Type 1 diabetes (T1D) is a challenging chronic condition. Young children with T1D require daily support to manage their condition while at school. In 2018, Ontario established a provincial policy to ensure safe and equitable school participation for children with diabetes. Despite this, children and parents describe very different school experiences. In this qualitative study we describe the interpretation and implementation of school board policy related to the care of children with T1D from the perspective of school educators (principals/teachers).
Methods
Policy documents were reviewed employing a qualitative descriptive research design using directed qualitative content analysis. Semistructured interviews were conducted with 13 teachers and principals from 10 publicly funded elementary schools across the Hamilton and Toronto District School Boards in 2021.
Results
There are major differences in how policies regarding T1D are being implemented in schools. This includes how school staff are educated about T1D, and how they interpret and act on blood glucose information. Although educators often play an active role in supporting children, many face barriers, including competing priorities, fear, lack of information, and lack of support. Facilitators include effective communication/collaboration, actionable information, time, and a diabetes “champion.” In some instances, access to nursing support could help to resolve barriers or create care gaps.
Conclusions
School board policy provides high-level guidance on how to support children with T1D in school, but gaps remain. We provide specific recommendations regarding policy, staff education/training, roles and responsibilities, and future research.
{"title":"Type 1 Diabetes in Ontario Schools: Policy and Practice","authors":"Hannah Geddie MSc, MD, FRCPC , Sanja Visekruna RN, MSc, PhD, CCNE , Sarah Lawrence MD, FRCPC , Diana Sherifali PhD , Ereny Bassilious MD, FRCPC, MHPE","doi":"10.1016/j.jcjd.2024.01.005","DOIUrl":"10.1016/j.jcjd.2024.01.005","url":null,"abstract":"<div><h3>Objectives</h3><p>Type 1 diabetes (T1D) is a challenging chronic condition. Young children with T1D require daily support to manage their condition while at school. In 2018, Ontario established a provincial policy to ensure safe and equitable school participation for children with diabetes. Despite this, children and parents describe very different school experiences. In this qualitative study we describe the interpretation and implementation of school board policy related to the care of children with T1D from the perspective of school educators (principals/teachers).</p></div><div><h3>Methods</h3><p>Policy documents were reviewed employing a qualitative descriptive research design using directed qualitative content analysis. Semistructured interviews were conducted with 13 teachers and principals from 10 publicly funded elementary schools across the Hamilton and Toronto District School Boards in 2021.</p></div><div><h3>Results</h3><p>There are major differences in how policies regarding T1D are being implemented in schools. This includes how school staff are educated about T1D, and how they interpret and act on blood glucose information. Although educators often play an active role in supporting children, many face barriers, including competing priorities, fear, lack of information, and lack of support. Facilitators include effective communication/collaboration, actionable information, time, and a diabetes “champion.” In some instances, access to nursing support could help to resolve barriers or create care gaps.</p></div><div><h3>Conclusions</h3><p>School board policy provides high-level guidance on how to support children with T1D in school, but gaps remain. We provide specific recommendations regarding policy, staff education/training, roles and responsibilities, and future research.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139517678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjd.2024.01.010
Alyssa Caldwell McGee MS , Trenton Reinicke BS , Diego Carrasco BS , Jesse Goodrich PhD , Meda E. Pavkov MD, PhD , Daniel H. van Raalte MD, PhD , Carissa Birznieks MS , Robert G. Nelson MD, PhD , Kristen J. Nadeau MD, MS , Ye Ji Choi MS , Tim Vigers MS , Laura Pyle PhD , Ian de Boer MD, MS , Petter Bjornstad MD , Kalie L. Tommerdahl MD
Objectives
Glycoprotein acetyls (GlycA's) are biomarkers of systemic inflammation and cardiovascular disease, yet little is known about their role in type 1 diabetes (T1D). In this study we examined the associations among GlycA's, central adiposity, insulin resistance, and early kidney injury in youth with T1D.
Methods
Glomerular filtration rate and renal plasma flow by iohexol and p-aminohippurate clearance, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry, and estimated insulin sensitivity were assessed in 50 youth with T1D (16±3.0 years of age, 50% female, glycated hemoglobin 8.7%±1.3%, T1D duration 5.7±2.6 years). Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed.
Results
GlycA's were higher in girls vs boys (1.05±0.26 vs 0.84±0.15 mmol/L, p=0.001) and in participants living with overweight/obesity vs normal weight (1.12±0.23 vs 0.87±0.20 mmol/L, p=0.0004). GlycA's correlated positively with estimated intraglomerular pressure (r=0.52, p=0.001), UACR (r=0.53, p<0.0001), and trunk mass (r=0.45, p=0.001), and inversely with estimated insulin sensitivity (r=−0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and glycated hemoglobin.
Conclusions
As biomarkers of inflammation, GlycA's were higher in girls and those with overweight or obese body habitus in T1D. GlycA's associated with parameters of early kidney dysfunction, central adiposity, and insulin resistance.
{"title":"Glycoprotein Acetyls Associate With Intraglomerular Hemodynamic Dysfunction, Albuminuria, Central Adiposity, and Insulin Resistance in Youth With Type 1 Diabetes","authors":"Alyssa Caldwell McGee MS , Trenton Reinicke BS , Diego Carrasco BS , Jesse Goodrich PhD , Meda E. Pavkov MD, PhD , Daniel H. van Raalte MD, PhD , Carissa Birznieks MS , Robert G. Nelson MD, PhD , Kristen J. Nadeau MD, MS , Ye Ji Choi MS , Tim Vigers MS , Laura Pyle PhD , Ian de Boer MD, MS , Petter Bjornstad MD , Kalie L. Tommerdahl MD","doi":"10.1016/j.jcjd.2024.01.010","DOIUrl":"10.1016/j.jcjd.2024.01.010","url":null,"abstract":"<div><h3>Objectives</h3><p>Glycoprotein acetyls (GlycA's) are biomarkers of systemic inflammation and cardiovascular disease, yet little is known about their role in type 1 diabetes (T1D). In this study we examined the associations among GlycA's, central adiposity, insulin resistance, and early kidney injury in youth with T1D.</p></div><div><h3>Methods</h3><p>Glomerular filtration rate and renal plasma flow by iohexol and <em>p</em>-aminohippurate clearance, urine albumin-to-creatinine ratio (UACR), central adiposity by dual-energy x-ray absorptiometry, and estimated insulin sensitivity were assessed in 50 youth with T1D (16±3.0 years of age, 50% female, glycated hemoglobin 8.7%±1.3%, T1D duration 5.7±2.6 years). Concentrations of GlycA were quantified by targeted nuclear magnetic resonance spectroscopy. Correlation and multivariable linear regression analyses were performed.</p></div><div><h3>Results</h3><p>GlycA's were higher in girls vs boys (1.05±0.26 vs 0.84±0.15 mmol/L, p=0.001) and in participants living with overweight/obesity vs normal weight (1.12±0.23 vs 0.87±0.20 mmol/L, p=0.0004). GlycA's correlated positively with estimated intraglomerular pressure (r=0.52, p=0.001), UACR (r=0.53, p<0.0001), and trunk mass (r=0.45, p=0.001), and inversely with estimated insulin sensitivity (r=−0.36, p=0.01). All relationships remained significant after adjustment for age, sex, and glycated hemoglobin.</p></div><div><h3>Conclusions</h3><p>As biomarkers of inflammation, GlycA's were higher in girls and those with overweight or obese body habitus in T1D. GlycA's associated with parameters of early kidney dysfunction, central adiposity, and insulin resistance.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjd.2024.02.003
Kaitlyn E. Watson BPharm (Hons), PhD, GradCertAppPharmPrac, FHEA , Kirnvir Dhaliwal RN, MN, PhD , Eleanor Benterud RN, MN , Sandra Robertshaw , Nancy Verdin , Ella McMurtry , Nicole Lamont MBT, BHSc , Kelsea M. Drall MSc , Sarah Gill , David J.T. Campbell MD, MSc, PhD, FRCPC , Kerry McBrien MD, MPH, CCFP , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc, FCSHP, FACC, FCAHS, ISHF , Neesh Pannu MD, SM , Matthew T. James MD, PhD, FRCPC , Maoliosa Donald PhD, BScPT
Objectives
Our aim in this work was to 1) explore barriers and enablers to patient and health-care provider (HCP) behaviours related to sick-day medication guidance (SDMG), 2) identify theory-informed strategies to advise SDMG intervention design, and 3) obtain perspectives on an eHealth tool for this purpose.
Methods
A qualitative descriptive study using qualitative conventional content analysis was undertaken. Interviews and focus groups were held with patients and HCPs from January 2021 to April 2022. Data were analyzed using the Behaviour Change Wheel and Theoretical Domains Framework to inform intervention design.
Results
Forty-eight people (20 patients, 13 pharmacists, 12 family physicians, and 3 nurse practitioners) participated in this study. Three interventions were designed to address the identified barriers and enablers: 1) prescriptions provided by a community-based care provider, 2) pharmacists adding a label to at-risk medications, and 3) built-in prompts for prescribing and dispensing software. Most participants accepted the concept of an eHealth tool and identified pharmacists as the ideal point-of-care provider. Challenges for an eHealth tool were raised, including credibility, privacy of data, medical liability, clinician remuneration and workload impact, and equitable access to use of the tool.
Conclusions
Patients and HCPs endorsed non-technology and eHealth innovations as strategies to aid in the delivery of SDMG. These findings can guide the design of future theory-informed SDMG interventions.
{"title":"Managing Medications During “Sick Days” in Patients With Diabetes, Kidney, and Cardiovascular Conditions: A Theory-informed Approach to Intervention Design and Implementation","authors":"Kaitlyn E. Watson BPharm (Hons), PhD, GradCertAppPharmPrac, FHEA , Kirnvir Dhaliwal RN, MN, PhD , Eleanor Benterud RN, MN , Sandra Robertshaw , Nancy Verdin , Ella McMurtry , Nicole Lamont MBT, BHSc , Kelsea M. Drall MSc , Sarah Gill , David J.T. Campbell MD, MSc, PhD, FRCPC , Kerry McBrien MD, MPH, CCFP , Ross T. Tsuyuki BSc(Pharm), PharmD, MSc, FCSHP, FACC, FCAHS, ISHF , Neesh Pannu MD, SM , Matthew T. James MD, PhD, FRCPC , Maoliosa Donald PhD, BScPT","doi":"10.1016/j.jcjd.2024.02.003","DOIUrl":"10.1016/j.jcjd.2024.02.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Our aim in this work was to 1) explore barriers and enablers to patient and health-care provider (HCP) behaviours related to sick-day medication guidance (SDMG), 2) identify theory-informed strategies to advise SDMG intervention design, and 3) obtain perspectives on an eHealth tool for this purpose.</p></div><div><h3>Methods</h3><p>A qualitative descriptive study using qualitative conventional content analysis was undertaken. Interviews and focus groups were held with patients and HCPs from January 2021 to April 2022. Data were analyzed using the Behaviour Change Wheel and Theoretical Domains Framework to inform intervention design.</p></div><div><h3>Results</h3><p>Forty-eight people (20 patients, 13 pharmacists, 12 family physicians, and 3 nurse practitioners) participated in this study. Three interventions were designed to address the identified barriers and enablers: 1) prescriptions provided by a community-based care provider, 2) pharmacists adding a label to at-risk medications, and 3) built-in prompts for prescribing and dispensing software. Most participants accepted the concept of an eHealth tool and identified pharmacists as the ideal point-of-care provider. Challenges for an eHealth tool were raised, including credibility, privacy of data, medical liability, clinician remuneration and workload impact, and equitable access to use of the tool.</p></div><div><h3>Conclusions</h3><p>Patients and HCPs endorsed non-technology and eHealth innovations as strategies to aid in the delivery of SDMG. These findings can guide the design of future theory-informed SDMG interventions.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1499267124000455/pdfft?md5=4af92579e548299ac5f7b13571a62efd&pid=1-s2.0-S1499267124000455-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjd.2024.01.006
Benazir Hodzic-Santor BA , Michael Colacci MD , Afsaneh Raissi BHSc , Prachi Ray HBSc , Amol A. Verma MD, MPhil , Fahad Razak MD, MSc , Derek R. MacFadden MD, ScD , Tor Biering-Sørensen MD, MPH, MSc, PhD , Kristoffer Grundtvig Skaarup MD , Shohinee Sarma MD, MPH , Michael Fralick MD, PhD
Objectives
International Classification of Diseases (ICD) codes are commonly used to identify cases of diabetic ketoacidosis (DKA) in health services research, but they have not been validated. Our aim in this study was to assess the accuracy of ICD, 10th revision (ICD-10) diagnosis codes for DKA.
Methods
We conducted a multicentre, cross-sectional study using data from 5 hospitals in Ontario, Canada. Each hospitalization event has a single most responsible diagnosis code. We identified all hospitalizations assigned diagnosis codes for DKA. A true case of DKA was defined using laboratory values (serum bicarbonate ≤18 mmol/L, arterial pH ≤7.3, anion gap ≥14 mEq/L, and presence of ketones in urine or blood). Chart review was conducted to validate DKA if laboratory values were missing or the diagnosis of DKA was unclear. Outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-10 codes in patients with laboratory-defined DKA.
Results
We identified 316,517 hospitalizations. Among these, 312,948 did not have an ICD-10 diagnosis code for DKA and 3,569 had an ICD-10 diagnosis code for DKA. Using a combination of laboratory and chart review, we identified that the overall PPV was 67.0%, the NPV was 99.7%, specificity was 99.6%, and sensitivity was 74.9%. When we restricted our analysis to hospitalizations in which DKA was the most responsible discharge diagnosis (n=3,374 [94.5%]), the test characteristics were PPV 69.8%, NPV 99.7%, specificity 99.7%, and sensitivity 71.9%.
Conclusion
ICD-10 codes can identify patients with DKA among those admitted to general internal medicine.
{"title":"Validation of the Diagnostic Accuracy Levels of International Classification of Diseases, 10th Revision Codes for Diabetic Ketoacidosis: A Multicentre, Cross-sectional Study of Adults","authors":"Benazir Hodzic-Santor BA , Michael Colacci MD , Afsaneh Raissi BHSc , Prachi Ray HBSc , Amol A. Verma MD, MPhil , Fahad Razak MD, MSc , Derek R. MacFadden MD, ScD , Tor Biering-Sørensen MD, MPH, MSc, PhD , Kristoffer Grundtvig Skaarup MD , Shohinee Sarma MD, MPH , Michael Fralick MD, PhD","doi":"10.1016/j.jcjd.2024.01.006","DOIUrl":"10.1016/j.jcjd.2024.01.006","url":null,"abstract":"<div><h3>Objectives</h3><p>International Classification of Diseases (ICD) codes are commonly used to identify cases of diabetic ketoacidosis (DKA) in health services research, but they have not been validated. Our aim in this study was to assess the accuracy of ICD, 10th revision (ICD-10) diagnosis codes for DKA.</p></div><div><h3>Methods</h3><p>We conducted a multicentre, cross-sectional study using data from 5 hospitals in Ontario, Canada. Each hospitalization event has a single most responsible diagnosis code. We identified all hospitalizations assigned diagnosis codes for DKA. A true case of DKA was defined using laboratory values (serum bicarbonate ≤18 mmol/L, arterial pH ≤7.3, anion gap ≥14 mEq/L, and presence of ketones in urine or blood). Chart review was conducted to validate DKA if laboratory values were missing or the diagnosis of DKA was unclear. Outcome measures included positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of ICD-10 codes in patients with laboratory-defined DKA.</p></div><div><h3>Results</h3><p>We identified 316,517 hospitalizations. Among these, 312,948 did not have an ICD-10 diagnosis code for DKA and 3,569 had an ICD-10 diagnosis code for DKA. Using a combination of laboratory and chart review, we identified that the overall PPV was 67.0%, the NPV was 99.7%, specificity was 99.6%, and sensitivity was 74.9%. When we restricted our analysis to hospitalizations in which DKA was the most responsible discharge diagnosis (n=3,374 [94.5%]), the test characteristics were PPV 69.8%, NPV 99.7%, specificity 99.7%, and sensitivity 71.9%.</p></div><div><h3>Conclusion</h3><p>ICD-10 codes can identify patients with DKA among those admitted to general internal medicine.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139518005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjd.2024.02.001
Soraia de Camargo Catapan BPharm, MPhil, PhD , Carina Vasconcelos Silva MPH , Dominique Bird MD , Monika Janda MPhil, PhD , Len Gray MBBS, MMed, PhD , Lisbeth Maunder , Jane Clemensen RN, MSN, PhD , Anish Menon MBBS, PhD , Anthony Russell MBBS, PhD
Objectives
Diabetes care in Australia is often fragmented and provider-centred, resulting in suboptimal care. Innovative solutions are needed to bridge the evidence–practice gap, and technology can facilitate the redesign of type 2 diabetes care. We used participatory design to increase the chances of fulfilling stakeholders’ needs. Using this method, we explored solutions aimed at redesigning diabetes care, focussing on the previously identified needs.
Methods
The participatory design project was guided by stakeholders’ contributions. Stakeholders of this project included people with type 2 diabetes, health-care professionals, technology developers, and researchers. Information uncovered at each step influenced the next: 1) identification of needs, 2) generation of solutions, and 3) testing of solutions. Here, we present steps 2 and 3. In step 2, we presented previously identified issues and elicited creative solutions. In step 3, we obtained stakeholders’ feedback on the solutions from step 2, presented as care pathways.
Results
Suggested solutions included a multidisciplinary wellness centre, a mobile app, increased access to education, improved care coordination, increased support for general practitioners, and a better funding model. The revised care pathways featured accessible community resources, a tailored self-management and educational app, a care coordinator, a digital dashboard, and specialized support for primary care to deal with complex cases.
Conclusions
Using a participatory design, we successfully identified multiple innovative solutions with the potential to improve person-centred and integrated type 2 diabetes care in Australia. These solutions will inform the implementation and evaluation of a redesigned care model by our team.
{"title":"Working Together to Improve Type 2 Diabetes Care: A Participatory Design Project to Address Identified Needs of People With Diabetes and Their Health-care Professionals","authors":"Soraia de Camargo Catapan BPharm, MPhil, PhD , Carina Vasconcelos Silva MPH , Dominique Bird MD , Monika Janda MPhil, PhD , Len Gray MBBS, MMed, PhD , Lisbeth Maunder , Jane Clemensen RN, MSN, PhD , Anish Menon MBBS, PhD , Anthony Russell MBBS, PhD","doi":"10.1016/j.jcjd.2024.02.001","DOIUrl":"10.1016/j.jcjd.2024.02.001","url":null,"abstract":"<div><h3>Objectives</h3><p>Diabetes care in Australia is often fragmented and provider-centred, resulting in suboptimal care. Innovative solutions are needed to bridge the evidence–practice gap, and technology can facilitate the redesign of type 2 diabetes care. We used participatory design to increase the chances of fulfilling stakeholders’ needs. Using this method, we explored solutions aimed at redesigning diabetes care, focussing on the previously identified needs.</p></div><div><h3>Methods</h3><p>The participatory design project was guided by stakeholders’ contributions. Stakeholders of this project included people with type 2 diabetes, health-care professionals, technology developers, and researchers. Information uncovered at each step influenced the next: 1) identification of needs, 2) generation of solutions, and 3) testing of solutions. Here, we present steps 2 and 3. In step 2, we presented previously identified issues and elicited creative solutions. In step 3, we obtained stakeholders’ feedback on the solutions from step 2, presented as care pathways.</p></div><div><h3>Results</h3><p>Suggested solutions included a multidisciplinary wellness centre, a mobile app, increased access to education, improved care coordination, increased support for general practitioners, and a better funding model. The revised care pathways featured accessible community resources, a tailored self-management and educational app, a care coordinator, a digital dashboard, and specialized support for primary care to deal with complex cases.</p></div><div><h3>Conclusions</h3><p>Using a participatory design, we successfully identified multiple innovative solutions with the potential to improve person-centred and integrated type 2 diabetes care in Australia. These solutions will inform the implementation and evaluation of a redesigned care model by our team.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1499267124000388/pdfft?md5=6d2b4857deb5662d55b74e640bf1262f&pid=1-s2.0-S1499267124000388-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139747959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1016/j.jcjd.2024.01.007
Mario B. Prado Jr MD , Karen Joy B. Adiao MD
Objectives
Current medications for diabetic neuropathy (DN) recommended by the American Diabetes Association and American Academy of Neurology do not address the pathologic process of denervation among patients with DN, because ancillary treatments, such as reactive oxygen scavengers, may be needed. The purpose of this work was to summarize the available evidence about the efficacy and safety of alpha lipoic acid (ALA) and gamma linolenic acid (GLA) in the management of DN.
Methods
Using the search terms [(alpha lipoic acid or ALA or thioctic acid or thioctacid) or (gamma linolenic acid or GLA)] AND [(diabetes or diabetes mellitus) AND (polyneuropathy or neuropathy or sensorimotor polyneuropathy or radiculopathy)], 11 studies were included in this review and combined meta-analysis.
Results
Eight of the 11 articles (73%) reported significant benefit of ALA vs placebo. In the meta-analysis, the Total Symptom Score (TSS) for ALA 600 mg/day (ALA600) was 1.05 points lower (standard mean difference [SMD] −1.05, 95% confidence interval [CI] −2.07 to −0.04, p=0.04, I2=98.18%) compared with control at the end of the study. In the network meta-analysis, ALA600 (SMD −1.68, 95% CI −2.8 to −0.6) and GLA (SMD −2.39, 95% CI −4.3 to −0.5) had significantly lower TSSs compared with placebo. Moreover, GLA had the highest probability of being the best (52.7%) for improving DN symptoms. In all studies, most adverse events include gastrointestinal disturbances. In terms of tolerability, no differences were detected between ALA and control groups.
Conclusion
ALA and GLA appear to be safe and efficacious biofactors for improvement of DN symptoms.
{"title":"Ranking Alpha Lipoic Acid and Gamma Linolenic Acid in Terms of Efficacy and Safety in the Management of Adults With Diabetic Peripheral Neuropathy: A Systematic Review and Network Meta-analysis","authors":"Mario B. Prado Jr MD , Karen Joy B. Adiao MD","doi":"10.1016/j.jcjd.2024.01.007","DOIUrl":"10.1016/j.jcjd.2024.01.007","url":null,"abstract":"<div><h3>Objectives</h3><p>Current medications for diabetic neuropathy (DN) recommended by the American Diabetes Association and American Academy of Neurology do not address the pathologic process of denervation among patients with DN, because ancillary treatments, such as reactive oxygen scavengers, may be needed. The purpose of this work was to summarize the available evidence about the efficacy and safety of alpha lipoic acid (ALA) and gamma linolenic acid (GLA) in the management of DN.</p></div><div><h3>Methods</h3><p>Using the search terms [(alpha lipoic acid or ALA or thioctic acid or thioctacid) or (gamma linolenic acid or GLA)] AND [(diabetes or diabetes mellitus) AND (polyneuropathy or neuropathy or sensorimotor polyneuropathy or radiculopathy)], 11 studies were included in this review and combined meta-analysis.</p></div><div><h3>Results</h3><p>Eight of the 11 articles (73%) reported significant benefit of ALA vs placebo. In the meta-analysis, the Total Symptom Score (TSS) for ALA 600 mg/day (ALA600) was 1.05 points lower (standard mean difference [SMD] −1.05, 95% confidence interval [CI] −2.07 to −0.04, p=0.04, I<sup>2</sup>=98.18%) compared with control at the end of the study. In the network meta-analysis, ALA600 (SMD −1.68, 95% CI −2.8 to −0.6) and GLA (SMD −2.39, 95% CI −4.3 to −0.5) had significantly lower TSSs compared with placebo. Moreover, GLA had the highest probability of being the best (52.7%) for improving DN symptoms. In all studies, most adverse events include gastrointestinal disturbances. In terms of tolerability, no differences were detected between ALA and control groups.</p></div><div><h3>Conclusion</h3><p>ALA and GLA appear to be safe and efficacious biofactors for improvement of DN symptoms.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139581240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jcjd.2023.12.004
David C.W. Lau MD, PhD, FRCPC , Eileen Shaw MSc , Megan S. Farris MSc , Suzanne McMullen MHA , Saman Brar MSc , Tara Cowling MA, MSc , Satabdi Chatterjee PhD , Kobina Quansah MSc , Moe H. Kyaw PhD , Louis P. Girard MD, MSc
Objectives
Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM.
Methods
We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008–2009 and 2018–2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014–2015 to 2018–2019. Individuals with newly identified T2DM, ascertained between 2010–2011 and 2017–2018 with a lookback period between 2008–2009 and 2009–2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age.
Results
The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions.
Conclusions
We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.
{"title":"Prevalence of Adult Type 2 Diabetes Mellitus and Related Complications in Alberta, Canada: A Retrospective, Observational Study Using Administrative Data","authors":"David C.W. Lau MD, PhD, FRCPC , Eileen Shaw MSc , Megan S. Farris MSc , Suzanne McMullen MHA , Saman Brar MSc , Tara Cowling MA, MSc , Satabdi Chatterjee PhD , Kobina Quansah MSc , Moe H. Kyaw PhD , Louis P. Girard MD, MSc","doi":"10.1016/j.jcjd.2023.12.004","DOIUrl":"10.1016/j.jcjd.2023.12.004","url":null,"abstract":"<div><h3>Objectives</h3><p>Type 2 diabetes mellitus (T2DM) is a prevalent chronic disease and a leading cause of morbidity/mortality in Canada. We evaluated the burden of T2DM in Alberta, Canada, by estimating the 5-year period prevalence of T2DM and rates of comorbidities and complications/conditions after T2DM.</p></div><div><h3>Methods</h3><p>We conducted a population-based, retrospective study linking administrative health databases. Individuals with T2DM (≥18 years of age) were identified between 2008–2009 and 2018–2019 using a published algorithm, with follow-up data to March 2020. The 5-year period prevalence was estimated for 2014–2015 to 2018–2019. Individuals with newly identified T2DM, ascertained between 2010–2011 and 2017–2018 with a lookback period between 2008–2009 and 2009–2010 and a minimum 1 year of follow-up data, were evaluated for subsequent cardiovascular, diabetic, renal, and other complication/condition frequencies (%) and rates (per 100 person-years). Complications/conditions were stratified by atherosclerotic cardiovascular disease (ASCVD) status at index and age.</p></div><div><h3>Results</h3><p>The 5-year period prevalence of T2DM was 11,051 per 100,000 persons, with the highest prevalence in men 65 to <75 years of age. There were 195,102 individuals included in the cohort (mean age 56.7±14.7 years). The most frequently reported complications/conditions (rates per 100 person-years) were acute infection (23.10, 95% confidence interval [CI] 23.00 to 23.30), hypertension (17.30, 95% CI 16.80 to 17.70), and dyslipidemia (12.20, 95% CI 11.90 to 12.40). Individuals who had an ASCVD event/procedure and those ≥75 years of age had higher rates of complications/conditions.</p></div><div><h3>Conclusions</h3><p>We found that over half of the individuals had hypertension or infection after T2DM. Also, those with ASCVD had higher rates of complications/conditions. Strategies to mitigate complications/conditions after T2DM are required to reduce the burden of this disease on individuals and health-care systems.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1499267123007232/pdfft?md5=da8b3ee1d40a2a2b229789a6122fa1d5&pid=1-s2.0-S1499267123007232-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138826612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jcjd.2024.02.002
Terra Arnason MD, PhD, FRCPC, Kerry Mansell BSP, PharmD, MBA
{"title":"The Juncture of Diabetes, Cancer, and Observational Population-based Studies: Novel Insights From Canadian Provincial Health Records","authors":"Terra Arnason MD, PhD, FRCPC, Kerry Mansell BSP, PharmD, MBA","doi":"10.1016/j.jcjd.2024.02.002","DOIUrl":"10.1016/j.jcjd.2024.02.002","url":null,"abstract":"","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139927308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01DOI: 10.1016/j.jcjd.2023.12.007
Gurjot Gill MD , Vasily Giannakeas PhD , Stephanie Read PhD , Iliana C. Lega MD, MSc , Baiju R. Shah MD , Lorraine L. Lipscombe MD, MSc
Objectives
Diabetes is associated with an increased risk of several cancers, including postmenopausal breast cancer. The evidence for higher breast cancer risk after diabetes in pregnancy is conflicting. We compared the incidence of breast and other cancers between pregnant women with and without diabetes.
Methods
This work was a propensity-matched, retrospective cohort study using population-based health-care databases from Ontario, Canada. Those deliveries with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pregestational DM) were identified and matched to deliveries without diabetes mellitus (non-DM). Deliveries from each diabetes cohort were matched 1:2 on age, parity, year of delivery, and propensity score to non-DM deliveries. Matched subjects were followed from delivery for incidence of breast cancer as a primary outcome, and other site-specific cancers as secondary outcomes. We performed Cox proportional hazards regression to compare rates of breast cancer between matched groups.
Results
Over a median of 8 (interquartile range 4 to 13) years of follow-up, compared with non-DM deliveries, the incidence of breast cancer was significantly lower for GDM but similar for pregestational DM deliveries (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82 to 0.98; and HR 0.92, 95% CI 0.80 to 1.07, respectively). GDM was associated with a significantly higher incidence of pancreatic and hepatocellular cancer, and pregestational DM was associated with a higher incidence of thyroid, hepatocellular, and endometrial cancers.
Conclusions
Diabetes in pregnancy does not have a higher short-term risk of subsequent breast cancer, but there may be a higher incidence of other cancers.
{"title":"Risk of Breast Cancer After Diabetes in Pregnancy: A Population-based Cohort Study","authors":"Gurjot Gill MD , Vasily Giannakeas PhD , Stephanie Read PhD , Iliana C. Lega MD, MSc , Baiju R. Shah MD , Lorraine L. Lipscombe MD, MSc","doi":"10.1016/j.jcjd.2023.12.007","DOIUrl":"10.1016/j.jcjd.2023.12.007","url":null,"abstract":"<div><h3>Objectives</h3><p>Diabetes is associated with an increased risk of several cancers, including postmenopausal breast cancer. The evidence for higher breast cancer risk after diabetes in pregnancy is conflicting. We compared the incidence of breast and other cancers between pregnant women with and without diabetes.</p></div><div><h3>Methods</h3><p><span>This work was a propensity-matched, retrospective cohort study using population-based health-care databases from Ontario, Canada. Those deliveries with gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (pregestational DM) were identified and matched to deliveries without diabetes mellitus (non-DM). Deliveries from each diabetes cohort were matched 1:2 on age, parity, year of delivery, and propensity score to non-DM deliveries. Matched subjects were followed from delivery for incidence of breast cancer as a primary outcome, and other site-specific cancers as secondary outcomes. We performed Cox </span>proportional hazards regression to compare rates of breast cancer between matched groups.</p></div><div><h3>Results</h3><p>Over a median of 8 (interquartile range 4 to 13) years of follow-up, compared with non-DM deliveries, the incidence of breast cancer was significantly lower for GDM but similar for pregestational DM deliveries (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.82 to 0.98; and HR 0.92, 95% CI 0.80 to 1.07, respectively). GDM was associated with a significantly higher incidence of pancreatic and hepatocellular cancer, and pregestational DM was associated with a higher incidence of thyroid, hepatocellular, and endometrial cancers.</p></div><div><h3>Conclusions</h3><p>Diabetes in pregnancy does not have a higher short-term risk of subsequent breast cancer, but there may be a higher incidence of other cancers.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139065082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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