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Sigal RJ, Yardley JE, Perkins BA, Riddell MC, Goldfield GS, Donovan L, Malcolm J, Hadjiyannakis S, Edwards AL, Gougeon R, Wells GA, Pacaud D, Woo V, Ford GT, Coyle D, Phillips P, Doucette S, Khandwala F, Kenny GP. The Resistance Exercise in Already Active Diabetic Individuals (READI) Randomised Clinical Trial. J Clin Endocrinol Metab 2022; 108:e63-e75. [PMID: 36459469 DOI: 10.1210/clinem/dgac682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To evaluate the incremental impact of resistance training on HbA1c, fitness, body composition and cardiometabolic risk factors in aerobically-active people with type 1 diabetes. RESEARCH DESIGN AND METHODS The Resistance Exercise in Already-active Diabetic Individuals (READI) trial (NCT00410436) was a four-centre randomized parallel-group trial. After a 5-week run-in period with diabetes management optimization, 131 aerobically-active individuals with type 1 diabetes were randomized to resistance exercise (n = 71, intervention - INT) or control (n = 60, CON) for 22 additional weeks. Both groups maintained their aerobic activities and were provided dietary counselling throughout. Exercise training was three times per week at community-based facilities. The primary outcome was HbA1c, and secondary outcomes included fitness (peak oxygen consumption, muscle strength), body composition (anthropometrics, dual-energy X-ray absorptiometry, computed tomography) and cardiometabolic risk markers (lipids, apolipoproteins). Assessors were blinded to group allocation. RESULTS There were no significant differences in HbA1c change between INT and CON. Declines in HbA1c [INT: 7.75 ± 0.10% (61.2 ± 1.1 mmol/mol) to 7.55 ± 0.10% (59 ± 1.1 mmol/mol); CON: 7.70 ± 0.11% (60.7 ± 1.2 mmol/mol) to 7.57 ± 0.11% (59.6 ± 1.3 mmol/mol); intergroup difference in change -0.07 [95% CI -0.31, 0.18]. Waist circumference decreased more in INT than CON after six months (p = 0.02). Muscular strength increased more in INT than in CON (p < 0.001). There were no intergroup differences in hypoglycemia or any other variables. CONCLUSIONS Adding resistance training did not impact glycemia, but it increased strength and reduced waist circumference, in aerobically active individuals with type 1 diabetes.
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Affiliation(s)
- Ronald J Sigal
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jane E Yardley
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- University of Alberta, Augustana Faculty, Camrose, Canada
- Alberta Diabetes Institute, Edmonton, Canada
| | - Bruce A Perkins
- Mount Sinai Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Michael C Riddell
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Gary S Goldfield
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Lois Donovan
- Departments of Medicine, Obstetrics and Gynecology, Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Janine Malcolm
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Stasia Hadjiyannakis
- Healthy Active Living & Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Alun L Edwards
- Departments of Medicine, Cardiac Sciences and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
| | - Réjeanne Gougeon
- Crabtree Nutrition Laboratories, Research Institute and Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Danièle Pacaud
- Alberta Children's Hospital, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Vincent Woo
- Section of Endocrinology and Metabolism, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
| | - Gordon T Ford
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Doug Coyle
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Penny Phillips
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steve Doucette
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Farah Khandwala
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Glen P Kenny
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Olstad DL, Beall R, Spackman E, Dunn S, Lipscombe LL, Williams K, Oster R, Scott S, Zimmermann GL, McBrien KA, Steer KJD, Chan CB, Tyminski S, Berkowitz S, Edwards AL, Saunders-Smith T, Tariq S, Popeski N, White L, Williamson T, L'Abbé M, Raine KD, Nejatinamini S, Naser A, Basualdo-Hammond C, Norris C, O'Connell P, Seidel J, Lewanczuk R, Cabaj J, Campbell DJT. Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies. BMJ Open 2022; 12:e050006. [PMID: 35168964 PMCID: PMC8852661 DOI: 10.1136/bmjopen-2021-050006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures. METHODS AND ANALYSIS 594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04725630. PROTOCOL VERSION Version 1.1; February 2022.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Reed Beall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eldon Spackman
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharlette Dunn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine L Lipscombe
- 2Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Oster
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sara Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gabrielle L Zimmermann
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, G012 Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada
| | - Kieran J D Steer
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Catherine B Chan
- Department of Agricultural, Food & Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
- Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sheila Tyminski
- Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Seth Berkowitz
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Gatineau, Quebec, Canada
| | - Alun L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Terry Saunders-Smith
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Saania Tariq
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Laura White
- Alberta Region, First Nations and Inuit Health Branch, Indigenous Services Canada, Edmonton, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mary L'Abbé
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aruba Naser
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinic Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Judy Seidel
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Primary Health Care Integration Network, Primary Health Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Calgary, Alberta, Canada
| | - Jason Cabaj
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David J T Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University Drive NW, Calgary, Alberta, Canada
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Dunn S, Olstad D, Beall RF, Spackman E, Lipscombe L, Williams K, Oster R, Scott S, Zimmermann G, McBrien KA, Steer KJD, Chan CB, Tyminski S, Berkowitz S, Edwards AL, Saunders-Smith T, Tariq S, Popeski N, White L, Williamson T, L'Abbe M, Raine K, Nejatinamini S, Naser A, Basualdo-Hammond C, Norris C, O'Connell P, Seidel J, Cabaj J, Campbell D. A Subsidized Healthy Food Prescription Program for Adults With Type 2 Diabetes Who Are Experiencing Food Insecurity: Protocol for a Randomized Controlled Trial. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab057_002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
It is vital for individuals with type 2 diabetes (T2DM) to adhere to a healthy dietary pattern to maintain optimal blood glucose levels and overall health. Increasing costs of healthy foods, however, are a barrier to maintaining healthful dietary patterns, particularly for individuals with T2DM who are experiencing food insecurity. Poor diet quality may result in difficulties maintaining optimal blood glucose levels, leading to higher rates of diabetes complications, and increased acute care usage and costs. Although the adverse impacts of food insecurity on maintaining optimal blood glucose levels are well documented, effective strategies to this among individuals with T2DM are lacking. One approach is providing subsidies to purchase healthy foods through subsidized healthy food prescription programs. These programs may help reduce food insecurity and improve diet quality, thereby improving blood glucose levels and reducing diabetes complications over time.
Methods
A parallel group randomized controlled trial will examine the effectiveness of a subsidized healthy food prescription program compared to a healthy food prescription alone in improving average blood glucose levels (primary outcome), and other secondary outcomes among 404 adults who are experiencing food insecurity and persistent hyperglycemia. The subsidized healthy food prescription program consists of two core elements: 1) A one-time healthy food prescription pamphlet that outlines an evidence-based healthy dietary pattern; 2) A healthy food subsidy of $1.50/day/household member to purchase healthy foods in participating supermarkets for 6 months. At baseline and 6-month follow-up, participants will provide responses to sociodemographic and health-related items, and a variety of patient-reported outcomes. Biochemical and physical measurements will also be obtained.
Results
The study's theory of change posits that reducing food insecurity and improving diet quality will be key mediators in improving blood glucose levels, which may reduce diabetes complications, and healthcare usage and costs over time.
Conclusions
The results of this study will demonstrate if a subsidized healthy food prescription program results in meaningful changes in average blood glucose levels and other clinically relevant outcomes.
Funding Sources
Alberta Innovates, Alberta Health Services.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science and Department of Physiology, University of Alberta, Edmonton, Alberta, Canada
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England KJ, Edwards AL, Paulson AC, Libby EP, Harrell PT, Mondejar KA. Rethink Vape: Development and evaluation of a risk communication campaign to prevent youth E-cigarette use. Addict Behav 2021; 113:106664. [PMID: 33038677 DOI: 10.1016/j.addbeh.2020.106664] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION E-cigarettes are now the most common form of tobacco use among adolescents, and use is associated with increased risk of initiation of cigarette smoking. This project used a community-engaged research process to develop and pilot a risk communication campaign to prevent youth vaping. METHOD The research team worked with a 36-member Teen Advisory Council and a 19-member Expert Panel. Together, the team employed survey (N = 674) and focus group (N = 82) methodologies, and hired a marketing company to partner on development of the campaign. Campaign concepts were developed, eliminated, and/or modified through an iterative process of feedback and refinement. The final campaign included video ads (https://bit.ly/2QMR8gH) a microsite (rethinkvape.org), and social media sites (@rethinkvape). The campaign communicated three messages to teens: what's in the vapor, health risks, and connections to big tobacco. Prior to launch of the campaign, a randomized controlled 2 (time) × 2 (group) online experiment was conducted to evaluate the campaign (N = 268). RESULTS Repeated measures mixed analyses of variance indicated that vaping knowledge, perceptions of risk, and anti-vape intentions significantly increased among teens viewing the Rethink Vape Materials compared to their own baseline, while control participants did not change. Following evaluation, the team launched a 6-week online media campaign with a teen-targeted geo-fence radius to deliver 3,838,465 impressions, 770,443 completed video views, and 18,316 clicks in mobile app, Snapchat, YouTube, and Spotify platforms. The majority of placements exceeded industry standards, with mobile pre-roll and Snapchat as top performers. CONCLUSIONS The e-cigarette campaign showed promising signs of effectiveness and scalability.
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Affiliation(s)
- K J England
- Pediatrics Division of Community Health and Research, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, United States.
| | - A L Edwards
- Pediatrics Division of Community Health and Research, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, United States
| | - A C Paulson
- Pediatrics Division of Community Health and Research, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, United States
| | - E P Libby
- Pediatrics Division of Community Health and Research, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, United States
| | - P T Harrell
- Pediatrics Division of Community Health and Research, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, United States
| | - K A Mondejar
- Pediatrics Division of Community Health and Research, Eastern Virginia Medical School, PO Box 1980, Norfolk, VA 23501, United States
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Helmle KE, Dechant AL, Edwards AL. Implementation of a Multidisciplinary Educational Strategy Promoting Basal-Bolus Insulin Therapy Improves Glycemic Control and Reduces Length of Stay for Inpatients With Diabetes. Clin Diabetes 2019; 37:82-85. [PMID: 30705501 PMCID: PMC6336121 DOI: 10.2337/cd17-0078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
IN BRIEF "Quality Improvement Success Stories" are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc. (ACP), and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes an initiative to increase the use of basal-bolus insulin therapy for hyperglycemia in an inpatient setting and to evaluate its effects on patient outcomes compared to sliding-scale insulin therapy.
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Affiliation(s)
- Karmon E Helmle
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anthony L Dechant
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alun L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Helmle KE, Edwards AL, Kushniruk AW, Borycki EM. Qualitative Evaluation of the Barriers and Facilitators Influencing the Use of an Electronic Basal Bolus Insulin Therapy Protocol to Improve the Care of Adult Inpatients With Diabetes. Can J Diabetes 2018; 42:459-464.e1. [PMID: 29395845 DOI: 10.1016/j.jcjd.2017.10.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES A qualitative evaluation of the perceived impact of a new evidence-informed electronic basal bolus insulin therapy order set on clinical workflow and practice, and exploration of potential barriers and facilitators to electronic basal bolus insulin order set uptake and use in acute care facilities for various acute care team members. METHODS We conducted 9 semistructured focus groups with multidisciplinary nursing staff (n=22), resident trainees (n=24) and attending physicians (n=23) involved in the delivery of inpatient diabetes care at 3 adult acute care facilities. The domains of inquiry included impact on workload, perceived impact on patient care and discipline-specific barriers and facilitators to use, including care-providers' needs, comfort and competencies, contributions from the clinical environment and efficacy of communication. The interviews were transcribed and analyzed using a content analysis approach. RESULTS Several major themes emerged from the focus group discussions, including impact of education, information technology/user interface, workflow, organizational issues and practices, and perceived outcomes. Barriers and facilitators were identified relating to each theme. CONCLUSIONS The outcomes highlight the complex interplay between educational, organizational and technical themes and the significance of employing a systemic approach to support the implementation of electronic inpatient glycemic-management protocols within complex social organizations.
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Affiliation(s)
- Karmon E Helmle
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Alun L Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andre W Kushniruk
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Elizabeth M Borycki
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
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Helmle KE, Chacko S, Chan T, Drake A, Edwards AL, Moore GE, Philp LC, Popeski N, Roedler RL, Rogers EJR, Zimmermann GL, McKeen J. Knowledge Translation to Optimize Adult Inpatient Glycemic Management With Basal Bolus Insulin Therapy and Improve Patient Outcomes. Can J Diabetes 2017; 42:505-513.e1. [PMID: 29555341 DOI: 10.1016/j.jcjd.2017.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/19/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To develop and evaluate a Basal Bolus Insulin Therapy (BBIT) Knowledge Translation toolkit to address barriers to adoption of established best practice with BBIT in the care of adult inpatients. METHODS This study was conducted in 2 phases and focused on the hospitalist provider group across 4 acute care facilities in Calgary. Phase 1 involved a qualitative evaluation of provider and site specific barriers and facilitators, which were mapped to validated interventions using behaviour change theory. This informed the co-development and optimization of the BBIT Knowledge Translation toolkit, with each tool targeting a specific barrier to improved diabetes care practice, including BBIT ordering. In Phase 2, the BBIT Knowledge Translation toolkit was implemented and evaluated, focusing on BBIT ordering frequency, as well as secondary outcomes of hyperglycemia (patient-days with BG >14.0 mmol/L), hypoglycemia (patient-days with BG <4.0 mmol/L), and acute length of stay. RESULTS Implementation of the BBIT Knowledge Translation toolkit resulted in a significant 13% absolute increase in BBIT ordering. Hyperglycemic patient-days were significantly reduced, with no increase in hypoglycemia. There was a significant, absolute 14% reduction in length of stay. CONCLUSIONS The implementation of an evidence-informed, multifaceted BBIT Knowledge Translation toolkit effectively reduced a deeply entrenched in-patient diabetes care gap. The resulting sustained practice change improved patient clinical and system resource utilization outcomes. This systemic approach to implementation will guide further scale and spread of glycemic optimization initiatives.
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Affiliation(s)
- Karmon E Helmle
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Sunita Chacko
- Hospitalist Program, Department of Family Medicine, Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada
| | - Trevor Chan
- Hospitalist Program, Department of Family Medicine, Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada
| | - Alison Drake
- Hospitalist Program, Department of Family Medicine, Alberta Health Services-Calgary Zone, Calgary, Alberta, Canada
| | - Alun L Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Glenda E Moore
- Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Leta C Philp
- Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Naomi Popeski
- Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Rhonda L Roedler
- Pharmacy Services, South Health Campus, Alberta Health Services, Calgary, Alberta, Canada
| | - Edwin J R Rogers
- Clinical Analytics, Analytics, Data Integration, Measurement and Reporting (DIMR), Alberta Health Services, Calgary, Alberta, Canada
| | - Gabrielle L Zimmermann
- Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julie McKeen
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Diabetes, Obesity, and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
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McBrien KA, Naugler C, Ivers N, Weaver RG, Campbell D, Desveaux L, Hemmelgarn BR, Edwards AL, Saad N, Nicholas D, Manns BJ. Barriers to care in patients with diabetes and poor glycemic control-A cross-sectional survey. PLoS One 2017; 12:e0176135. [PMID: 28459820 PMCID: PMC5411045 DOI: 10.1371/journal.pone.0176135] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 04/05/2017] [Indexed: 01/01/2023] Open
Abstract
AIMS To determine and quantify the prevalence of patient, provider and system level barriers to achieving diabetes care goals; and to examine whether barriers were different for people with poor glycemic control (HbA1c ≥ 10%; 86 mmol/mol) compared to fair glycemic control (7 to <8%; 53-64 mmol/mol). METHODS We administered a survey by telephone to community-dwelling patients with diabetes, to examine patient-reported barriers and facilitators to care. We compared responses in individuals with HbA1c ≥ 10% (86 mmol/mol) against those with HbA1c between 7-8% (53-64 mmol/mol). We examined associations between HbA1c group and barriers to care, adjusting for sociodemographic factors and diabetes duration. RESULTS The survey included 805 people with HbA1c ≥ 10% (86 mmol/mol), and 405 people with HbA1c 7-8% (53-64 mmol/mol). Participants with HbA1c ≥ 10% (86 mmol/mol) reported good access to care, however 20% of participants with HbA1c ≥ 10% (86 mmol/mol) felt that their care was not well-coordinated and 9.6% reported having an unmet health care need. In adjusted analysis, patients with HbA1c ≥10% (86 mmol/mol) were more likely to report lack of confidence and inadequate social support, compared to patients with HbA1c 7-8% (53-64 mmol/mol). They were also significantly more likely not to have drug insurance nor to have received recommended treatments because of cost. CONCLUSIONS These results reinforce the importance of an individualized, yet multi-faceted approach. Specific attention to financial barriers seems warranted. These findings can inform the development of programs and initiatives to overcome barriers to care, and improve diabetes care and outcomes.
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Affiliation(s)
- Kerry A. McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Laboratory Services, Calgary, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women’s College Hospital, Toronto, Canada
| | - Robert G. Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Brenda R. Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Alun L. Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Canada
| | - Nathalie Saad
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Donovan LE, Edwards AL, Savu A, Butalia S, Ryan EA, Johnson JA, Kaul P. Population-Level Outcomes with a 2-Step Approach for Gestational Diabetes Screening and Diagnosis. Can J Diabetes 2017; 41:596-602. [PMID: 28454899 DOI: 10.1016/j.jcjd.2016.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine outcomes associated with alternative glucose thresholds in a 2-step approach for screening and diagnosing gestational diabetes mellitus (GDM). METHODS We studied 178,527 pregnancies between 2008 and 2012 in Alberta, Canada. They were categorized retrospectively as normal 50 g screen (n=144,191); normal 75 g oral glucose tolerance test (OGTT) (n=21,248); abnormal at glucose thresholds suggested by the International Association of Diabetes and Pregnancy Group (IADPSG) (HAPO 1.75, n=4308); abnormal at glucose thresholds associated with an odds ratio of 2.0 for adverse events in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. This latter group, which would have been treated for GDM based on customary care, was further divided into those with 1 (HAPO 2-1 n=5528) or 2 or more abnormal glucose values (HAPO 2-2 n=3252). Main outcomes were large for gestational age (LGA), induced labour and Cesarean-section rates. RESULTS LGA rates were 8.2%, 10.5%, 14.2%, 11.8% and 16.5% among normal 50 g, normal 75 g OGTT, HAPO 1.75, HAPO 2-1, and HAPO 2-2 groups, respectively. Labour induction and caesarean-section rates were 29.6% and 36.2% in the IADPSG, 38.2% and 36.8% in the HAPO 2-1 group, and 42.3% and 41.1% in the HAPO 2-2 groups, respectively. Excessive maternal weight (≥91 kg) was associated with a higher risk for all adverse outcomes. CONCLUSIONS The 2-step approach effectively identifies pregnancies at low risk for adverse outcomes. Labelling influences induction practice. Any glucose intolerance increases risk for adverse outcomes, and pregnancies with highest (2 or higher) abnormal glucose values remain at greatest risk. Further research is needed to determine whether glycemic thresholds for GDM diagnosis should incorporate information about maternal weight.
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Affiliation(s)
- L E Donovan
- University of Calgary, Department of Medicine, Division of Endocrinology and Metabolism, Calgary, Alberta, Canada; University of Calgary, Department of Obstetrics and Gynecology, Calgary, Alberta, Canada.
| | - A L Edwards
- University of Calgary, Department of Medicine, Division of Endocrinology and Metabolism, Calgary, Alberta, Canada
| | - A Savu
- University of Alberta, Canadian Vigour Centre, Edmonton, Alberta, Canada
| | - S Butalia
- University of Calgary, Department of Medicine, Division of Endocrinology and Metabolism, Calgary, Alberta, Canada
| | - E A Ryan
- University of Alberta, Department of Medicine, Division of Endocrinology and Metabolism, Edmonton, Alberta, Canada
| | - J A Johnson
- University of Alberta, School of Public Health, Edmonton, Alberta, Canada
| | - P Kaul
- University of Alberta, Canadian Vigour Centre, Edmonton, Alberta, Canada; University of Alberta, School of Public Health, Edmonton, Alberta, Canada
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McBrien KA, Manns BJ, Hemmelgarn BR, Weaver R, Edwards AL, Ivers N, Rabi D, Lewanczuk R, Braun T, Naugler C, Campbell D, Saad N, Tonelli M. The association between sociodemographic and clinical characteristics and poor glycaemic control: a longitudinal cohort study. Diabet Med 2016; 33:1499-1507. [PMID: 26526088 DOI: 10.1111/dme.13023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
AIMS People with diabetes and poor glycaemic control are at higher risk of diabetes-related complications and incur higher healthcare costs. An understanding of the sociodemographic and clinical characteristics associated with poor glycaemic control is needed to overcome the barriers to achieving care goals in this population. METHODS We used linked administrative and laboratory data to create a provincial cohort of adults with prevalent diabetes, and a measure of HbA1c that occurred at least 1 year following the date of diagnosis. The primary outcome was poor glycaemic control, defined as at least two consecutive HbA1c measurements ≥ 86 mmol/mol (10%), not including the index measurement, spanning a minimum of 90 days. We used multivariable Cox proportional hazards models to evaluate the association between baseline sociodemographic and clinical factors and poor glycaemic control. RESULTS In this population-based cohort of 169 890 people, younger age was significantly associated with sustained poor glycaemic control, with a hazard ratio (HR) of 3.08, 95% CI (2.79-3.39) for age 18-39 years compared with age ≥ 75 years. Longer duration of diabetes, First Nations status, lower neighbourhood income quintile, history of substance abuse, mood disorder, cardiovascular disease, albuminuria and high LDL cholesterol were also associated with poor glycaemic control. CONCLUSIONS Although our results may be limited by the observational nature of the study, the large geographically defined sample size, longitudinal design and robust definition of poor glycaemic control are important strengths. These findings demonstrate the complexity associated with poor glycaemic control and indicate a need for tailored interventions.
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Affiliation(s)
- K A McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - B J Manns
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - B R Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - R Weaver
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A L Edwards
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Toronto, Canada
| | - N Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Hospital, Toronto, Canada
| | - D Rabi
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - R Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Provincial Primary Health Care, Alberta Health Services, Calgary, Canada
| | - T Braun
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Zone, Alberta Health Services, Calgary, Canada
| | - C Naugler
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Calgary Laboratory Services, Calgary, Canada
| | - D Campbell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - N Saad
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Padwal R, McAlister FA, Wood PW, Boulanger P, Fradette M, Klarenbach S, Edwards AL, Holroyd-Leduc JM, Alagiakrishnan K, Rabi D, Majumdar SR. Telemonitoring and Protocolized Case Management for Hypertensive Community-Dwelling Seniors With Diabetes: Protocol of the TECHNOMED Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e107. [PMID: 27343147 PMCID: PMC4938881 DOI: 10.2196/resprot.5775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/03/2016] [Indexed: 12/22/2022] Open
Abstract
Background Diabetes and hypertension are devastating, deadly, and costly conditions that are very common in seniors. Controlling hypertension in seniors with diabetes dramatically reduces hypertension-related complications. However, blood pressure (BP) must be lowered carefully because seniors are also susceptible to low BP and attendant harms. Achieving “optimal BP control” (ie, avoiding both undertreatment and overtreatment) is the ultimate therapeutic goal in such patients. Regular BP monitoring is required to achieve this goal. BP monitoring at home is cheap, convenient, widely used, and guideline endorsed. However, major barriers prevent proper use. These may be overcome through use of BP telemonitoring—the secure teletransmission of BP readings to a health portal, where BP data are summarized for provider and patient use, with or without protocolized case management. Objective To examine the incremental effectiveness, safety, cost-effectiveness, usability, and acceptability of home BP telemonitoring, used with or without protocolized case management, compared with “enhanced usual care” in community-dwelling seniors with diabetes and hypertension. Methods A 300-patient, 3-arm, pragmatic randomized controlled trial with blinded outcome ascertainment will be performed in seniors with diabetes and hypertension living independently in seniors’ residences in greater Edmonton. Consenting patients will be randomized to usual care, home BP telemonitoring alone, or home BP telemonitoring plus protocolized pharmacist case management. Usual care subjects will receive a home BP monitor but neither they nor their providers will have access to teletransmitted data. In both telemonitored arms, providers will receive telemonitored BP data summaries. In the case management arm, pharmacist case managers will be responsible for reviewing teletransmitted data and initiating guideline-concordant and protocolized changes in BP management. Results Outcomes will be ascertained at 6 and 12 months. Within-study-arm change scores will be calculated and compared between study arms. These include: (1) clinical outcomes: proportion of subjects with a mean 24-hour ambulatory systolic BP in the optimal range (110-129 mmHg in patients 65-79 years and 110-139 mmHg in those ≥80 years: primary outcome); additional ambulatory and home BP outcomes; A1c and lipid profile; medications, cognition, health care use, cardiovascular events, and mortality. (2) Safety outcomes: number of serious episodes of hypotension, syncope, falls, and electrolyte disturbances (requiring third party assistance or medical attention). (3) Humanistic outcomes: quality of life, satisfaction, and medication adherence. (4) Economic outcomes: incremental costs, incremental cost-utility, and cost per mmHg change in BP of telemonitoring ± case management compared with usual care (health payor and societal perspectives). (5) Intervention usability and acceptability to patients and providers. Conclusion The potential benefits of telemonitoring remain largely unstudied and unproven in seniors. This trial will comprehensively assess the impact of home BP telemonitoring across a range of outcomes. Results will inform the value of implementing home-based telemonitoring within supportive living residences in Canada. Trial Registration Clinicaltrials.gov NCT02721667; https://clinicaltrials.gov/ct2/show/NCT02721667 (Archived by Webcite at http://www.webcitation.org/6i8tB20Mc)
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Affiliation(s)
- Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, AB, Canada.
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Donovan LE, Savu A, Edwards AL, Johnson JA, Kaul P. Prevalence and Timing of Screening and Diagnostic Testing for Gestational Diabetes Mellitus: A Population-Based Study in Alberta, Canada. Diabetes Care 2016; 39:55-60. [PMID: 26486187 DOI: 10.2337/dc15-1421] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/03/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The extent to which pregnant women are screened for gestational diabetes mellitus (GDM) at the population level is not known. We examined the rate, type, and timing of GDM screening and diagnostic testing in the province of Alberta, Canada. Geographic and temporal differences in screening rates, and maternal risk factors associated with lower likelihood of screening, were also determined. RESEARCH DESIGN AND METHODS Our retrospective linked-database cohort study included 86,842 primiparous women with deliveries between 1 October 2008 and 31 December 2012. Multivariable logistic regression analysis was used to examine maternal factors associated with lower likelihood of GDM screening. RESULTS Overall, 94% (n = 81,304) of women underwent some form of glycemic assessment in the 270 days prior to delivery. The majority (91%) received a 50-g glucose screen (GDS). Women not screened were younger and more likely to smoke and had lower maternal weight and median household income. When a diagnostic 75-g oral glucose tolerance test (OGTT) was indicated, it occurred a median of 10 (interquartile range 7, 15) days after the screen. CONCLUSIONS GDS occurred widely in a system where it was universally recommended and paid for publicly. When indicated, a 75-g OGTT was completed within 15 days in 75% of cases. Our finding that this two-step approach was widely implemented in a timely fashion supports continued endorsement of a two-step approach to screening and diagnosis of GDM. Further research is merited to assess whether the one-step GDM diagnostic approach results in different rates and timing of the 75-g OGTT and affects pregnancy outcomes.
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Affiliation(s)
- Lois E Donovan
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Anamaria Savu
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Alun L Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Center, University of Alberta, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Edwards AL, Noseworthy TW. Alberta's Caring for Diabetes Project: Engaged Scholarship Informing Quality Improvement. Can J Diabetes 2015; 39 Suppl 3:S75-6. [DOI: 10.1016/j.jcjd.2015.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
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14
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Al Sayah F, Soprovich A, Qiu W, Edwards AL, Johnson JA. Diabetic Foot Disease, Self-Care and Clinical Monitoring in Adults with Type 2 Diabetes: The Alberta's Caring for Diabetes (ABCD) Cohort Study. Can J Diabetes 2015; 39 Suppl 3:S120-6. [PMID: 26243464 DOI: 10.1016/j.jcjd.2015.05.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/20/2015] [Accepted: 05/01/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the prevalence and predictors of foot disease, self-care and clinical monitoring in adults with type 2 diabetes in Alberta, Canada. METHOD Baseline data from a prospective cohort of adults with type 2 diabetes were used. Assessment of foot disease included self-reported peripheral neuropathy, peripheral vasculopathy, foot or leg ulcer/infection or gangrene/amputation. Foot self-care was assessed using the Summary of Diabetes Self-Care Activities, and clinical monitoring using patients' reports of having feet checked for lesions or sensory loss. RESULTS The mean age of respondents (N=2040) was 64 (SD 10.7) years; 45% were female, and 91% were Caucasian. Peripheral neuropathy was reported by 18% of the respondents, peripheral vasculopathy by 28%, ulcer/infection by 6% and gangrene/amputation by 1.4%. Only 14% of respondents performed foot self-care behaviours ≥6 days per week, and only 41% and 34% had their feet clinically checked for lesions or sensory loss, respectively. Predictors of foot disease included longer duration of diabetes, smoking, depressive symptoms, low self-efficacy and a history of cardiovascular diseases. Predictors of good self-care included older age, female sex, longer duration of diabetes and no report of hyperlipidemia. Predictors of clinical monitoring included female sex, current smoking, residing in urban areas, longer duration of diabetes, and histories of heart disease or hyperlipidemia. CONCLUSIONS Peripheral neuropathy and vasculopathy were the most common reported foot problems in this population. Foot self-care is generally infrequent, and clinical monitoring is performed for less than half of these patients, with significant variations by patient demographics and clinical presentation.
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Affiliation(s)
- Fatima Al Sayah
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Soprovich
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Weiyu Qiu
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Alun L Edwards
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey A Johnson
- Alliance for Canadian Health Outcomes Research in Diabetes, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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15
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Weaver RG, Hemmelgarn BR, Rabi DM, Sargious PM, Edwards AL, Manns BJ, Tonelli M, James MT. Association between participation in a brief diabetes education programme and glycaemic control in adults with newly diagnosed diabetes. Diabet Med 2014; 31:1610-4. [PMID: 24890340 DOI: 10.1111/dme.12513] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/25/2014] [Accepted: 05/30/2014] [Indexed: 12/27/2022]
Abstract
AIMS To determine the association between participation in a brief introductory didactic diabetes education programme and change in HbA1c among individuals with newly diagnosed diabetes. METHODS We identified a population-based cohort of adults newly diagnosed with diabetes between October 2005 and June 2008 in Calgary, Canada, and conducted a retrospective cohort study by linking administrative and laboratory data with programme attendance data. We matched individuals who attended the programme within the first 6 months after diagnosis with those who did not attend, based on their propensity scores. We measured the change in HbA1c between time of diagnosis and 6-18 months later to determine the association between programme participation and change in HbA1c . RESULTS HbA1c was measured at baseline and follow-up for 7793 individuals, including 803 programme participants. After propensity score matching, programme participation was associated with a significantly greater adjusted mean reduction in HbA1c between baseline and follow-up of 3.3 mmol/mol (95% CI 2.2-4.3) or 0.30% (95% CI 0.20-0.39). There was a significant interaction between baseline HbA1c and programme participation-the difference in adjusted mean reduction in HbA1c associated with programme participation ranged from 2.7 mmol/mol (0.25%) at baseline HbA1c of 53 mmol/mol (7%) to 6.2 mmol/mol (0.56%) at baseline HbA1c of 97 mmol/mol (11%). CONCLUSION Despite its brevity, participation in a diabetes education programme was associated with an additional reduction in HbA1c in newly diagnosed people that was comparable with that reported in trials of programmes targeted at those with prevalent diabetes.
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Affiliation(s)
- R G Weaver
- Department of Medicine, University of Calgary, Calgary, AB, Canada
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Seida JC, Mitri J, Colmers IN, Majumdar SR, Davidson MB, Edwards AL, Hanley DA, Pittas AG, Tjosvold L, Johnson JA. Clinical review: Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2014; 99:3551-60. [PMID: 25062463 PMCID: PMC4483466 DOI: 10.1210/jc.2014-2136] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Observational studies report consistent associations between low vitamin D concentration and increased glycemia and risk of type 2 diabetes, but results of randomized controlled trials (RCTs) are mixed. OBJECTIVE The objective of the study was to systematically review RCTs that report on the effects of vitamin D supplementation on glucose homeostasis or diabetes prevention. DATA SOURCES Sources of data for the study were MEDLINE, EMBASE, SCOPUS, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment, and Science Citation Index from inception to June 2013. STUDY SELECTION Study selection was trials that compared vitamin D3 supplementation with placebo or a non-vitamin D supplement in adults with normal glucose tolerance, prediabetes, or type 2 diabetes. DATA EXTRACTION AND SYNTHESIS Two reviewers collected data and assessed trial quality using the Cochrane Risk of Bias tool. Random-effects models were used to estimate mean differences (MDs) and odds ratios. The main outcomes of interest were homeostasis model assessment of insulin resistance, homeostasis model assessment of β-cell function, hemoglobin A1c levels, fasting blood glucose, incident diabetes, and adverse events. DATA SYNTHESIS Thirty-five trials (43 407 patients) with variable risk of bias were included. Vitamin D had no significant effects on insulin resistance [homeostasis model assessment of insulin resistance: MD -0.04; 95% confidence interval (CI) -0.30 to 0.22, I-squared statistic (I(2)) = 45%], insulin secretion (homeostasis model of β-cell function: MD 1.64; 95% CI -25.94 to 29.22, I(2) = 40%), or hemoglobin A1c (MD -0.05%; 95% CI -0.12 to 0.03, I(2) = 55%) compared with controls. Four RCTs reported on the progression to new diabetes and found no effect of vitamin D (odds ratio 1.02; 95% CI 0.94 to 1.10, I(2) = 0%). Adverse events were rare, and there was no evidence of publication bias. CONCLUSIONS Evidence from available trials shows no effect of vitamin D3 supplementation on glucose homeostasis or diabetes prevention. Definitive conclusions may be limited in the context of the moderate degree of heterogeneity, variable risk of bias, and short-term follow-up duration of the available evidence to date.
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Affiliation(s)
- Jennifer C Seida
- Alliance for Canadian Health Outcomes Research in Diabetes (J.C.S., I.N.C., S.R.M., L.T., J.A.J.) and Division of General Internal Medicine (S.R.M.), Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2E1; Division of Endocrinology, Diabetes & Metabolism, Tufts Medical Center (J.M., A.G.P.), Boston, Massachusetts 02111; Department of Medicine, Charles R. Drew University (M.B.D.), Los Angeles, California 90059; and Division of Endocrinology and Metabolism, University of Calgary (A.L.E., D.A.H.), Calgary, Canada T2N 1N4
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Edwards AL. A1C screening less expensive? CMAJ 2013; 185:799. [DOI: 10.1503/cmaj.113-2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jones KW, Eller LK, Parnell JA, Doyle-Baker PK, Edwards AL, Reimer RA. Effect of a dairy- and calcium-rich diet on weight loss and appetite during energy restriction in overweight and obese adults: a randomized trial. Eur J Clin Nutr 2013; 67:371-6. [PMID: 23462943 PMCID: PMC3948984 DOI: 10.1038/ejcn.2013.52] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND/OBJECTIVES A diet rich in dairy and calcium (Ca) has been variably associated with improvements in body composition and decreased risk of type 2 diabetes. Our objective was to determine if a dietary pattern high in dairy and Ca improves weight loss and subjective appetite to a greater extent than a low dairy/Ca diet during energy restriction in overweight and obese adults with metabolic syndrome. SUBJECTS/METHODS A total of 49 participants were randomized to one of two treatment groups: Control (low dairy, ≈ 700 mg/day Ca, -500 kcal/day) or Dairy/Ca (high dairy, ≈ 1400 mg/day Ca, -500 kcal/day) for 12 weeks. Body composition, subjective ratings of appetite, food intake, plasma satiety hormones, glycemic response and inflammatory cytokines were measured. RESULTS Control (-2.2 ± 0.5 kg) and Dairy/Ca (-3.3 ± 0.6 kg) had similar weight loss. Based on self-reported energy intake, the percentage of expected weight loss achieved was higher with Dairy/Ca (82.1 ± 19.4%) than Control (32.2 ± 7.7%; P=0.03). Subjects in the Dairy/Ca group reported feeling more satisfied (P=0.01) and had lower dietary fat intake (P=0.02) over 12 weeks compared with Control. Compared with Control, Dairy/Ca had higher plasma levels of peptide tyrosine tyrosine (PYY, P=0.01) during the meal tolerance test at week 12. Monocyte chemoattractant protein-1 was reduced at 30 min with Dairy/Ca compared with Control (P=0.04). CONCLUSIONS In conclusion, a dairy- and Ca-rich diet was not associated with greater weight loss than control. Modest increases in plasma PYY concentrations with increased dairy/Ca intake, however, may contribute to enhanced sensations of satisfaction and reduced dietary fat intake during energy restriction.
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Affiliation(s)
- K W Jones
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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Sandercock LE, Edwards AL, Rorstad OP. Use of Glycated Hemoglobin (A1C) for the Diagnosis of Diabetes Mellitus Type 2 in Ethnic Populations of Alberta- What are the Limitations? Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.07.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Edwards AL. Screening for Diabetes with A1C: Staring at the Empty Stable. Can J Diabetes 2012. [DOI: 10.1016/j.jcjd.2012.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
PURPOSE Diabetic patients with co-morbid mental illness are commonly encountered in clinical practice. Not only are diabetes and mental illness both common in the general population, but rates of diabetes are significantly higher in individuals with psychiatric disorders. This paper reviews literature related to the interplay between these pathologies and the consequent clinical challenge faced by physicians. METHODS A systematic review was conducted, examining specific aspects of psychiatric illness which may affect diabetic outcomes. RESULTS Decreased adherence is a feature of many psychiatric conditions, and can have a major effect on diabetic management and development of long term complications. Glycemic regulation may also be complicated by physiologic changes affecting carbohydrate metabolism. Patterns of counter-regulatory hormone secretion are altered in many psychiatric conditions, which may necessitate an altered diabetic treatment regimen. Further difficulties arise as many psychiatric medications have adverse metabolic effects. CONCLUSIONS Diabetic patients with mental illness present a unique clinical challenge as a result of issues related to behaviour, physiology and medications. Clinicians should be able to recognize "problem patients" who may in fact have undiagnosed, treatable, psychiatric pathology. In patients carrying existing diagnoses, complicating factors to diabetic control should be recognized, and steps taken to minimize adverse effects.
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Affiliation(s)
- Kenneth A Myers
- Faculty of Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada.
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Rabi DM, Edwards AL, Svenson LW, Graham MM, Knudtson ML, Ghali WA. Association of Median Household Income With Burden of Coronary Artery Disease Among Individuals With Diabetes. Circ Cardiovasc Qual Outcomes 2010; 3:48-53. [DOI: 10.1161/circoutcomes.108.840611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background—
Low income is associated with adverse cardiovascular outcomes. Diabetes is more prevalent among low income groups, and low income patients with diabetes have been shown to have a greater burden of cardiovascular risk factors and worse cardiovascular outcomes. The objective of this study was to determine whether income status was associated with burden of coronary atherosclerosis in patients with diabetes.
Methods and Results—
All patients with diabetes presenting for cardiac catheterization between January 1, 2000, and December 31, 2002, in Calgary, Canada, were identified through the use of the Alberta Provincial Project for Assessing Outcomes in Coronary Heart Disease (APPROACH) database. This clinical database was merged with Canadian 2001 Census data on median household income per dissemination area using patient postal code data, and income quintiles were derived. Clinical profiles, severity of coronary atherosclerosis, and myocardial jeopardy were compared across income quintiles. Mean scores for severity and jeopardy were compared across income quintiles using analysis of variance. Multivariate linear regression was used to control for baseline differences across income groups.
A total of 4596 patients were eligible for inclusion in this study. Clinical profiles differed significantly across income quintiles, with the highest income quintile being younger (
P
<0.0005), more likely to be male (
P
=0.029), and having a lower prevalence of smoking (
P
=0. 039). Low income groups were more likely to report a history of myocardial infarction (
P
<0.0005) or congestive heart failure (
P
<0.0005). The highest income groups has significantly less coronary atherosclerosis as measured by the weighted Duke index (6.67 versus 7.38,
P
<0.002), but there were no differences in lesion severity as measured by the Duke severity scale (2.31 versus 2.41,
P
=0.334). High income patients has significantly less myocardial jeopardy compared with the lowest income group as measured by the Duke and APPROACH scores (36.44 versus 46.23,
P
=0.0187, and 39.96 versus 45.36,
P
=0.0182, respectively). These differences remained significant even after controlling for baseline clinical differences in cardiovascular risk factor burden.
Conclusions—
Low income is associated with a greater degree of atherosclerosis and greater myocardial jeopardy in patients with diabetes. More needs to be done to reduce cardiovascular risk factor burden in this vulnerable population.
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Affiliation(s)
- Doreen M. Rabi
- From the Department of Medicine (D.M.R., A.L.E., W.A.G.), the Department of Community Health Sciences (D.M.R., L.W.S., W.A.G.), and the Department of Cardiac Sciences (D.M.R., M.K., W.A.G.), University of Calgary, Calgary Canada; Alberta Health and Wellness (L.W.S.), Alberta, Canada; and the Division of Cardiology (M.M.G.), University of Alberta, Alberta, Canada
| | - Alun L. Edwards
- From the Department of Medicine (D.M.R., A.L.E., W.A.G.), the Department of Community Health Sciences (D.M.R., L.W.S., W.A.G.), and the Department of Cardiac Sciences (D.M.R., M.K., W.A.G.), University of Calgary, Calgary Canada; Alberta Health and Wellness (L.W.S.), Alberta, Canada; and the Division of Cardiology (M.M.G.), University of Alberta, Alberta, Canada
| | - Lawrence W. Svenson
- From the Department of Medicine (D.M.R., A.L.E., W.A.G.), the Department of Community Health Sciences (D.M.R., L.W.S., W.A.G.), and the Department of Cardiac Sciences (D.M.R., M.K., W.A.G.), University of Calgary, Calgary Canada; Alberta Health and Wellness (L.W.S.), Alberta, Canada; and the Division of Cardiology (M.M.G.), University of Alberta, Alberta, Canada
| | - Michelle M. Graham
- From the Department of Medicine (D.M.R., A.L.E., W.A.G.), the Department of Community Health Sciences (D.M.R., L.W.S., W.A.G.), and the Department of Cardiac Sciences (D.M.R., M.K., W.A.G.), University of Calgary, Calgary Canada; Alberta Health and Wellness (L.W.S.), Alberta, Canada; and the Division of Cardiology (M.M.G.), University of Alberta, Alberta, Canada
| | - Merril L. Knudtson
- From the Department of Medicine (D.M.R., A.L.E., W.A.G.), the Department of Community Health Sciences (D.M.R., L.W.S., W.A.G.), and the Department of Cardiac Sciences (D.M.R., M.K., W.A.G.), University of Calgary, Calgary Canada; Alberta Health and Wellness (L.W.S.), Alberta, Canada; and the Division of Cardiology (M.M.G.), University of Alberta, Alberta, Canada
| | - William A. Ghali
- From the Department of Medicine (D.M.R., A.L.E., W.A.G.), the Department of Community Health Sciences (D.M.R., L.W.S., W.A.G.), and the Department of Cardiac Sciences (D.M.R., M.K., W.A.G.), University of Calgary, Calgary Canada; Alberta Health and Wellness (L.W.S.), Alberta, Canada; and the Division of Cardiology (M.M.G.), University of Alberta, Alberta, Canada
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23
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Rabi DM, Lewin AM, Brown GE, Edwards AL, Johnson JA, Ghali WA. Lay media reporting of rosiglitazone risk: extent, messaging and quality of reporting. Cardiovasc Diabetol 2009; 8:40. [PMID: 19630978 PMCID: PMC2727509 DOI: 10.1186/1475-2840-8-40] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 07/24/2009] [Indexed: 11/29/2022] Open
Abstract
Background A meta-analysis suggested the use of rosiglitazone was associated with an increased risk for cardiovascular (CV) events. Rosiglitazone remained available for use as more definitive safety trials were ongoing. This issue was reported in the lay media. Objective To review lay media articles to determine the extent of media coverage, the nature of the messaging, and to assess the quality of reporting. Methods The Factiva media database was used to identify articles published between May 18 and August 31, 2007. Two reviewers (a lay person and a physician) screened full text articles for eligibility, appraised the articles for their tone (worrisome, neutral, not worrisome), and for the quality of medical data reporting. Results The search identified 156 articles, 95 of which were eligible for our review. Agreement between the lay and medical reviewers in the appraisal of the article tone was 67.4%. Among those with agreement, the articles were often appraised as "worrisome" (75.3%). Among those with disagreement, the lay reviewer was significantly more likely to appraise articles as worrisome compared to the medical reviewer (77.4% vs. 3.2%, X2 = 9.11, P = 0.003). Cardiovascular risk was discussed in 91.6% of the articles, but risk was often reported in qualitative or relative terms. Conclusion There were many lay media articles addressing the safety of rosiglitazone, and the general messaging of these articles was considered "worrisome" by reviewers. Quality of risk reporting in the articles reviewed was poor. The impact of such media coverage on public anxiety and confidence in treatment should be explored.
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Affiliation(s)
- Doreen M Rabi
- Department of Medicine, University of Calgary, Calgary, Canada.
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24
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Abstract
BACKGROUND Venous thromboembolism (VTE) is a significant problem in oncology patients. VTE prophylaxis is underutilized in hospitalized medical patients, but there are few data for the appropriateness and frequency of its use in the oncology subgroup. We aimed to document local practice. METHODS A cross-sectional chart review of all hospitalized patients cared for by the Christchurch Hospital Oncology Service was carried out during two defined 4-week periods. Assessment for indications and contraindications to prophylactic anticoagulation was based on the 2004 American College of Chest Physicians evidence-based consensus guidelines. RESULTS Of 113 admissions to the oncology service, 38 (33.6%) had indications for prophylactic anticoagulation. However, 23 of these also had contraindications, leaving only 15 (13%) admissions where prophylactic anticoagulation was deemed appropriate. Only one was appropriately given prophylactic anticoagulation. CONCLUSION Only a minority of hospitalized oncology patients are appropriate for prophylactic anticoagulation. Where it is suitable, however, it is poorly utilized locally. Local promotion of VTE prophylaxis and further study of this subgroup of hospitalized medical patients may improve uptake of this practice and attenuate morbidity from VTE.
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Affiliation(s)
- P K L Chin
- Diabetes Centre, Christchurch Hospital, Christchurch, New Zealand.
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25
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Rabi DM, Brown G, Lewin AM, Edwards AL, Johnson J, Ghali WA. The Reporting of Cardiovascular Risk Associated with Rosiglitazone in the Lay Press. Can J Diabetes 2008. [DOI: 10.1016/s1499-2671(08)24163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Freedman RJ, Samson SL, Edwards AL, Schaefer JP, Southern DA, Quan H, Ghali WA. Glycemic control and use of the insulin sliding scale in hospitalized patients with diabetes. J Healthc Qual 2007; 29:31-7. [PMID: 17465168 DOI: 10.1111/j.1945-1474.2007.tb00181.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study assessed the extent of use of the subcutaneous insulin sliding scale (ISS) with hospitalized medical patients and examined the association between ISS use and glucose control. Despite some concerns about efficacy and suitability, the ISS is often used in the hospital studied. Researchers reviewed records of patients with a secondary diagnosis of diabetes who were admitted to the medical teaching unit of a tertiary care hospital. On day 1, 45.2% of patients were on an ISS alone. Patients on an ISS were more likely to experience hyperglycemia compared with patients on scheduled regimens, but they also had fewer hypoglycemic episodes.
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Affiliation(s)
- Renee J Freedman
- Department of Biomedical Science, Charles E. Schmidt College of Science, Florida, Atlantic University, Boca Raton, FL, USA
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27
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Rabi DM, Edwards AL, Svenson LW, Sargious PM, Norton P, Larsen ET, Ghali WA. Clinical and medication profiles stratified by household income in patients referred for diabetes care. Cardiovasc Diabetol 2007; 6:11. [PMID: 17397550 PMCID: PMC1852090 DOI: 10.1186/1475-2840-6-11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 03/30/2007] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low income individuals with diabetes are at particularly high risk for poor health outcomes. While specialized diabetes care may help reduce this risk, it is not currently known whether there are significant clinical differences across income groups at the time of referral. The objective of this study is to determine if the clinical profiles and medication use of patients referred for diabetes care differ across income quintiles. METHODS This cross-sectional study was conducted using a Canadian, urban, Diabetes Education Centre (DEC) database. Clinical information on the 4687 patients referred to the DEC from May 2000 - January 2002 was examined. These data were merged with 2001 Canadian census data on income. Potential differences in continuous clinical parameters across income quintiles were examined using regression models. Differences in medication use were examined using Chi square analyses. RESULTS Multivariate regression analysis indicated that income was negatively associated with BMI (p < 0.0005) and age (p = 0.023) at time of referral. The highest income quintiles were found to have lower serum triglycerides (p = 0.011) and higher HDL-c (p = 0.008) at time of referral. No significant differences were found in HBA1C, LDL-c or duration of diabetes. The Chi square analysis of medication use revealed that despite no significant differences in HBA1C, the lowest income quintiles used more metformin (p = 0.001) and sulfonylureas (p < 0.0005) than the wealthy. Use of other therapies were similar across income groups, including lipid lowering medications. High income patients were more likely to be treated with diet alone (p < 0.0005). CONCLUSION Our findings demonstrate that low income patients present to diabetes clinic older, heavier and with a more atherogenic lipid profile than do high income patients. Overall medication use was higher among the lower income group suggesting that differences in clinical profiles are not the result of under-treatment, thus invoking lifestyle factors as potential contributors to these findings.
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Affiliation(s)
- Doreen M Rabi
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
| | - Alun L Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | | | | | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | | | - William A Ghali
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
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28
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Rabi DM, Edwards AL, Southern DA, Svenson LW, Sargious PM, Norton P, Larsen ET, Ghali WA. Association of socio-economic status with diabetes prevalence and utilization of diabetes care services. BMC Health Serv Res 2006; 6:124. [PMID: 17018153 PMCID: PMC1618393 DOI: 10.1186/1472-6963-6-124] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 10/03/2006] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, however, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system. METHODS Data on referral for diabetes care, diabetes prevalence and median household income were obtained from a regional Diabetes Education Centre (DEC) database, the Canadian National Diabetes Surveillance System (NDSS) and the 2001 Canadian Census respectively. Diabetes rate per capita, referral rate per capita and proportion with diabetes referred was determined for census dissemination areas. We used Chi square analyses to determine if diabetes prevalence or population rates of referral differed across income quintiles, and Poisson regression to model diabetes rate and referral rate in relation to income while controlling for education and age. RESULTS There was a significant gradient in both diabetes prevalence (chi2 = 743.72, p < 0.0005) and population rates of referral (chi2 = 168.435, p < 0.0005) across income quintiles, with the lowest income quintiles having the highest rates of diabetes and referral to the DEC. Referral rate among those with diabetes, however, was uniform across income quintiles. Controlling for age and education, Poisson regression models confirmed a significant socio-economic gradient in diabetes prevalence and population rates of referral. CONCLUSION Low income is associated with a higher prevalence of diabetes and a higher population rate of referral to this regional DEC. After accounting for diabetes prevalence, however, the equal proportions referred to the DEC across income groups suggest that there is no access bias based on income.
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Affiliation(s)
- Doreen M Rabi
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
| | - Alun L Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Danielle A Southern
- Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
| | | | | | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | | | - William A Ghali
- Department of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
- Centre for Health and Policy Studies, University of Calgary, Calgary, Canada
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29
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Affiliation(s)
- Jeffrey A Johnson
- Department of Public Health Sciences, University of Alberta and Institute of Health Economics, Edmonton, Alta.
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30
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Affiliation(s)
- Andrew W Lyon
- Department of Medicine, University of Calgary, Calgary, Alta
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31
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Van Rosendaal GMA, Shaffer EA, Edwards AL, Brant R. Effect of time of administration on cholesterol-lowering by psyllium: a randomized cross-over study in normocholesterolemic or slightly hypercholesterolemic subjects. Nutr J 2004; 3:17. [PMID: 15453909 PMCID: PMC522822 DOI: 10.1186/1475-2891-3-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 09/28/2004] [Indexed: 11/22/2022] Open
Abstract
Background Reports of the use of psyllium, largely in hypercholesterolemic men, have suggested that it lowers serum cholesterol as a result of the binding of bile acids in the intestinal lumen. Widespread advertisements have claimed an association between the use of soluble fibre from psyllium seed husk and a reduced risk of coronary heart disease. Given the purported mechanism of cholesterol-lowering by psyllium, we hypothesized that there would be a greater effect when psyllium is taken with breakfast than when taken at bedtime. Secondarily, we expected to confirm a cholesterol-lowering effect of psyllium in subjects with "average" cholesterol levels. Methods Sixteen men and 47 women ranging in age from 18 to 77 years [mean 53 +/- 13] with LDL cholesterol levels that were normal or slightly elevated but acceptable for subjects at low risk of coronary artery disease were recruited from general gastroenterology and low risk lipid clinics. Following a one month dietary stabilization period, they received an average daily dose of 12.7 g of psyllium hydrophilic mucilloid, in randomized order, for 8 weeks in the morning and 8 weeks in the evening. Change from baseline was determined for serum total cholesterol, LDL, HDL and triglycerides. Results Total cholesterol for the "AM first" group at baseline, 8 and 16 weeks was 5.76, 5.77 and 5.80 mmol/L and for the "PM first" group the corresponding values were 5.47, 5.61 and 5.57 mmol/L. No effect on any lipid parameter was demonstrated for the group as a whole or in any sub-group analysis. Conclusion The timing of psyllium administration had no effect on cholesterol-lowering and, in fact, no cholesterol-lowering was observed. Conclusions regarding the effectiveness of psyllium for the prevention of heart disease in the population at large may be premature.
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Affiliation(s)
- Guido MA Van Rosendaal
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Eldon A Shaffer
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Alun L Edwards
- Department of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Rollin Brant
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
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32
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Ooi TC, Cousins M, Ooi DS, Nakajima K, Edwards AL. Effect of fibrates on postprandial remnant-like particles in patients with combined hyperlipidemia. Atherosclerosis 2004; 172:375-82. [PMID: 15019549 DOI: 10.1016/j.atherosclerosis.2003.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2003] [Revised: 07/26/2003] [Accepted: 10/15/2003] [Indexed: 11/18/2022]
Abstract
We have investigated the effect of standard doses of two fibrates, gemfibrozil and fenofibrate, on fasting and postprandial remnant-like particles (RLP) in subjects with combined hyperlipidemia. Forty-eight subjects participated; of these, 14 underwent a Vitamin A-fat loading test before and after 6 months of treatment with gemfibrozil (n = 8) and fenofibrate (n = 6). Blood was drawn every 2h for 12h after the test meal. The postprandial response was calculated as the area under the curve (AUC). There was no difference in fasting levels and pre-treatment AUC for triglycerides (TG), RLP cholesterol (RLP-C), RLP triglycerides (RLP-TG) and retinyl palmitate (RetP) between the two treatment groups. There was also no difference in the treatment effect on all parameters between the two treatment groups. Combining the two treatment groups, treatment resulted in a significant reduction in fasting levels and AUC of all four parameters. Assigning the difference observed between pre-treatment AUC of the combined study group and AUC of a normolipidemic (NL) control group as 100%, fibrate treatment resulted in decreases in AUC for TG, RLP-C, RLP-TG and RetP of 68, 69, 69 and 94%, respectively. These results indicate that fibrates are effective agents in reducing the postprandial increase in remnant lipoprotein particles.
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Affiliation(s)
- T C Ooi
- Metabolism and Hormone Laboratory, Division of Endocrinology and Metabolism, Department of Medicine, Ottawa Hospital, University of Ottawa, Civic Campus, 1053 Carling Avenue, Ottawa, Ont., Canada K1Y 4E9.
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33
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Fernandes DD, Edwards AL, Larsen ET, Norton P, Sargious PM, Quan H, Ghali WA. Patient profiles at a centralized, urban, diabetes education centre. CLIN INVEST MED 2002; 25:236-42. [PMID: 12516994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
BACKGROUND Little is known about the characteristics of patients attending diabetes education centres (DECs). To address this knowledge gap, we examined the clinical characteristics of patients referred to a centralized urban DEC. METHODS Using a clinically detailed patient registry, we studied the profiles of 1459 patients seen in an urban DEC, and compared patients referred to the DEC by family physicians (FPs) to those referred by other physicians (usually specialists), and patients referred to the DEC for the first time to those who had been referred a number of times (multiply-referred patients). RESULTS Among patients with a known source of referral, 73% were referred by their FP and 27% by a physician other than the FP. Eighty-seven percent of patients were being referred for the first time, and 13% had previous referrals. Blood glucose control at the time of referral was poorer for non-FP referrals and for multiply-referred patients. Patients in the former subgroup were more likely taking insulin when referred (38% v. 12%, p < 0.000), to have type 1 diabetes (19% v. 8%, p < 0.000) and to be referred for insulin initiation (12% v. 2%, p < 0.000) than were FP referrals. Meanwhile, multiply-referred patients were younger (51.9 v. 56.1 yr, p < 0.000) and were more likely to be female (59% v. 46%, p = 0.001) than were patients referred only once. INTERPRETATION Source of referral (FP v. non-FP) and presence or absence of previous referrals define unique DEC patient subgroups. Attention to the relative size and service needs of these subgroups is relevant to the planning of diabetes services.
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Affiliation(s)
- Dellano D Fernandes
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alta
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34
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van Rosendaal GM, Shaffer EA, Edwards AL, Sutherland LR. Issues raised by psyllium meta-analysis. Am J Clin Nutr 2001; 73:653-4. [PMID: 11237946 DOI: 10.1093/ajcn/73.3.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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35
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Campbell NR, Edwards AL, Brant R, Jones C, Mitchell D. Effect on lipid, complete blood count and blood proteins of a standardized preparation for drawing blood: a randomized controlled trial. CLIN INVEST MED 2000; 23:350-4. [PMID: 11152403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To compare a standardized recommended procedure for drawing blood to measure blood lipid and lipoprotein levels with the procedure commonly used in clinical practice. The aim was to see if hemoconcentration and spuriously elevated lipid levels could be avoided. DESIGN An open randomized crossover clinical trial. SETTING The University of Calgary. PATIENTS Twenty-five patients with dyslipidemia. INTERVENTIONS Blood drawing using a standardized procedure in which the patient remained seated for 5 minutes before blood collection and tourniquet use was minimized or avoided. MAIN OUTCOME MEASURES Differences in lipid levels between the usual clinical procedure and the recommended procedure for drawing blood. RESULTS Prior to drawing blood, laboratories have sat patients for an average of 1.4 minutes (95% CI, 0.9 to 1.9) and used a tourniquet in every patient. In the standardized procedure, patients rested for an average of 5.6 minutes (95% CI 5.0 to 6.2), and a tourniquet was used briefly in only 3 of 23 patients. There were no differences in lipid and lipoprotein values and no clinically significant difference in hemoglobin or albumin levels or in the calculation of hemoconcentration. CONCLUSIONS Efforts to rest patients and avoid tourniquet use when drawing blood for assessment of lipid levels are unlikely to be useful.
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Affiliation(s)
- N R Campbell
- Division of General Internal Medicine and Geriatrics, University of Calgary, Alta.
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36
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Edwards AL, Sharitz RR. Population genetics of two rare perennials in isolated wetlands: Sagittaria isoetiformis and S. teres (Alismataceae). Am J Bot 2000; 87:1147-1158. [PMID: 10947999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We investigated genetic structure in two closely related perennial plants that occur in isolated wetlands: Sagittaria isoetiformis, restricted to the southeastern Coastal Plain of North America, and S. teres, endemic to the northeastern Coastal Plain. Using horizontal starch-gel electrophoresis, we screened 527 individuals from 11 populations of S. isoetiformis and 367 individuals from seven populations of S. teres. A high proportion of the 16 loci were polymorphic (%P(S) = 93.8% in S. isoetiformis and %P(S) = 75.0% in S. teres), with higher mean numbers of alleles per polymorphic locus and effective alleles per locus in S. isoetiformis (AP = 3.27, A(E) = 1.90) than in S. teres (AP = 2.58, A(E) = 1.30). Species- and population-level expected heterozygosities were higher in S. isoetiformis (H(ES) = 0.399, H(EP) = 0.218) than in S. teres (H(ES) = 0.177, H(EP) = 0.101). Jackknife estimates of F statistics indicated moderate levels of inbreeding in S. teres (F(IS) = 23.1%). Strong differentiation characterized these geographically isolated populations (G(ST) = 39.9% in S. isoetiformis, and G(ST) = 26.1% in S. teres). Genetic identities varied substantially within (Ī = 75%, range = 0.558-0.963 in S. isoetiformis; Ī = 89%, range = 0.776-0.963 in S. teres) and among species (Ī = 81%, range = 0.506-0.882), leading to the discrimination of four regional population clusters using nonmetric multidimensional scaling (NMDS). It appears that S. isoetiformis and S. teres are a progenitor-derivative species pair.
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Affiliation(s)
- A L Edwards
- Department of Botany, University of Georgia, Athens, Georgia 30602 USA; and Savannah River Ecology Laboratory, Drawer E, Aiken, South Carolina 29802 USA
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37
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38
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Wells MD, Edwards AL, Luce EA. Intraoral reconstructive techniques. Clin Plast Surg 1995; 22:91-108. [PMID: 7743714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A multitude of reconstructive options are possible for the patient afflicted with an intraoral malignancy. The reconstructive technique chosen depends on the stage of the disease and the extent of the soft- and hard-tissue defects after extirpation. A graded approach is applied to reconstruction. If local tissues are not available for reconstruction, the surgeon must look to more distant sites in choosing a reconstructive procedure. Microsurgical transfer of composite tissues have allowed us a high degree of success in effecting immediate one-stage closure of complex three-dimensional wounds.
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Affiliation(s)
- M D Wells
- Department of Surgery, University of Kentucky Chandler Medical Center, Lexington, USA
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39
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Abstract
The development of both type II diabetes and gestational diabetes is probably governed by a complex and variable interaction of genes and environment. Molecular genetics has so far failed to identify discrete gene mutations accounting for metabolic changes in NIDDM. Both beta cell dysfunction and insulin resistance are operative in the manifestation of these disorders. Specific and sensitive immunoradiometric assays found fasting hyperproinsulinemia and first-phase hypoinsulinemia early in the natural history of the disorder. A lack of specificity of early radioimmunoassays for insulin resulted in measuring not only insulin but also proinsulins, leading to overestimation of insulin and misleading conclusions about its role in diabetes. The major causes of insulin resistance are the genetic deficiency of glycogen synthase activation, compounded by additional defects due to metabolic disorders, receptor downregulation, and glucose transporter abnormalities, all contributing to the impairment in muscle glucose uptake. The liver is also resistant to insulin in NIDDM, reflected in persistent hepatic glucose production despite hyperglycemia. Insulin resistance is present in many nondiabetics, but in itself is insufficient to cause type II diabetes. Gestational diabetes is closely related to NIDDM, and the combination of insulin resistance and impaired insulin secretion is of importance in its pathogenesis.
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Affiliation(s)
- T R Csorba
- Julia McFarlane Diabetes Research Center, University of Calgary, Alberta, Canada
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Ma Y, Ooi TC, Liu MS, Zhang H, McPherson R, Edwards AL, Forsythe IJ, Frohlich J, Brunzell JD, Hayden MR. High frequency of mutations in the human lipoprotein lipase gene in pregnancy-induced chylomicronemia: possible association with apolipoprotein E2 isoform. J Lipid Res 1994; 35:1066-75. [PMID: 8077845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Partial deficiency in lipolysis usually results in only mild disturbances of lipid levels. However, when this is associated with impairment of the uptake of remnant particles and increased production of triglyceride-rich lipoproteins stimulated by environmental factors such as during normal pregnancy, chylomicronemia may ensue. We have previously reported a patient who had approximately 12% of normal LPL activity and developed severe chylomicronemia during pregnancy (Ma et al. 1993. J. Clin. Invest. 91: 1953-1958). Here we report four new patients with pregnancy-induced chylomicronemia. In the nonpregnant state, these patients had mild to modest elevation of triglyceride levels ranging from 80 to 623 mg/dl (0.9-7.0 mmol/l) but during the third trimester they became severely chylomicronemic with triglyceride levels ranging from 2314 to 14,596 mg/dl (26 to 164 mmol/l). Three of these four patients had partial lipoprotein lipase (LPL) deficiency. The molecular characterization of the LPL gene in these three patients with partial LPL deficiency revealed four novel unpublished mutations. Patient #1 is a compound heterozygote for Leu252Arg and Ala261Thr mutations which are associated with 25% of normal LPL activity. In addition, she has an apoE3/2 genotype. Patient #2 is a heterozygote for a Asn291Ser substitution with 69% of LPL activity and also has an apoE3/2 genotype, while patient #3 is a heterozygote for a Trp382Stop mutation with 54% of normal LPL activity and has an apoE4/2 genotype. The fourth patient (#4) with pregnancy-induced chylomicronemia does not have LPL deficiency and has an apoE3/3 genotype. The previously reported patient (#5) who had 12% of normal LPL activity due to homozygosity for a Ser172Cys mutation also has an E3/3 genotype. Our data suggest that mutations in the LPL gene that cause partial LPL deficiency might be a frequent factor in the pathogenesis of pregnancy-induced chylomicronemia.
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Affiliation(s)
- Y Ma
- Department of Medicine, University of British Columbia, Vancouver, Canada
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Ma Y, Ooi TC, Liu MS, Zhang H, McPherson R, Edwards AL, Forsythe IJ, Frohlich J, Brunzell JD, Hayden MR. High frequency of mutations in the human lipoprotein lipase gene in pregnancy-induced chylomicronemia: possible association with apolipoprotein E2 isoform. J Lipid Res 1994. [DOI: 10.1016/s0022-2275(20)40102-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wells MD, Luce EA, Edwards AL, Vasconez HC, Sadove RC, Bouzaglou S. Sequentially linked free flaps in head and neck reconstruction. Clin Plast Surg 1994; 21:59-67. [PMID: 8112013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Free tissue transfer has become a useful technique for reconstructing complex three-dimensional defects following the extirpation of head and neck malignancies. This technique, however, may be limited by inadequate vascularity in the recipient site when a patient has been subjected to operative procedures or radiation therapy. The use of serial flaps, with the first flap connected sequentially to the second, reduces the need for dual recipient vessels in a surgical field when two flaps are required for reconstruction. Although this procedure is more technically demanding than more traditional approaches, it can provide a satisfactory, reliable one-stage composite reconstruction under these difficult circumstances. Results have been functionally and aesthetically superior to those achieved with pedicled one-flap reconstructive methods.
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Affiliation(s)
- M D Wells
- Department of Surgery, University of Kentucky, Lexington
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Edwards AL. "Stress" and lipids. CMAJ 1992; 147:456. [PMID: 1498756 PMCID: PMC1336244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- A L Edwards
- Division of Endocrinology, Calgary General Hospital
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Abstract
Using the Minnesota Multiphasic Personality Inventory (MMPI) item pool, Wiggins (1966) developed 13 scales, each with a homogeneous content. The 13 scales, along with marker scales for the 1st 3 MMPI factors, Edward's social desirability (SD), Welsh's repression (R), and Wiggins's social desirability (Sd) respectively were scored in the MMPI. The same scales were scored in an Experimental Multiphasic Personality Inventory (EMPI). A principal-components analysis of the 16 scales when scored in the MMPI resulted in 4 factors. A principal-components analysis of these same scales when scored in the MMPI and when scored in the EMPI were found to be highly congruent. The SD, R, and Sd scales proved to be excellent markers for the 1st 3 factors of the MMPI and also for the 1st 3 factors of the EMPI. Results provide further evidence that the 1st MMPI factor is a social desirability factor rather than a content factor.
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Abstract
Using the Minnesota Multiphasic Personality Inventory (MMPI) item pool, Wiggins (1966) developed 13 scales, each with a homogeneous content. The 13 scales, along with marker scales for the 1st 3 MMPI factors, Edward's social desirability (SD), Welsh's repression (R), and Wiggins's social desirability (Sd) respectively were scored in the MMPI. The same scales were scored in an Experimental Multiphasic Personality Inventory (EMPI). A principal-components analysis of the 16 scales when scored in the MMPI resulted in 4 factors. A principal-components analysis of these same scales when scored in the MMPI and when scored in the EMPI were found to be highly congruent. The SD, R, and Sd scales proved to be excellent markers for the 1st 3 factors of the MMPI and also for the 1st 3 factors of the EMPI. Results provide further evidence that the 1st MMPI factor is a social desirability factor rather than a content factor.
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Stevens SL, Tyler JD, Freeman MB, Hopkins F, Lewis T, Bray J, Edwards AL, Brockbank K, Goldman MH. Factors affecting patency of venous allografts in miniature swine. J Vasc Surg 1990; 12:361-6. [PMID: 2398594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In immunologically defined National Institutes of Health miniswine, a segment of internal jugular vein was anastomosed to the carotid artery as an interposition graft. Patency of swine major histocompatibility complex matched, one haplotype mismatched, and complete mismatched veins was 9.8, 6.3, and 3.0 weeks respectively (p = 0.009). More than 90% of mismatched and 20% of matched allografts developed a positive crossmatch before occlusion (p = 0.006). The mixed lymphocyte response did not predict graft occlusion. Treatment of 10 swine with cyclosporine (10 mg/kg/day) did not significantly improve patency for one haplotype mismatched grafts. In haplotype mismatched veins, cryopreserved grafts occluded more rapidly than noncryopreserved grafts: mean 2.4 versus 6.3 weeks, respectively (p = 0.002). In all cryopreserved vein grafts, alloantibody appeared at or after graft occlusion rather than before occlusion as seen with fresh allografts (p = 0.046). The mean patency of cryopreserved versus fresh autografts was 3.3 and greater than 32 weeks, respectively (p = 0.004). In summary, these results indicate that (1) allograft patency is related to the degree of swine major histocompatibility complex match and development of cytotoxic alloantibodies; (2) moderate-dose cyclosporine does not prolong allograft patency nor suppress development of antibody; (3) cryopreservation may accelerate graft occlusion through nonimmunologic mechanisms.
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Affiliation(s)
- S L Stevens
- Department of Surgery, University of Tennessee Medical Center, Knoxville 37920
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Edwards AL. Funduscopic examination of patients with diabetes who are admitted to hospital. CMAJ 1986; 134:1263-5. [PMID: 3708471 PMCID: PMC1491086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The charts of 123 patients with diabetes mellitus who were admitted to hospital were reviewed; 35 (28%) did not undergo funduscopic examination to detect diabetic retinopathy, and in 27 (22%) the examination was inadequate. Only four patients were referred to an ophthalmologist. Evidence of nephropathy and admission for diabetes control did not increase the probability of funduscopic examination. The findings suggest that house staff lack awareness of the natural history of diabetic retinopathy and of the success of current treatment. Annual funduscopic examination by an ophthalmologist in patients with diabetes is recommended, from the time of diagnosis in those with type II diabetes and starting 8 to 10 years after diagnosis in those with type I diabetes.
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Blandford RL, Sewell H, Edwards AL, Hearnshaw JR. Points: Allergy to purified bovine, porcine, and human insulins. West J Med 1983. [DOI: 10.1136/bmj.287.6396.914-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Edwards AL, Abbott RD. Relationships among the Edwards Personality Inventory scales, the Edwards Personality Preference Schedule, and the Personality Research Form scales. J Consult Clin Psychol 1973; 40:27-32. [PMID: 4688677 DOI: 10.1037/h0033856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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