiagnosed unless postprandial glucose values were tested (odds ratio 5.4 [95% CI 2.5-12]) compared with noncarriers. Of carriers with prediabetes or type 2 diabetes, 32% would remain undiagnosed without an oral glucose tolerance test (OGTT). CONCLUSIONS Disruption of TBC1D4 is common among North American Inuit, resulting in exclusively elevated postprandial glucose. This leads to underdiagnosis of type 2 diabetes, unless an OGTT is performed. Accounting for genetic factors in the care of Inuit with diabetes provides an opportunity to implement precision medicine in this population.
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Affiliation(s)
- Despoina Manousaki
- Centre for Clinical Epidemiology, Department of Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Jack W Kent
- Texas Biomedical Research Institute, San Antonio, TX
| | - Karin Haack
- Texas Biomedical Research Institute, San Antonio, TX
| | - Sirui Zhou
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Pingxing Xie
- Department of Medicine, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada
| | - Celia M Greenwood
- Centre for Clinical Epidemiology, Department of Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Oncology, McGill University, Montreal, Quebec, Canada
| | - Paul Brassard
- Centre for Clinical Epidemiology, Department of Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Shelley Cole
- Texas Biomedical Research Institute, San Antonio, TX
| | - Jason G Umans
- MedStar Health Research Institute, Hyattsville, MD.,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington
| | - Guy Rouleau
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | | | - J Brent Richards
- Centre for Clinical Epidemiology, Department of Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada .,Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Twin Research and Genetic Epidemiology, King's College London, London, U.K
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Lipscombe C, Smith KJ, Gariepy G, Schmitz N. Gender differences in the association between lifestyle behaviors and diabetes distress in a community sample of adults with type 2 diabetes. J Diabetes 2016; 8:269-78. [PMID: 25850582 DOI: 10.1111/1753-0407.12298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/13/2015] [Accepted: 03/30/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The present study examined the association between moderate and severe diabetes distress (DD) and lifestyle behaviors (physical activity, smoking, alcohol consumption) in a community sample of adults with type 2 diabetes mellitus (T2DM). METHODS A total of 1971 adults with T2DM were recruited using mixed methods sampling. Participants were considered eligible if they had a doctor diagnosis of T2DM (≤10 years), were insulin naïve, aged 40-75 years, and were from Quebec, Canada. Participants provided information on DD, lifestyle behaviors, sociodemographic, and diabetes-related factors. Multinomial logistic regressions examined the association between moderate and severe DD and each lifestyle behavior, according to gender. Effect estimates can be interpreted as probability ratios (PR). RESULTS In females, physical inactivity was associated with an increased likelihood of moderate distress (PR 2.2; 95% confidence interval [CI] 1.49-3.24) and severe distress (PR 1.80; 95% CI 1.00-3.24). In males, only severe distress was associated with physical inactivity (PR 1.92; 95% CI 1.00-3.66). Current smoking was associated with a greater probability of severe distress in males (PR 3.0; 95% CI 1.54-5.84) and females (PR 1.32; 95% CI 0.67-2.60); however this effect was stronger in males. No association was found between alcohol consumption and DD in females. In males, frequent alcohol consumption was associated with a reduced probability of moderate (PR 0.56; 95% CI 0.34-0.91) and severe distress (PR 0.47; 95% CI 0.21-1.06). CONCLUSIONS The findings of this study suggest important gender differences in the association between DD and lifestyle behaviors.
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Affiliation(s)
- Carla Lipscombe
- Department of Epidemiology and Biostatistics, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Kimberley J Smith
- Department of Life Sciences
- Institute of Environment Health and Societies, Healthy Ageing, Brunel University, Uxbridge, UK
| | - Geneviève Gariepy
- Department of Epidemiology and Biostatistics, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Epidemiology and Biostatistics, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Douglas Mental Health University Institute, Montreal, Quebec, Canada
- Montréal Diabetes Research Centre, Montreal, Quebec, Canada
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Lesage A, Rochette L, Émond V, Pelletier É, St-Laurent D, Diallo FB, Kisely S. A Surveillance System to Monitor Excess Mortality of People With Mental Illness in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:571-9. [PMID: 26720826 PMCID: PMC4679166 DOI: 10.1177/070674371506001208] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada. METHODS We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290-319 or ICD-10 F00-F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval. RESULTS We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods. CONCLUSIONS Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.
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Affiliation(s)
- Alain Lesage
- Professor, Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec; Invited Psychiatric Expert, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Louis Rochette
- Statistician, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Valérie Émond
- Head, Chronic Disease Surveillance Unit, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Éric Pelletier
- Epidemiologist, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Danielle St-Laurent
- Scientific Director, Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, Quebec
| | - Fatoumata Binta Diallo
- Research Coordinator, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
| | - Stephen Kisely
- Professor, Queensland Centre for Health Data Services, University of Queensland, Brisbane, Australia
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Jin Y, Zhang Q, Mao JL, He B. Image-guided left ventricular lead placement in cardiac resynchronization therapy for patients with heart failure: a meta-analysis. BMC Cardiovasc Disord 2015; 15:36. [PMID: 25957994 PMCID: PMC4443661 DOI: 10.1186/s12872-015-0034-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Heart failure (HF) is a debilitating condition that affects millions of people worldwide. One means of treating HF is cardiac resynchronization therapy (CRT). Recently, several studies have examined the use of echocardiography (ECHO) in the optimization of left ventricular (LV) lead placement to increase the response to CRT. The objective of this study was to synthesize the available data on the comparative efficacy of image-guided and standard CRT. Methods We searched the PubMed, Cochrane, Embase, and ISI Web of Knowledge databases through April 2014 with the following combinations of search terms: left ventricular lead placement, cardiac resynchronization therapy, image-guided, and echocardiography-guided. Studies meeting all of the inclusion criteria and none of the exclusion criteria were eligible for inclusion. The primary outcome measures were CRT response rate, change in LV ejection fraction (LVEF), and change in LV end systolic volume (LVESV). Secondary outcomes included the rates of all-cause mortality and HF-related hospitalization. Results Our search identified 103 articles, 3 of which were included in the analysis. In total, 270 patients were randomized to the image-guided CRT and 241, to the standard CRT. The pooled estimates showed a significant benefit for image-guided CRT (CRT response: OR, 2.098, 95 % CI, 1.432–3.072; LVEF: difference in means, 3.457, 95 % CI, 1.910–5.005; LVESV: difference in means, −20.36, 95 % CI, −27.819 – −12.902). Conclusions Image-guided CRT produced significantly better clinical outcomes than the standard CRT. Additional trials are warranted to validate the use of imaging in the prospective optimization of CRT.
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Affiliation(s)
- Yan Jin
- Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China.
| | - Qi Zhang
- Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China.
| | - Jia-Liang Mao
- Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China.
| | - Ben He
- Department of Cardiology, Ren Ji hospital, School of Medicine, Shanghai Jiao Tong University, 200001, Shanghai, China.
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Coghill CL, Valaitis RK, Eyles JD. Built environment interventions aimed at improving physical activity levels in rural Ontario health units: a descriptive qualitative study. BMC Public Health 2015; 15:464. [PMID: 25935410 PMCID: PMC4426164 DOI: 10.1186/s12889-015-1786-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies to date have explored the relationship between the built environment and physical activity specifically in rural settings. The Ontario Public Health Standards policies mandate that health units in Ontario address the built environment; however, it is unclear how public health practitioners are integrating the built environment into public health interventions aimed at improving physical activity in chronic disease prevention programs. METHODS This descriptive qualitative study explored interventions that have or are being implemented which address the built environment specifically related to physical activity in rural Ontario health units, and the impact of these interventions. Data were collected through twelve in-depth semi-structured interviews with rural public health practitioners and managers representing 12 of 13 health units serving rural communities. Key themes were identified using qualitative content analysis. RESULTS Themes that emerged regarding the types of interventions that health units are employing included: Engagement with policy work at a municipal level; building and working with community partners, committees and coalitions; gathering and providing evidence; developing and implementing programs; and social marketing and awareness raising. Evaluation of interventions to date has been limited. CONCLUSIONS Public health interventions, and their evaluations, are complex. Health units who serve large rural populations in Ontario are engaging in numerous activities to address physical activity levels. There is a need to further evaluate the impact of these interventions on population health.
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Affiliation(s)
| | - Ruta K Valaitis
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, , L8S 4K1, , Ontario, Canada.
| | - John D Eyles
- School of Geography & Earth Sciences, Faculty of Science, McMaster University, Hamilton, , L8S 4K1, , Ontario, Canada. .,Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
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Heinelt M, Drennan IR, Kim J, Lucas S, Grant K, Spearen C, Tavares W, Al-Imari L, Philpott J, Hoogeveen P, Morrison LJ. Prehospital Identification of Underlying Coronary Artery Disease by Community Paramedics. PREHOSP EMERG CARE 2015; 19:548-53. [DOI: 10.3109/10903127.2015.1005261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Triador L, Farmer A, Maximova K, Willows N, Kootenay J. A school gardening and healthy snack program increased Aboriginal First Nations children's preferences toward vegetables and fruit. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:176-180. [PMID: 25439764 DOI: 10.1016/j.jneb.2014.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 08/28/2014] [Accepted: 09/08/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The researchers evaluated the impact of a 7-month gardening and 4-month vegetable and fruit snack program on Aboriginal First Nations children's home consumption and preferences toward vegetables and fruit. METHODS The intervention was based on the Social Cognitive Theory. Children in grades 1-6 planted and tended classroom container gardens and prepared and ate what grew. At baseline and 7 months later, children tasted and rated 17 vegetables and fruit using a Likert scale and indicated whether they ate each food at home. RESULTS Data were collected from 76 of 116 children (65.5%). Preference scores for vegetables, fruit, and vegetables and fruit combined increased over the 7 months (P < .017). Self-reported home consumption did not change. CONCLUSIONS AND IMPLICATIONS School interventions have the potential to increase children's preferences for vegetables and fruit. Family participation is likely required, along with increased community availability of produce, to promote home consumption.
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Affiliation(s)
- Lucila Triador
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Alberta, Canada
| | - Anna Farmer
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Alberta, Canada; Centre for Health Promotion Studies, University of Alberta, Alberta, Canada
| | | | - Noreen Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Alberta, Canada.
| | - Jody Kootenay
- Alexander First Nation Education, Morinville, Alberta, Canada
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Moreau M, Gagnon MP, Boudreau F. Development of a fully automated, web-based, tailored intervention promoting regular physical activity among insufficiently active adults with type 2 diabetes: integrating the I-change model, self-determination theory, and motivational interviewing components. JMIR Res Protoc 2015; 4:e25. [PMID: 25691346 PMCID: PMC4376153 DOI: 10.2196/resprot.4099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/24/2022] Open
Abstract
Background Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention. Objective This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance. Methods The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention’s usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase. Results The intervention development cost was about CDN $59,700 and took approximately 54 full-time weeks. The intervention officially started on September 29, 2014. Out of 2300 potential participants targeted for the tailored intervention, approximately 530 people visited the website, 170 people completed the registration process, and 83 corresponded to the selection criteria and were enrolled in the intervention. Conclusions Usability evaluation is an essential step in the development of a Web-based tailored intervention in order to make pre-implementation improvements. The effectiveness and relevance of the theoretical framework used for the intervention will be analyzed following the process and impact evaluation. Implications for future research are discussed.
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Affiliation(s)
- Michel Moreau
- Interdisciplinary Group of Health Applied Research, Nursing Department, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
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Vigneault J, Lemieux S, Garneau V, Weisnagel SJ, Tchernof A, Robitaille J. Association between metabolic deteriorations and prior gestational diabetes according to weight status. Obesity (Silver Spring) 2015; 23:345-50. [PMID: 25452048 DOI: 10.1002/oby.20940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/28/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of the present study is to investigate the effect of prior gestational diabetes mellitus (GDM) on glucose and insulin homeostasis according to weight status. METHODS The analysis included 299 women, 216 with [GDM(+)] and 83 without prior GDM [GDM(-)]. The mean time between pregnancy and testing was 3.9 years. Glucose values were obtained from a 2-h 75 g oral glucose tolerance test (OGTT). Body composition was measured by dual-energy X-ray. RESULTS In women with normal BMI, fasting glucose, 2-h post-OGTT glucose, and HbA1 were higher for GDM(+) (P<0.05). Normal-weight women with GDM(+) presented lower HOMA-IS, insulin secretion, and insulinogenic index (P<0.05) compared to GDM(-). Body fat and android fat mass were higher, gynoid fat mass was similar, and lean body mass was decreased in GDM(+) vs. GDM(-) with normal weight (P<0.05). A greater proportion of GDM(+) with overweight/obesity had prediabetes (72.1%) or type 2 diabetes (T2D) (21.7%) vs. GDM(-) and overweight/obesity (17.1 and 2.4%) or GDM(+) and normal weight (60.5 and 14.0%). CONCLUSIONS A combination of GDM and overweight/obesity is associated with T2D-related metabolic deteriorations. Nevertheless, normal-weight women with GDM(+) had increased android fat and greater metabolic complications, suggesting that women with prior GDM should benefit from lifestyle intervention, regardless of their weight status.
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Affiliation(s)
- Jessica Vigneault
- Department of Food Science and Nutrition, Laval University, Quebec City, Canada; Institute of Nutrition and Functional Foods (INAF), Laval University, Quebec City, Canada
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Deschênes SS, Burns RJ, Schmitz N. Associations between diabetes, major depressive disorder and generalized anxiety disorder comorbidity, and disability: findings from the 2012 Canadian Community Health Survey--Mental Health (CCHS-MH). J Psychosom Res 2015; 78:137-42. [PMID: 25510185 DOI: 10.1016/j.jpsychores.2014.11.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/26/2014] [Accepted: 11/30/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the associations between diabetes, disability, and the likelihood of comorbid major depressive disorder (MDD) and generalized anxiety disorder (GAD). METHODS Data were obtained from the 2012 Canadian Community Health Survey - Mental Health (N=17 623). Diabetes assessment consisted of a self-reported diagnosis of diabetes made by a health care professional. Disability was assessed via self-report. 12-Month and lifetime MDD and GAD were assessed with the Composite International Diagnostic Interview 3.0. RESULTS In multinomial logistic regression models adjusted for sociodemographic and health-related factors, having diabetes was associated with a greater likelihood of 12-month comorbid MDD and GAD (OR=1.99, 95% CI [1.22, 3.25], p=.006), compared with those with neither MDD nor GAD. No significant associations were found for MDD without GAD or GAD without MDD. This pattern of effects held when lifetime diagnoses of MDD and GAD were considered. For individuals with diabetes (n=1730), adjusted binary logistic regression models demonstrated that with 12-month diagnoses, MDD without GAD (OR=2.79, 95% CI [1.39-5.62], p=.004), GAD without MDD (OR=3.69, 95% CI [1.34-10.11], p=.01), and comorbid MDD and GAD (OR=4.17, 95% CI [1.66-10.51], p=.002) were associated with greater disability than the control group. Only comorbid MDD and GAD were associated with disability when lifetime diagnoses of MDD and GAD were considered. CONCLUSIONS Individuals with diabetes may be particularly vulnerable to comorbid MDD and GAD, and MDD-GAD comorbidity may exacerbate disability in persons with diabetes.
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Affiliation(s)
- Sonya S Deschênes
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Rachel J Burns
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Norbert Schmitz
- Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Douglas Mental Health University Institute, Montreal, Quebec, Canada; Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Singer J, Putulik Kidlapik C, Martin B, Dean HJ, Trepman E, Embil JM. Food consumption, obesity and abnormal glycaemic control in a Canadian Inuit community. Clin Obes 2014; 4:316-23. [PMID: 25826161 DOI: 10.1111/cob.12074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 05/18/2014] [Accepted: 06/03/2014] [Indexed: 01/22/2023]
Abstract
Dietary and lifestyle factors may contribute to diabetes and obesity in the Canadian Inuit. We documented dietary patterns, physical activity level, obesity, blood glucose abnormalities and diabetes prevalence in a Canadian Inuit community. There were 250 Inuit residents of Repulse Bay, Nunavut, who had an interview about diet and physical activity, measurement of weight and height, and laboratory studies (194 subjects). Children, adolescents and younger adults (aged < 48 years) consumed significantly less country food and more processed snack foods and sweet drinks than older adults (aged ≥ 48 years). Only 88 of 250 subjects (35%) reported that they went out on the land once or more per week. Of the 85 children and adolescent subjects (aged 7-17 years), 11 (13%) were obese. Average body mass index for adults (aged ≥ 18 years) was 29 ± 6 kg m(-2) , and 61 adults (37%) were obese (body mass index ≥30 kg m(-2) ). In the 140 adults who had laboratory studies, 18 adults (13%) had a blood glucose abnormality, including 10 adults (7%) with impaired fasting glucose, four adults (3%) with impaired glucose tolerance and six adults (4%) with diabetes (five adults previously undiagnosed). Twelve of the 194 subjects tested (6%) had fasting insulin ≥140 pmol L(-1) (mean, 196 ± 87 pmol L(-1) ). In summary, there was a high prevalence of poor dietary choices, limited physical activity, obesity and type 2 diabetes in this Inuit community. Public health programmes are needed to improve the dietary and health status of this community.
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Affiliation(s)
- J Singer
- School of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Valencia WM, Florez H. Pharmacological treatment of diabetes in older people. Diabetes Obes Metab 2014; 16:1192-203. [PMID: 25073699 DOI: 10.1111/dom.12362] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/23/2014] [Accepted: 07/23/2014] [Indexed: 12/21/2022]
Abstract
The pharmacological management of diabetes in older people is complex and challenging. It requires a comprehensive understanding of the individual beyond the diabetes itself. Through the ageing years, the older individual presents with diabetes-related and non-related comorbidities and complications, develops functional limitations and psychological issues, and may lack social support and access to care. A disturbance in these categories, known as the four geriatric domains, will negatively affect diabetes self-management and self-efficacy, leading to poor outcomes and complications. Furthermore, older people with diabetes may be more interested in the management of other chronic conditions such as pain or impaired mobility, and diabetes may be lower in their list of priorities. Proper education must be provided to the older individual and caregivers, with continuous monitoring and counselling, especially when pharmacological interventions offer risks of side effects, adverse reactions and interactions with other medications. Informed shared medical decisions will help to improve adherence to the regimen; however, such discussions ought to be based on the best evidence available, which is unfortunately limited in this age group. We performed a review focused on pharmacological agents and summarize current evidence on their use for the treatment of diabetes in older people. We encourage clinicians to investigate and incorporate the four geriatrics domains in the selection and monitoring of these agents.
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Affiliation(s)
- W M Valencia
- Geriatrics Research, Education and Clinical Center, Miami Bruce W. Carter VA Medical Center, Miami, FL, USA; Department of Public Health Sciences, Division of Epidemiology, University of Miami Miller School of Medicine, Miami, FL, USA
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