Canadian journal of diabetes最新文献

Objective: This study aimed to determine the feasibility of using electronic medical record (EMR) data to assess whether virtual care provided by Family Health Team (FHT) located in Ontario during the early COVID-19 pandemic impacted key diabetes indicators, and to see whether content of diabetes-specific appointments was comparable to in-person care.

Methods: A retrospective pre-post cohort study was performed using patient-level EMR data from eligible FHT patients with type 2 diabetes. Feasibility outcomes were defined with pre-specified success criteria. Scientific outcomes include three diabetes indicators: hemoglobin A1c (HbA1c), low density lipoprotein (LDL), and blood pressure (BP). Indicator results from the pre-pandemic period (September 2019) and during-pandemic period (March 2020-March 2021) were recorded and compared. Patient characteristics and content of diabetes-specific appointments were also collected.

Results: All feasibility outcomes met pre-defined criteria for success. No significant differences in HbA1c, LDL or BP were identified between pre- and during-pandemic cohorts. Depression screening was performed significantly more frequently during the pandemic (73.85% vs. 47.06%, p < 0.001) at diabetes-specific appointments compared to the pre-pandemic period. No significant differences in frequency of screening for other complications (i.e., hypoglycemia, foot, eye) were found.

Discussion: Results signal that virtual care delivery in the during-pandemic period was not associated with significant changes in diabetes indicators or reduced screening for complications, however, many patients did not have BP measurements recorded during the pandemic.

Conclusions: Findings support evidence that virtual care may help maintain continuity of care for diabetes management in times where in-person appointments may not be possible.

Aims: To gain more insight in the way emerging adults with type 1 diabetes experience and manage conflicts between their desire to take good care of their diabetes and daily goals in other life domains.

Methods: Participants were recruited via three locations of a Dutch type 1 diabetes care and research center until researchers deemed data saturation was reached. Sixteen emerging adults were interviewed and completed a diary for three days. Interview transcripts were analyzed by two researchers, using directed content analysis.

Results: Participants experienced conflicts between self-management and goals in various life domains (including food, alcohol, sports, school/work, and leisure activities) on a daily basis; social goals figured prominently. Generally, they first tried to combine their diabetes goal and other goals by means of flexible self-care supported by modern technology, thorough planning, and social support. When combining was not possible, most participants tended to prioritize non-diabetes goals, unless they perceived a high risk for adverse health outcomes. Prioritization of diabetes- as well as non-diabetes goals often resulted in negative emotions, including sadness and guilt.

Conclusions: For emerging adults, it is a challenge to take good care of their diabetes while also addressing other goals in daily life. Combination and prioritization strategies both play a role in their efforts to deal with these goal conflicts, although the latter often trigger negative emotions. The findings can be used for the optimization of diabetes self-management support, by taking the broader life context into account.

Objective: Our aim in this study was to describe incident-use of second-line diabetes medications and serious adverse events among older adults before and after the introduction of glucagon-like peptide-1 receptor agonists (GLP-1 RAs).

Methods: We conducted a population-based cohort study from June 2011 to March 2023 using administrative data from Ontario, Canada. We identified individuals 66⁺ years of age with a new prescription for a second-line diabetes medication and recent history of metformin use. We also calculated the number and proportion of individuals using medications monthly with hypoglycemia and gastrointestinal events, stratified by drug class. Joinpoint models were used to determine whether any significant changes aligned with the introduction of GLP-1 RAs.

Results: Metformin was initially the most dispensed diabetes drug (peak 105,245 individuals treated in 2016), but its use was overtaken by second-line medications in 2019. Among second-line drugs, dipeptidyl peptidase-4 (DPP-4) inhibitors were dominant (peak 77,477 individuals in 2020). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors surpassed DPP-4 inhibitor use in 2022. Adverse events of interest were rare; however, insulin had the highest percentage of individuals affected with hypoglycemia (average 0.13% per month), while more individuals using second-line medications were affected with gastrointestinal outcomes (average 0.23% for diverticular disease in those using GLP-1 RA). Joinpoint models did not reveal any breaks in trend during the time of GLP-1 introduction.

Conclusions: Metformin was the most common drug class used, but the use of second-line medications, such as SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 RAs, exceeded the number of individuals using metformin in recent years---a major shift from historic trends.

Objectives: Adults with diabetes have 37% to 109% higher odds of sarcopenia than normoglycemic individuals. Handgrip strength (HGS) is a key marker of sarcopenia, yet its association with glycated hemoglobin (A1C), a measure of long-term glycemia, remains unclear.

Methods: We conducted a cross-sectional study of 121 outpatients ≥65 years of age (80 women, 41 men). HGS was measured 3 times per hand using a calibrated dynamometer and the mean was recorded. Low HGS was defined using cutoffs of the European Working Group on Sarcopenia in Older People. Fasting A1C, analyzed in an accredited laboratory, was categorized as normal (<5.7%), prediabetes (5.7% to 6.4%), and diabetes (≥6.5%). Correlations between A1C and anthropometric/functional measures were evaluated and multivariate linear regression identified A1C predictors.

Results: The mean HGS was 26 kg in women and 39 kg in men; 11 participants (9.5%) had low HGS. Prediabetes prevalence was 49% in women and 41% in men. A1C correlated inversely with HGS in men (r=-0.47, p=0.002), but not in women (r=-0.16, p=0.14). Trend analysis showed decreasing grip strength and gait speed across A1C categories in men (p_trend=0.0015 and 0.012, respectively), but not in women. Post hoc power analysis showed that the smaller correlation between HGS and A1C in women had low statistical power, suggesting that the nonsignificant result may be due to insufficient power rather than a true absence of association.

Conclusions: Lower HGS was associated with higher A1C in older men. The nonsignificant results in women are likely attributable to low statistical power.

Background: Diabetes is a global health emergency, affecting more than 420 million people worldwide, but care gaps persist. Patient engagement (PE) in research may address these gaps, but meaningful engagement with representative populations of diverse race, language and socioeconomic status is lacking. Power imbalances and tokenistic engagement are common.

Objective: To understand what diverse patient partners (PPs) who live with diabetes need to participate in research and how to integrate and engage them meaningfully.

Design: Qualitative study of focus groups.

Methods: A purposive sampling strategy was used to recruit PPs from the Diabetes Action Canada (DAC) research network. A semi-structured focus group guide was used to conduct focus group sessions. Sessions were audio-recorded and transcribed verbatim. Data analysis and synthesis involved Braun and Clark's reflexive thematic analysis to develop patterned meanings across the dataset.

Results: 35 PPs participated in 13 focus groups (9 English, 4 French). PPs had a mean age of 55 years, living with type 2 (46%) or type 1 (37%) diabetes, identified as female/woman (77%), residing in Ontario (47%) or Quebec (40%); 34% identified as racialized. Themes were developed across three broad domains: 1) enablers, 2) opportunities for improvement (challenges and recommendations); and 3) diabetes-specific considerations, highlighting distinct challenges and enablers related to participants' lived experiences with diabetes. We used this data to co-design research-stage-specific recommendations to optimize patient integration and engagement in research.

Conclusions: Our focus group study identified enablers and opportunities for improvement to integrate PP perspectives into the DAC research network more meaningfully.

Introduction: The prevalence of type 2 diabetes (T2D) has increased substantially over the last decade among young populations living in Canada, with certain ethnic groups, such as African, Caribbean, and Black (ACB), being disproportionately affected. Yet little is known about the suitability of the widely adopted T2D risk assessment tool, Canadian Diabetes Risk Questionnaire (CANRISK), for this population.

Methods: Two analytical samples of individuals aged 18 - 39 were identified from three phases of CANRISK validation data collection i) young individuals from ACB ethnicities, and ii) all young individuals. Descriptive analyses were conducted for all predictors from the CANRISK questionnaire, and prevalent dysglycemia (assessed by oral glucose tolerance test). The discriminatory ability of the CANRISK model was assessed by generating the area under the curve (AUC) and other model metrics. In addition, we assessed several cut-points for the ACB subgroup to identify the optimal threshold.

Results: The prevalence of dysglycemia was higher among the ACB subgroup (n= 722) than the overall young sample (n=3,958) (8.7% vs 7.7%). The CANRISK model performance was comparable for both groups, but slightly more accurate in the ACB subgroup (AUC=72.4% vs, AUC=71.5%). The optimal cut-off for young ACB individuals was the same optimal cut-off of 19 as for the general Canadian youth population.

Conclusions: Our findings indicate that the CANRISK tool, with a modified cut-off point, is a suitable tool to identify T2D risk among young adults from ACB ethnicities. Future studies could explore the tool's predictive ability via longitudinal studies to assess long-term diabetes risk.

Objective: This study aimed to investigate the uptake of Flash Glucose Monitoring (FGM) among Ontario residents aged 66 and older, who are insulin-requiring and are eligible for Ontario's universal drug coverage program (the Ontario Drug Benefit (ODB)), specifically examining differences based on immigrant status.

Methods: Using administrative data, we conducted a population-based, repeated cross-sectional study among Ontarians aged 66 and older with insulin-requiring diabetes between September 1, 2019, and March 31, 2023. The primary outcome was the monthly rate of unique individuals receiving publicly funded FGM through the ODB program. We compared characteristics of FGM users based on immigration status, considering demographic, neighborhood, and healthcare utilization factors.

Results: We found a total of 14,151 immigrants and 85,710 long-term residents who received an FGM over the study period. In the first month of funding, the rate of new users was lower among immigrants (37.1 per 1000) compared to long-term residents (48.8 per 1000). Rates peaked at 94.3 and 91.3 per 1000, respectively, in October 2019, declining thereafter and stabilizing in April 2020. Immigrants receiving FGM were younger, more likely to reside in neighborhoods with greater racialized and newcomer populations, and more likely to have received non-insulin diabetes medications in the prior year, compared to long-term residents receiving the FGM.

Conclusion: We observed significant FGM uptake in the first months following public funding among both immigrants and long-term residents. While long-term residents showed slightly higher initial uptake, differences between groups were minimal after the first month of funding.

Objectives: Diabetic ketoacidosis (DKA) is a major acute complication whose prevention depends on patient knowledge and self-management skills. We aimed to identify the patient-level barriers to effective DKA prevention behaviours.

Methods: We conducted a qualitative study using a behavioral science lens and implementation science methods involving three independent, sequential focus groups. Informed by the Action, Actor, Context, Target, Time framework, three targeted behaviors were defined: Testing ketone levels, acting upon ketone results, and seeking emergency medical care. Deductive coding was used to categorize barriers and enablers for each targeted behavior using the Theoretical Domains Framework (TDF). This was followed by thematic analysis and then member checking of key findings.

Results: Twenty-two participants (9 with type 1 diabetes, 1 caregiver, 12 healthcare providers) contributed to one of three focus groups. Key barriers to engaging in the target behaviors were: 1) a lack of understanding of the clinical relevance of ketones; 2) inability to retain necessary steps for ketone testing and a lack of access to supplies; 3) mental health challenges, sense of identity, and resistance to change; and 4) negative experiences with and fear of stigma from the healthcare system. Key enablers included: 1) reminders from clinicians and technologies; 2) community supports and accessible resources.

Conclusions: Acknowledgment of specific barriers are essential to designing future simplified DKA prevention educational tools and to implement continuous ketone monitoring. We aim in a subsequent step to co-create with people living diabetes a simplified DKA prevention infographic that addresses these barriers.