Canadian journal of diabetes最新文献

Objective: The aim of the study was to compare cardiac and respiratory function at rest in participants with early-onset type 2 diabetes and a control group without diabetes, matched for age, sex and body mass index (BMI).

Research design and methods: A total of 18 participants with early-onset type 2 diabetes (12M/6F, age 34.9±6 years, diabetes duration 3.1±3.0 years) and 14 control participants without diabetes matched for age, sex, and BMI (9M/5F age 32.9±5.2) were studied. Participants underwent resting echocardiography and pulmonary function tests. Fasting blood samples were analysed for HbA1c, glucose, C-reactive protein, insulin, free fatty acids and N-terminal pro b-type natriuretic peptide (NT-proBNP).

Results: Significant differences between groups were observed in left ventricular diastolic function at rest. Compared to controls, the group with early-onset type 2 diabetes had lower E/A (ratio between early (E) and late (A) ventricular filling velocity) (p=0.002), higher E/e ' (representing left ventricular filling pressure) (p = 0.017), lower e' (early myocardial relaxation velocity) (p < 0.001) and lower diffusion of the lung for carbon monoxide (DLCO) (p=0.003).

Conclusions: Subclinical left ventricular diastolic dysfunction and lower lung diffusing capacity were detected in participants with early-onset type 2 diabetes compared to matched controls.

Objective: Indigenous peoples in Canada are considered the highest-risk populations for type 2 diabetes mellitus (T2DM). Quality improvement (QI) strategies may be considered effective interventions to improving T2DM health outcomes. The purpose of this study was to understand experiences associated with the implementation of the SOAR QI program to improve prevention and management of T2DM.

Method: A qualitative study was conducted, and in-depth, semi-structured interviews were held with QI team members and key contacts, in person and through videoconference with two First Nations communities. Interviews were audio recorded and transcribed for data analysis.

Results: 10 interviews were conducted and emerging themes from the data analysis were organized into two categories, namely facilitators and barriers. Four subthemes were identified. Two subthemes emerged under the category of facilitators (cultural relevance, and partnership building). Two subthemes emerged under the category of barriers, (workload burden, role ambiguity).

Discussion: This study highlighted the necessity of implementing diabetes QI strategies that foster cultural sensitivity and provide opportunities for partnership building, to strengthen community relationships. The study also highlighted the importance of diminishing role ambiguity, and increased workload burdens, which can hinder the successful implementation of QI programs long-term.

Conclusion: The findings of this study can be utilized to improve future adaptations of SOAR and other diabetes First Nations focused QI strategies, to benefit Indigenous people in acquiring optimal outcomes relative to T2DM care. Findings can also inform the design, practices, and policies of such QI interventions in support of the spread and sustainability of the intervention long-term.

Background: Activating transcription factor 4 (ATF4) and mean amplitude of glycemic excursion (MAGE) have been implicated in the pathogenesis of osteoporosis (OP) and type 2 diabetes mellitus (T2DM). This retrospective cohort study assessed the predictive value of serum ATF4 and MAGE for the occurrence of OP in T2DM patients.

Methods: A total of 162 patients with T2DM were assigned to T2DM and T2DM + OP groups. All participants underwent serum ATF4 level detection and 72-h blood glucose monitoring (MAGE measurement). The correlations of ATF4 and MAGE with glucose and bone metabolism indicators and bone mineral density (BMD) were analyzed. A multivariate logistic regression model was developed to evaluate the correlations of ATF4 and MAGE with T2DM-associated OP. The diagnostic performance of concomitant detection of ATF4 and MAGE was assessed based on the area under the receiver-operating characteristics curve (AUC).

Results: T2DM patients with OP had higher serum ATF4 levels and MAGE than T2DM patients. ATF4 and MAGE were correlated positively with FINS, HbA1c, HOMA-IR, β-CTX, and TRACP-5b and negatively with BALP, PINP, PICP, and BMD. Elevated levels of ATF4 and MAGE were independent risk factors but increased BMD at the hip, femoral neck, and lumbar spine was a protective factor for T2DM patients with OP. More importantly, the AUC of concomitant ATF4 and MAGE was considerably higher than that of ATF4 or MAGE alone.

Conclusion: Concomitant detection of ATF4 and MAGE potentially aids in predicting the occurrence of OP in patients with T2DM.

Introduction: Glucagon-like peptide 1 receptor agonists (GLP-1RA) are effective medications for type 2 diabetes mellitus (T2DM) and obesity, yet their uptake among patients most likely to benefit has been slow.

Methods: We conducted a cross-sectional analysis of medication exposure in adults hospitalized at 16 hospitals in Ontario, Canada between 2015 and 2022. We estimated the proportion with T2DM, obesity, and cardiovascular disease. We identified the frequency of GLP-1RA use, and conducted multivariable logistic regression to identify factors associated with their use.

Results: Across 1,278,863 hospitalizations, 396,084 (31%) had T2DM and approximately 327,844 (26%) had obesity. GLP-1RA use (n=1,274) was low among those with a diagnosis of T2DM (0.3%) or obesity (0.7%), despite high prevalence of cardiovascular disease (36%). In contrast, use of diabetes medications lacking cardiovascular benefits was high during inpatient hospitalizations related to diabetes: 60% (n=236,612) received insulin and 14% (n=54,885) received a sulfonylurea. Apart from T2DM (OR=29.6, 95% CI 23.5, 37.2), characteristics associated with greater odds of receiving GLP-1RA were age 50-70 years (OR=1.71, 95% CI 1.38, 2.11) compared to age < 50 years, hemoglobin A1C > 9% (OR=1.83, 95% CI 1.36, 2.47) compared to < 6.5%, and highest income quintile (OR=1.73, 95% CI 1.45, 2.07) compared to lowest income quintile.

Conclusion: Knowledge translation interventions are needed to address the low adoption of GLP-1RA among hospitalized patients with T2DM and obesity, who are the most likely to benefit.

Introduction: Whereas marginal food insecurity has been recognized as important in Canadian food security policy, the category of marginal food security (MFS) is often ignored in US food security research.

Methods: Prevalence of FI was estimated according to the conventional and an alternate classification of MFS with food insecurity among 938 youth and young adults (YYA) with youth-onset type 1 diabetes (T1D) and 156 with youth-onset of type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study (2018-2021). Multivariable regression was used to estimate the association of MFS and conventionally defined food insecurity (FI) ascertained with diabetes-related outcomes, including acute diabetes complications, health care utilization, and diabetes self-management among YYA with T1D.

Results: MFS affected 10% of participants with T1D diabetes and 20% of participants with T2D. Classifying MFS with FI increased FI prevalence from 18.0% to 27.8% in participants with T1D and 34.6% to 55.1% in participants with T2D. Compared to T1D with high food security, YYA with T1D who were FI had higher odds hypoglycemia (2.1, 95% CI 1.2 to 3.6) and ketoacidosis (1.6, 95% CI 1.0 to 2.6), but no association was seen in MFS. The FI group also had higher odds of emergency department use and hospitalization (2.3, 95% CI 1.5 to 3.4; 2.4, 95% CI 1.5 to 3.9) and lower odds of technology use and checking glucose (0.6, 95% CI 0.4 to 0.9; 0.3, 95% CI 0.1 to 0.6). The MFS group exhibited associations of similar directions.

Discussion and conclusion: Health care providers should consider care of patients with T1D and MFS the same way they care for patients with FI.

Objectives: Individuals living with diabetes are often hospitalized. Despite this, little is known about their experiences with hospital care. In this study we examined the comprehensive experiences of patients hospitalized due to diabetes in Alberta, Canada, and compared them with those of patients hospitalized for other chronic conditions.

Methods: We conducted a retrospective cohort study that linked survey data with inpatient records. Survey data were collected using the Canadian Patient Experiences Survey-Inpatient Care (CPES-IC) instrument. Results from 37 questions were classified as percent in "top box," which reflects the most positive answer choice. We also examined the association between overall experience and demographic and clinical factors among those living with diabetes.

Results: Over a 7-year period, 12,593 surveys (2,288 with diabetes and 10,305 other chronic conditions) were obtained. Patients hospitalized due to diabetes had lower "top-box" scores on 24 questions, higher scores on 3 questions, and the remaining 10 questions showed no difference between groups. Those hospitalized due to diabetes indicated potential areas for improvement. These included receiving information about their condition and about the admission process, the nighttime quietness of their hospital room, being informed about possible side effects of new medications, and pain control. Overall experience was also shown to vary according to demographic and clinical factors.

Conclusions: We found that individuals hospitalized due to diabetes reported lower experience scores than those hospitalized due to other chronic conditions. Our findings may be used to develop strategies to improve the patient experience among this cohort.

Objectives: Gestational diabetes mellitus (GDM) is a common pregnancy complication. Studies have shown that the prevalence of GDM is rising worldwide. In this study we aimed to describe the prevalence of GDM in Ontario, Canada, between 2015 and 2021.

Methods: Population-based linked health-care administrative databases were used to identify women with GDM via a validated algorithm. Age-standardized GDM prevalence was described for each year between 2015 and 2021. Crude GDM prevalence trends were stratified according to age and income, and trend over time was evaluated using negative binomial regression.

Results: Crude GDM prevalence was 9.5% within this period, with age-standardized prevalence increasing by 35% over the duration of the study (p<0.0001). Prevalence declined in the first year of the COVID-19 pandemic, but it rose again the next year. Prevalence was directly associated with age (p<0.0001) and inversely associated with income (p=0.04), but these disparities did not change over time.

Conclusions: GDM prevalence is rising, but the transient decline in the first year of the pandemic may reflect forgone GDM screening. Disparities in prevalence by age and income are not worsening. GDM is creating a growing burden for the health-care system, particularly for lower income individuals.

Objectives: In this study we aimed to identify sleep patterns, physical fitness, and barriers to physical activity (PA) during Ramadan observance in a cohort of nonfasting individuals with type 1 diabetes (T1D).

Methods: Sixty-one nonfasting patients with T1D, age 28.34±9.43 years, ranging from 15 to 54 years, completed questionnaires before and during Ramadan. The questionnaires included 3 assessment instruments: the Barriers to Physical Activity in Type 1 Diabetes (BAPAD1), the Pittsburgh Sleep Quality Index (PSQI), and the International Physical Activity Questionnaire.

Results: During Ramadan, there was no significant change in BAPAD1 scores compared to before Ramadan (p=0.378). The primary barriers encompassed hypoglycemia risk, work schedules, diabetes control, and fatigue. Moreover, subjective sleep quality deteriorated during Ramadan compared to the pre-Ramadan period (p<0.001). Sleep duration decreased by 58 minutes (p<0.01) and was associated with later bedtimes and more awakenings. There was a notably decrease in PA levels (p=0.042), particularly for vigorous activities (p=0.017), whereas sedentary time showed a significant increase (p=0.008).

Conclusions: Ramadan observance did not affect barriers to PA in individuals with T1D despite alteration of sleep patterns and PA levels. Lifestyle alterations associated with Ramadan observance significantly impact individuals with T1D who are not fasting, resulting in reduced PA, shortened sleep duration, and increased sedentary time.

Objectives: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) provide heart and kidney benefit in adults with diabetes and cardiovascular disease (CVD). Public drug coverage policies for SGLT2i differ by province in Canada. Our study aimed to describe the potential effects of prior authorization / step therapy (PA/ST) and relatively high income-based deductibles, compared to regular benefit status with modest co-pay, on SGLT2i prescriptions in high-risk adults.

Methods: Cross-sectional study of individuals age ≥ 65 years with type 2 diabetes and CVD, taking ≥ 1 antihyperglycemic agent from 2019 to 2020, using electronic medical record data from primary care practices. We compared SGLT2i use (2019-2020) in Alberta (PA/ST, modest co-pay), and Manitoba (PA/ST, relatively high income-based deductible), to Ontario (regular benefit status, modest co-pay). Poisson regression was used to adjust for confounders, including age, sex, glycated hemoglobin, and other medication use. Other diabetes medications were estimated as control cases.

Results: We included 3,191 adults (average age 75 years, 31% female). SGLT2i use was lowest in Manitoba (15.6%), then Alberta (25.9%), and highest in Ontario (31.9%). After adjustment, compared to Ontario, SGLT2i prescriptions were lower in Alberta (prevalence ratio [PR] 0.80, 95% CI [0.71-0.91], p < 0.001) and Manitoba (PR 0.48 [0.39-0.59], p < 0.001).

Conclusions: PA/ST and relatively high deductibles are associated with reduced SGLT2i prescribing - PA/ST by approximately 20% in Alberta and Manitoba, and relatively high deductibles by an additional relative reduction of 40% in Manitoba. PA/ST and cost-sharing policies should be flexible and responsive to changing evidence of clinical benefit.