Journal articles on the topic 'Diabetes – Ontario – Toronto'
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1
Zinman, Bernard. "The International Diabetes Federation World Diabetes Congress 2015." US Endocrinology 11, no. 02 (2015): 104. http://dx.doi.org/10.17925/use.2015.11.02.104.
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Bernard Zinman, Programme Committee Chair of the International Diabetes Federation (IDF) World Diabetes Congress 2015, talks about the scientific programme highlights, the experience of attending the Congress and his involvement in diabetes care and research. Bernard Zinman is Director of the Leadership Sinai Centre for Diabetes and holds the Sam and Judy Pencer Family Chair in Diabetes Research at Mount Sinai Hospital and the University of Toronto, Canada. He is Professor of Medicine at the University of Toronto and Senior Scientist at the Samuel Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, Ontario, Canada.
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Chan, Justine, Margaret DeMelo, Jacqui Gingras, and Enza Gucciardi. "Challenges of Diabetes Self-Management in Adults Affected by Food Insecurity in a Large Urban Centre of Ontario, Canada." International Journal of Endocrinology 2015 (2015): 1–9. http://dx.doi.org/10.1155/2015/903468.
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Objective.To explore how food insecurity affects individuals’ ability to manage their diabetes, as narrated by participants living in a large, culturally diverse urban centre.Design.Qualitative study comprising of in-depth interviews, using a semistructured interview guide.Setting.Participants were recruited from the local community, three community health centres, and a community-based diabetes education centre servicing a low-income population in Toronto, Ontario, Canada.Participants.Twenty-one English-speaking adults with a diagnosis of diabetes and having experienced food insecurity in the past year (based on three screening questions).Method.Using six phases of analysis, we used qualitative, deductive thematic analysis to transcribe, code, and analyze participant interviews.Main Findings.Three themes emerged from our analysis of participants’ experiences of living with food insecurity and diabetes: (1) barriers to accessing and preparing food, (2) social isolation, and (3) enhancing agency and resilience.Conclusion.Food insecurity appears to negatively impact diabetes self-management. Healthcare professionals need to be cognizant of resources, skills, and supports appropriate for people with diabetes affected by food insecurity. Study findings suggest foci for enhancing diabetes self-management support.
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Syed, Muzammil H., Konrad Salata, Mohamad A. Hussain, Abdelrahman Zamzam, Charles de Mestral, Mark Wheatcroft, John Harlock, et al. "The economic burden of inpatient diabetic foot ulcers in Toronto, Canada." Vascular 28, no. 5 (May 7, 2020): 520–29. http://dx.doi.org/10.1177/1708538120923420.
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Objective Diabetic foot ulcer, which often leads to lower limb amputation, is a devastating complication of diabetes that is a major burden on patients and the healthcare system. The main objective of this study is to determine the economic burden of diabetic foot ulcer-related care. Methods We conducted a multicenter study of all diabetic foot ulcer patients admitted to general internal medicine wards at seven hospitals in the Greater Toronto Area, Canada from 2010 to 2015, using the GEMINI database. We compared the mean costs of care per patient for diabetic foot ulcer-related admissions, admissions for other diabetes-related complications, and admissions for the top five most costly general internal medicine conditions, using the Ontario Case Costing Initiative. Regression models were used to determine adjusted estimates of cost per patient. Propensity-score matched analyses were performed as sensitivity analyses. Results Our study cohort comprised of 557 diabetic foot ulcer patients; 2939 non-diabetic foot ulcer diabetes patients; and 23,656 patients with the top 5 most costly general internal medicine conditions. Diabetic foot ulcer admissions incurred the highest mean cost per patient ($22,754) when compared to admissions with non-diabetic foot ulcer diabetes ($8,350) and the top five most costly conditions ($10,169). Using adjusted linear regression, diabetic foot ulcer admissions demonstrated a 49.6% greater mean cost of care than non-diabetic foot ulcer-related diabetes admissions (95% CI 1.14–1.58), and a 25.6% greater mean cost than the top five most costly conditions (95% CI 1.17–1.34). Propensity-scored matched analyses confirmed these results. Conclusion Diabetic foot ulcer patients incur significantly higher costs of care when compared to admissions with non-diabetic foot ulcer-related diabetes patients, and the top five most costly general internal medicine conditions.
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Castanov, Valera, Xiya Ma, Adam Pietrobon, Alexander Levit, Danielle Weber-Adrian, Julieta Lazarte, Margaret Man-Ger Sun, et al. "Scientific Overview on CSCI-CITAC Annual General Meeting and 2018 Young Investigators’ Forum." Clinical and Investigative Medicine 42, no. 3 (September 29, 2019): E6—E13. http://dx.doi.org/10.25011/cim.v42i3.33087.
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The 2018 Annual General Meeting (AGM) and Young Investigators’ Forum (YIF) of the Canadian Society of Clinician Investigators (CSCI) and Clinician Investigator Trainee Association of Canada/Association des Cliniciens-Chercheurs en Formation du Canada (CITAC/ACCFC) was held in Toronto, Ontario on November 19–20, 2018, in conjunction with the University of
Toronto Clinician Investigator Program Research Day. The theme for the meeting was “Prepare for Success—Things to Master Now for Clinician Scientists in Training”; with lectures and workshops that were designed to provide knowledge and hands-on skills to navigate life as a clinician investigator. The opening remarks were by Jason Berman (President of CSCI), Josh Abraham (President of CITAC/ACCFC) and Nicola Jones (University of Toronto Clinician Investigator Symposium Chair). The keynote speakers were Dr. Ruth Ann Marrie (University of Manitoba), who received the Distinguished Scientist Award, Dr. Davinder Jassal (University of Manitoba), who received the CSCI-RCPSC Henry Friesen Award, and Dr. Aleixo Muise (University of Toronto), who received the Joe Doupe Young Investigator Award. Dr. Minna Woo (University of Toronto), Canada Research Chair in Diabetes Signal Transduction, delivered the keynote lecture “From Onion Cells to Single Cell Seq—A Constant Change in Lenses: A perspective of an evolving clinician scientist”.
The workshops, focusing on career development for clinician-scientists, were hosted by Drs. Robert Chen, Stephen Juvet, Lorraine Kalia, Phyllis Billia, Neil Goldenberg, Nicola Jones, Srdjanaa Filipovic, Jason Berman, Josh Abraham, Melanie Szweras, Joseph Ferenbok and Uri Tabori. The AGM also included presentations from clinician investigator trainees from across the country, and these abstracts are summarized in this review. Over 80 abstracts were showcased at this year’s meeting during the poster session, with six outstanding abstracts selected for oral presentations during the President’s Forum.
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Kornas, Kathy, Laura C. Rosella, Ghazal S. Fazli, and Gillian L. Booth. "Forecasting Diabetes Cases Prevented and Cost Savings Associated with Population Increases of Walking in the Greater Toronto and Hamilton Area, Canada." International Journal of Environmental Research and Public Health 18, no. 15 (July 31, 2021): 8127. http://dx.doi.org/10.3390/ijerph18158127.
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Promoting adequate levels of physical activity in the population is important for diabetes prevention. However, the scale needed to achieve tangible population benefits is unclear. We aimed to estimate the public health impact of increases in walking as a means of diabetes prevention and health care cost savings attributable to diabetes. We applied the validated Diabetes Population Risk Tool (DPoRT) to the 2015/16 Canadian Community Health Survey for adults aged 18–64, living in the Greater Toronto and Hamilton area, Ontario, Canada. DPoRT was used to generate three population-level scenarios involving increases in walking among individuals with low physical activity levels, low daily step counts and high dependency on non-active forms of travel, compared to a baseline scenario (no change in walking rates). We estimated number of diabetes cases prevented and health care costs saved in each scenario compared with the baseline. Each of the three scenarios predicted a considerable reduction in diabetes and related health care cost savings. In order of impact, the largest population benefits were predicted from targeting populations with low physical activity levels, low daily step counts, and non active transport use. Population increases of walking by 25 min each week was predicted to prevent up to 10.4 thousand diabetes cases and generate CAD 74.4 million in health care cost savings in 10 years. Diabetes reductions and cost savings were projected to be higher if increases of 150 min of walking per week could be achieved at the population-level (up to 54.3 thousand diabetes cases prevented and CAD 386.9 million in health care cost savings). Policy, programming, and community designs that achieve modest increases in population walking could translate to meaningful reductions in the diabetes burden and cost savings to the health care system.
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Finkelstein, Murray M., Kenneth R. Chapman, R. Andrew McIvor, and Malcolm R. Sears. "Mortality among Subjects with Chronic Obstructive Pulmonary Disease or Asthma at Two Respiratory Disease Clinics in Ontario." Canadian Respiratory Journal 18, no. 6 (2011): 327–32. http://dx.doi.org/10.1155/2011/539136.
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BACKGROUND: Chronic obstructive pulmonary disease (COPD) and asthma are common; however, mortality rates among individuals with these diseases are not well studied in North America.OBJECTIVE: To investigate mortality rates and risk factors for premature death among subjects with COPD.METHODS: Subjects were identified from the lung function testing databases of two academic respiratory disease clinics in Hamilton and Toronto, Ontario. Mortality was ascertained by linkage to the Ontario mortality registry between 1992 and 2002, inclusive. Standardized mortality ratios were computed. Poisson regression of standardized mortality ratios and proportional hazards regression were performed to examine the multivariate effect of risk factors on the standardized mortality ratios and mortality hazards.RESULTS: Compared with the Ontario population, all-cause mortality was approximately doubled among subjects with COPD, but was lower than expected among subjects with asthma. The risk of mortality in patients with COPD was related to cigarette smoking, to the presence of comorbid conditons of ischemic heart disease and diabetes, and to Global initiative for chronic Obstructive Lung Disease severity scores. Individuals living closer to traffic sources showed an elevated risk of death compared with those who lived further away from traffic sources.CONCLUSIONS: Mortality rates among subjects diagnosed with COPD were substantially elevated. There were several deaths attributed to asthma among subjects in the present study; however, overall, patients with asthma demonstrated lower mortality rates than the general population. Subjects with COPD need to be managed with attention devoted to both their respiratory disorders and related comorbidities.
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Kovacs, Kalman. "Fifth international conference of the pituitary pathologists' club, 17–22 September 1992, Toronto, and Hockley Valley Resort, Orangeville, Ontario, Canada." Trends in Endocrinology & Metabolism 4, no. 1 (January 1993): 33. http://dx.doi.org/10.1016/1043-2760(93)90061-i.
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Ezzat, Shereen, George Kontogeorgos, Donald A. Redelmeier, Eva Horvath, Alan G. Harris, and Kalman Kovacs. "In vivo responsiveness of morphological variants of growth hormone-producing pituitary adenomas to octreotide." European Journal of Endocrinology 133, no. 6 (December 1995): 686–90. http://dx.doi.org/10.1530/eje.0.1330686.
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Ezzat S, Kontogeorgos G, Redelmeier DA, Horvath E, Harris AG, Kovacs K. In vivo responsiveness of morphological variants of growth hormone-producing pituitary adenomas to octreotide. Eur J Endocrinol 1995;133:686–90. ISSN 0804–4643 The somatostatin analog, octreotide, is an inhibitor of growth hormone (GH) secretion that has been used to treat patients with GH-producing pituitary tumors. In this study we investigated the in vivo responsiveness to treatment with this analog in patients harboring different morphological types of GH-producing pituitary adenomas. Both GH and insulin-like growth factor I (IGF-I) plasma levels in 30 patients treated with octreotide (300 μg/day) for 4 months preoperatively were compared with those from 30 patients who did not receive treatment preoperatively. Tissue samples were studied using ultrastructural and immunohistochemical techniques. Amongst patients harboring densely granulated (DG) adenomas, mean GH levels were reduced to 32 ± 9% by octreotide, to 30 ± 7% by surgery and to 26 ± 9% of baseline by both interventions. Surgery was equally as effective in lowering GH levels in patients with sparsely granulated (SG) adenomas as it was in those with DG adenomas; in patients with SG adenomas, GH levels were reduced by surgery alone to 37 ± 16% and to 24 ± 15% when performed following octreotide pretreatment. In contrast, treatment with octreotide alone in patients harbouring SG adenomas reduced GH levels to only 70 ± 13% of baseline (p < 0.02 compared to surgery alone, or surgery and octreotide). We conclude that the GH inhibitory effects of octreotide are significantly better in patients harboring DG somatotroph adenomas compared with those harboring SG adenomas. Shereen Ezzat, University of Toronto-Wellesley Hospital, 160 Wellesley St East, Toronto, Ontario M4Y-1J3, Canada
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O’Neill, Braden, Sumeet Kalia, Babak Aliarzadeh, Frank Sullivan, Rahim Moineddin, Martina Kelly, and Michelle Greiver. "Cardiovascular risk factor documentation and management in primary care electronic medical records among people with schizophrenia in Ontario, Canada: retrospective cohort study." BMJ Open 10, no. 10 (October 2020): e038013. http://dx.doi.org/10.1136/bmjopen-2020-038013.
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ObjectivesIn order to address the substantial increased risk of cardiovascular disease among people with schizophrenia, it is necessary to identify the factors responsible for some of that increased risk. We analysed the extent to which these risk factors were documented in primary care electronic medical records (EMR), and compared their documentation by patient and provider characteristics.DesignRetrospective cohort study.SettingEMR database of the University of Toronto Practice-Based Research Network Data Safe Haven.Participants197 129 adults between 40 and 75 years of age; 4882 with schizophrenia and 192 427 without.Primary and secondary outcome measuresDocumentation of cardiovascular disease risk factors (age, sex, smoking history, presence of diabetes, blood pressure, whether a patient is currently on medication to reduce blood pressure, total cholesterol and high-density lipoprotein cholesterol).ResultsDocumentation of cardiovascular risk factors was more complete among people with schizophrenia (74.5% of whom had blood pressure documented at least once in the last 2 years vs 67.3% of those without, p>0.0001). Smoking status was not documented in 19.8% of those with schizophrenia and 20.8% of those without (p=0.0843). Factors associated with improved documentation included older patients (OR for ages 70–75 vs 45–49=3.51, 95% CI 3.26 to 3.78), male patients (OR=1.39, 95% CI 1.33 to 1.45), patients cared for by a female provider (OR=1.52, 95% CI 1.12 to 2.07) and increased number of encounters (OR for ≥10 visits vs 3–5 visits=1.53, 95% CI 1.46 to 1.60).ConclusionsDocumentation of cardiovascular risk factors was better among people with schizophrenia than without, although overall documentation was inadequate. Efforts to improve documentation of risk factors are warranted in order to facilitate improved management.
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Pal, Tuya, Florian D. Vogl, Pierre O. Chappuis, Richard Tsang, James Brierley, Helene Renard, Kevin Sanders, et al. "Increased Risk for Nonmedullary Thyroid Cancer in the First Degree Relatives of Prevalent Cases of Nonmedullary Thyroid Cancer: A Hospital-Based Study." Journal of Clinical Endocrinology & Metabolism 86, no. 11 (November 1, 2001): 5307–12. http://dx.doi.org/10.1210/jcem.86.11.8010.
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The genetic basis for nonmedullary forms of thyroid cancer (NMTC) is less well established than that of medullary thyroid cancer. However, epidemiological and family studies suggest that a proportion of NMTC may be due to inherited predisposition. To estimate the familial risk of thyroid cancer, we conducted a hospital-based case-control study at the Princess Margaret Hospital in Toronto, Ontario, Canada, and at 2 university hospitals in Montréal, Québec, Canada. We obtained pedigrees from 339 unselected patients diagnosed with NMTC and from 319 unaffected ethnically matched controls. Family histories of cancer were obtained from the cases and controls for 3292 first degree relatives of cases and controls. Seventeen cases (5.0%) and 2 controls (0.6%) reported at least one first degree relative with thyroid cancer. In relatives of patients with thyroid cancer, the incidence of any type of cancer (including NMTC) was 38% higher than in relatives of controls (incidence rate ratio, 1.4; 95% confidence interval, 1.1–1.7). The relative risk for thyroid cancer was 10-fold higher in relatives of cancer patients than in controls (incidence rate ratio, 10.3; 95% confidence interval, 2.2–47.6). Our findings suggest that hereditary or other familial factors are important in a small proportion of NMTC. Molecular studies are needed to determine the genetic basis of cancer susceptibility in these families.
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Hanley, Anthony J. G., Ravi Retnakaran, Ying Qi, Hertzel C. Gerstein, Bruce Perkins, Janet Raboud, Stewart B. Harris, and Bernard Zinman. "Association of Hematological Parameters with Insulin Resistance and β-Cell Dysfunction in Nondiabetic Subjects." Journal of Clinical Endocrinology & Metabolism 94, no. 10 (October 1, 2009): 3824–32. http://dx.doi.org/10.1210/jc.2009-0719.
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Objective: Previous studies reported independent associations of hematological parameters with risk of incident type 2 diabetes, although limited data are available on associations of these parameters with insulin resistance (IR) and (especially) pancreatic β-cell dysfunction in large epidemiological studies. Our objective was to evaluate the associations of hematological parameters, including hematocrit (HCT), hemoglobin (Hgb), red blood cell count (RBC), and white blood cell count with IR and β-cell dysfunction in a cohort of nondiabetic subjects at high metabolic risk. Methods: Nondiabetic subjects (n = 712) were recruited in Toronto and London, Ontario, Canada, between 2004 and 2006, based on the presence of one or more risk factors for type 2 diabetes mellitus including obesity, hypertension, a family history of diabetes, and/or a history of gestational diabetes. Fasting blood samples were collected and oral glucose tolerance tests administered, with additional samples for glucose and insulin drawn at 30 and 120 min. Measures of IR included the homeostasis model assessment (HOMA-IR) and Matsuda’s insulin sensitivity index, whereas measures of β-cell dysfunction included the insulinogenic index divided by HOMA-IR as well as the insulin secretion-sensitivity index-2. Associations of hematological parameters with IR and β-cell dysfunction were assessed using multiple linear regression and analysis of covariance with adjustments for age, gender, ethnicity, smoking, cardiovascular disease, systolic and diastolic blood pressure, and waist circumference. Results: HOMA-IR increased across quartiles of HCT, Hgb, RBC, and white blood cell count after adjustment for age, gender, ethnicity, and smoking (all P (trend) <0.0001). Similarly, there was a strong stepwise decrease in the Matsuda’s insulin sensitivity index across increasing quartiles of these hematological measures (all P (trend) <0.0001). The associations remained significant after further adjustment for previous cardiovascular disease, blood pressure, and waist circumference (all P (trend) <0.0001). Similarly, there was a strong pattern of decreasing β-cell function across increasing quartiles of all hematological patterns (all P (trend) <0.0001). The findings for HCT, Hgb, and RBC were attenuated slightly after full multivariate adjustment, although the trend across quartiles remained highly significant. Conclusion: These findings suggest that standard, clinically relevant hematological variables may be related to the underlying pathophysiological changes associated with type 2 diabetes mellitus. In a large sample of non-diabetic subjects with metabolic risk factors, hematological parameters were significantly associated with insulin sensitivity and β-cell dysfunction, the main physiological disorders underlying type 2 diabetes.
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Greiver, Michelle, Kimberly Wintemute, Babak Aliarzadeh, Ken Martin, Shahriar Khan, Dave Jackson, Jannet Leggett, Anita Lambert-Lanning, and Maggie Siu. "Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study." Journal of Innovation in Health Informatics 23, no. 3 (October 12, 2016): 580. http://dx.doi.org/10.14236/jhi.v23i3.843.
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Background Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.Methods Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.Results Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%–8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%–9.5%, p < 0.01).Conclusions Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.
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Kayaniyil, Sheena, Reinhold Vieth, Stewart B. Harris, Ravi Retnakaran, Julia A. Knight, Hertzel C. Gerstein, Bruce A. Perkins, Bernard Zinman, and Anthony J. Hanley. "Association of 25(OH)D and PTH with Metabolic Syndrome and Its Traditional and Nontraditional Components." Journal of Clinical Endocrinology & Metabolism 96, no. 1 (January 1, 2011): 168–75. http://dx.doi.org/10.1210/jc.2010-1439.
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Context: Emerging evidence suggests that 25-hydroxy vitamin D [25(OH)D] and PTH may play a role in the etiology of the metabolic syndrome (MetS). However, evidence to date is limited and inconsistent, and few studies have examined associations with nontraditional MetS components. Objective: The objective of the study was to examine the association of vitamin D and PTH with MetS and its traditional and nontraditional components in a large multiethnic sample. Design, Setting, and Participants: In this cross-sectional study, we examined 654 participants from London and Toronto, Ontario, Canada, aged 30 yr and older with risk factors for type 2 diabetes. Main Outcome Measures: Presence of MetS and its traditional and nontraditional components was measured. Results: Approximately 43% of the study participants were classified as having MetS. Higher 25(OH)D was significantly associated with a reduced presence of MetS after adjustment for age, sex, season, ethnicity, supplement use, physical activity, and PTH (odds ratio 0.76, 95% confidence interval 0.62–0.93). PTH was not associated with the presence of MetS after multivariate adjustment. Multivariate linear regression analyses indicated significant adjusted inverse associations of 25(OH)D with waist circumference, triglyceride level, fasting insulin, and alanine transaminase (P < 0.041). Elevated PTH was positively associated with waist circumference and high-density lipoprotein cholesterol (P < 0.04). Other associations between PTH and MetS components were attenuated after adjustment for adiposity. Conclusions: Serum 25(OH)D, but not PTH, was significantly associated with MetS as well as a number of MetS components after multivariate adjustment. These results suggest that low 25(OH)D may play a role in the etiology of the MetS.
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Wells, Greg D., Clodagh S. O'Gorman, Tammy Rayner, Jessica Caterini, Sara Thompson, Tim Bradley, and Jill Hamilton. "Skeletal Muscle Abnormalities in Girls and Adolescents With Turner Syndrome." Journal of Clinical Endocrinology & Metabolism 98, no. 6 (June 1, 2013): 2521–27. http://dx.doi.org/10.1210/jc.2012-4016.
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Context: Turner syndrome (TS) is a chromosomal disorder occurring in approximately 1 in 2500 live births. Individuals with TS report lower levels of physical activity than healthy control (HC) subjects. Cardiorespiratory limitations may contribute to the observed reduction in physical activity. Objective: The objective of this study was to compare muscle metabolism of patients with TS vs HC subjects before and after exercise using exercise testing, magnetic resonance imaging, and magnetic resonance spectroscopy techniques. Design: We hypothesized that girls and adolescents with TS would have muscle metabolic abnormalities not present in the HC population. Setting: The research was conducted at the Hospital for Sick Children in Toronto, Ontario, Canada. Participants: Fifteen participants with TS were age-, activity-, and body mass index Z-score–matched with 16 HC subjects. Main Outcome Measures: 31P magnetic resonance spectroscopy was used to characterize muscle metabolism at rest and after 30 seconds of high-intensity exercise, 60 seconds of moderate-intensity exercise, and 5 minutes of low-intensity exercise. Results: While achieving the same workloads, participants with TS exhibited a greater difference between rest and end-exercise pH compared with HC subjects after 30 seconds (TS, 0.29 ± 0.04; HC, 0.21 ± 0.08; P = .03) and 90 seconds (TS, 0.47 ± 0.22; HC, 0.32 ± 0.13; P = .02) of exercise. During the 5-minute exercise test, similar workloads were achieved between groups; however, ATP production was greater in participants with TS vs the HC subjects via all 3 bioenergetic pathways (total ATP: TS, 0.90 ± 0.34; HC, 0.60 ± 0.25; P = .01). Conclusions: The results of this study suggest that patients with TS exhibit greater anaerobic stress during exercise than HC subjects, which may lead to symptoms of increased muscle fatigue with short bursts of activity. Recovery metabolism after exercise appears to be similar between participants with TS and HC subjects, which is suggestive of normal mitochondrial metabolism and oxygen transport.
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Rosenfeld, Louis. "Insulin: Discovery and Controversy." Clinical Chemistry 48, no. 12 (December 1, 2002): 2270–88. http://dx.doi.org/10.1093/clinchem/48.12.2270.
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Abstract During the first two decades of the 20th century, several investigators prepared extracts of pancreas that were often successful in lowering blood sugar and reducing glycosuria in test animals. However, they were unable to remove impurities, and toxic reactions prevented its use in humans with diabetes. In the spring of 1921, Frederick G. Banting, a young Ontario orthopedic surgeon, was given laboratory space by J.J.R. Macleod, the head of physiology at the University of Toronto, to investigate the function of the pancreatic islets. A student assistant, Charles Best, and an allotment of dogs were provided to test Banting’s hypothesis that ligation of the pancreatic ducts before extraction of the pancreas, destroys the enzyme-secreting parts, whereas the islets of Langerhans, which were believed to produce an internal secretion regulating sugar metabolism, remained intact. He believed that earlier failures were attributable to the destructive action of trypsin. The name “insuline” had been introduced in 1909 for this hypothetic substance. Their experiments produced an extract of pancreas that reduced the hyperglycemia and glycosuria in dogs made diabetic by the removal of their pancreases. They next developed a procedure for extraction from the entire pancreas without the need for duct ligation. This extract, now made from whole beef pancreas, was successful for treating humans with diabetes. Facilitating their success was a development in clinical chemistry that allowed blood sugar to be frequently and accurately determined in small volumes of blood. Success with purification was largely the work of J.B. Collip. Yield and standardization were improved by cooperation with Eli Lilly and Company. When the Nobel Prize was awarded to Banting and Macleod for the discovery of insulin, it aggravated the contentious relationship that had developed between them during the course of the investigation. Banting was outraged that Macleod and not Best had been selected, and he briefly threatened to refuse the award. He immediately announced that he was giving one-half of his share of the prize money to Best and publicly acknowledged Best’s contribution to the discovery of insulin. Macleod followed suit and gave one-half of his money award to Collip. Years later, the official history of the Nobel Committee admitted that Best should have been awarded a share of the prize.
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Schauf, C. L. "Hommage à Edward Alexander Sellers, M.D., Ph.D." Canadian Journal of Physiology and Pharmacology 65, no. 6 (June 1, 1987): 1241. http://dx.doi.org/10.1139/y87-197.
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Les vingt-trois articles suivants de ce numéro du Journal canadien de physiologie et pharmacologie sont dédiés à la mémoire d'un grand Canadien qui a consacré sa vie et son travail d'abord à ses hommes dans la Marine royale du Canada puis à ses patients, ses étudiants, ses collègues et ses concitoyens.Edward Alexander Sellers, physicien, scientifique, administrateur, humaniste et philanthrope, est né le 14 septembre 1916 à Winnipeg au Manitoba, et fit ses études au Collège Ridley à St. Catherines en Ontario, ainsi qu'à l'Université du Manitoba (M.D., 1939). Il s'engaga ensuite dans la Marine royale du Canada à titre de médecin. Pendant la guerre, il se consacra à la pratique médicale et à la recherche. C'est à cette époque que naquit la longue amitié qui le lia à Charles H. Best.En 1945, Ed se joignit au personnel enseignant de l'Université de Toronto où il occupa les postes de professeur de physiologie, de professeur et directeur du Département de pharmacologie et de vice-doyen (sciences fondamentales) du Département de médecine. Il fut également membre du sénat et du conseil d'administration.C'est alors qu'il était médecin dans la Marine que s'éveilla chez lui l'intérêt qu'il porta toujours aux relations entre l'homme et son environnement. Les problèmes rencontrés dans l'exploration des terres et mers arctiques, la lutte pour la survie et l'adaptation aux conditions de vie dans ces régions confirmèrent cet intérêt. Il contribua au travail du Conseil de recherches de la Défense du Canada et fut le directeur des laboratoires de recherches médicales du ministère de la Défense de 1955 à 1958, tout en maintenant son affiliation à l'Université de Toronto. Au cours de sa carrière, c'est à partir de problèmes médicaux pratiques non résolus qu'il élabora ses projets de recherches biomédicales.La recherche productive ne fut qu'une des nombreuses réalisations de Ed. Sa plus remarquable contribution au progrès de la recherche fut son travail sur la thermogenèse sans frisson. Une grande partie de la physiologie thermique moderne est fondée sur les résultats de ces études. Ed a suivi trois avenues de recherche distinctes : l'étude de l'acclimatation (principalement chez les rongeurs), avec un intérêt soutenu pour les aspects mécanistes, particulièrement le rôle du système nerveux sympathique; l'étude de la fonction thyroïdienne; et la recherche pharmacologique générale. Ed a créé le "Toronto Thyroid Group," un groupe interdisciplinaire qui se réunissait fréquemment et dont les travaux réalisé en collaboration ont donné lieu à de nombreuses publications pour ses étudiants et ses confrères. L'un deux écrivit : "Lorsque j'avais besoin d'un professeur, il était là, lorsque j'avais besoin d'un conseiller, il était là, et lorsque j'avais besoin d'un père, il était encore là." L'Université de Toronto demanda à Ed d'occuper diverses fonctions administratives. Ed avait un faible pour le Collège Innis qu'il avait aidé à fonder. Il fut le premier président de son conseil d'administration. Il travailla en outre avec autant d'enthousiasme à l'élaboration d'un nouveau programme de médecine qui fut introduit en 1968.L'influence de Ed dépassa de loin le milieu universitaire. Il fut actif dans plusieurs sociétés et comités professionnels et contribua à l'avancement de la recherche médicale au Canada. Ses nombreuses tâches d'administrateur ne l'empêchèrent pas d'être toujours à l'écoute des autres et de prodiquer des conseils et des avis judicieux. Ed était un homme de jugement qui pouvait présenter ses idées de façon claire et pondérée. Ses opinions inspiraient confiance et furent toujours très respectées.Après le décès de Charles H. Best, Ed contribua à la fondation du "Banting and Best Diabetes Centre" de l'Université de Toronto et devint président des comités consultatif et exécutif de cet organisme.Une longue maladie ne l'empêcha pas de consacrer une grande partie de son temps à ce centre, jusqu'à ce qu'une mort prématurée mette fin à ses activités le 28 août 1985. Par son exemple personnel et sa capacité d'inspirer autrui, il donna un sens et un but aux efforts de plusieurs. Pour cette raison, il occupe une place particulière dans la vie de chacun de nous.Les participants, les organisateurs et les éditeurs de ce symposium remercient le Conseil national de recherches du Canada de leur avoir permis d'exprimer leur reconnaissance. Les éditeurs remercient les nombreux amis de Ed de leur collaboration. Nous dédions ce numéro spécial du Journal canadien de physiologie et pharmacologie à la mémoire d'Edward Alexander Sellers.
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Nazarali, Samina, Cal H. Robinson, Farah Khan, Tayler Pocsai, Dipika Desai, Russell J. De Souza, Girish Bhatt, et al. "Deriving Normative Data on 24-Hour Ambulatory Blood Pressure Monitoring for South Asian Children (ASHA): A Clinical Research Protocol." Canadian Journal of Kidney Health and Disease 9 (January 2022): 205435812110723. http://dx.doi.org/10.1177/20543581211072329.
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Background: The global prevalence of hypertension in children and adolescents has increased over the past 2 decades and is the strongest predictor of adult hypertension. South Asians have an increased prevalence of metabolic syndrome associated risk factors including abdominal obesity, diabetes, and hypertension. All these factors contribute to their increased cardiovascular disease burden. Accurate and early identification of hypertension in South Asian children is a necessary aspect of cardiovascular disease prevention. Ambulatory blood pressure monitoring (ABPM) is considered the gold-standard for pediatric blood pressure (BP) measurement. However, its utilization is limited due to the lack of validated normative reference data in diverse, multiethnic pediatric populations. Objective: The primary objective is to establish normative height-sex and age-sex-specific reference values for 24-h ABPM measurements among South Asian children and adolescents (aged 5-17 years) in Ontario and British Columbia, Canada. Secondary objectives are to evaluate differences in ABPM measurements by body mass index classification, to compare our normative data against pre-existing data from German and Hong Kong cohorts, and to evaluate relationships between habitual movement behaviors, diet quality, and ABPM measurements. Design: Cross-sectional study, quasi-representative sample. Setting: Participants will be recruited from schools, community centers, and places of worship in Southern Ontario (Greater Toronto and Hamilton area, including the Peel Region) and Greater Vancouver, British Columbia. Participants: We aim to recruit 2113 nonoverweight children (aged 5-17 years) for the primary objective. We aim to recruit an additional 633 overweight or obese children to address the secondary objectives. Measurements: Ambulatory BP monitoring measurements will be obtained using Spacelabs 90217 ABPM devices, which are validated for pediatric use. The ActiGraph GT3X-BT accelerometer, which has also been validated for pediatric use, will be used to obtain movement behavior data. Methods: Following recruitment, eligible children will be fitted with 24-h ABPM and physical activity monitors. Body anthropometrics and questionnaire data regarding medical and family history, medications, diet, physical activity, and substance use will be collected. Ambulatory BP monitoring data will be used to develop height-sex- and age-sex-specific normative reference values for South Asian children. Secondary objectives include evaluating differences in ABPM measures between normal weight, overweight and obese children; and comparing our South Asian ABPM data to existing German and Hong Kong data. We will also use compositional data analysis to evaluate associations between a child’s habitual movement behaviors and ABPM measures. Limitations: Bloodwork will not be performed to facilitate recruitment. A non-South Asian comparator cohort will not be included due to feasibility concerns. Using a convenience sampling approach introduces the potential for selection bias. Conclusions: Ambulatory BP monitoring is a valuable tool for the identification and follow-up of pediatric hypertension and overcomes many of the limitations of office-based BP measurement. The development of normative ABPM data specific to South Asian children will increase the accuracy of BP measurement and hypertension identification in this at-risk population, providing an additional strategy for primary prevention of cardiovascular disease.
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Ware, Patrick, Amika Shah, Heather Joan Ross, Alexander Gordon Logan, Phillip Segal, Joseph Antony Cafazzo, Katarzyna Szacun-Shimizu, Myles Resnick, Tessy Vattaparambil, and Emily Seto. "Challenges of Telemonitoring Programs for Complex Chronic Conditions: Randomized Controlled Trial With an Embedded Qualitative Study." Journal of Medical Internet Research 24, no. 1 (January 26, 2022): e31754. http://dx.doi.org/10.2196/31754.
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Background Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on telemonitoring for this population. Objective This randomized controlled trial and embedded qualitative study aims to evaluate the impact on and experiences of patients and health care providers (HCPs) using a telemonitoring system with decision support to manage patients with complex conditions, including those with multiple chronic conditions, compared with the standard of care. Methods A pragmatic, unblinded, 6-month randomized controlled trial sought to recruit 146 patients with ≥1 diagnosis of heart failure (HF), uncontrolled hypertension (HT), and insulin-requiring diabetes mellitus (DM) from outpatient specialty settings in Toronto, Ontario, Canada. Participants were randomized into the control and telemonitoring groups, with the latter being instructed to take readings relevant to their conditions. The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status (36-Item Short Form Health Survey questionnaire). Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported health service use. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group was interviewed about their experiences. Results A total of 96 patients were recruited and randomized. Recruitment was terminated early because of implementation challenges and the onset of the COVID-19 pandemic. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of patients with HF found improvements in self-care maintenance (P=.04) and physical quality of life (P=.046). Opinions expressed by the 5 HCPs and 13 patients who were interviewed differed based on the monitored conditions. Although patients with HF reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care and the design of the decision support, whereby fluctuations in the status of HT and DM typically required less urgent interventions compared with patients with HF. Conclusions We recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary but not sufficient components of such programs for patients with complex conditions and lower acuity. We conclude that telemonitoring for patients with complex conditions or within multidisciplinary care settings may be best operationalized through nurse-led models of care. Trial Registration ClinicalTrials.gov NCT03127852; https://clinicaltrials.gov/ct2/show/NCT03127852 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.8367
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Avery, Lisa, Raglan Maddox, Robert Abtan, Octavia Wong, Nooshin Khobzi Rotondi, Stephanie McConkey, Cheryllee Bourgeois, et al. "Modelling prevalent cardiovascular disease in an urban Indigenous population." Canadian Journal of Public Health, August 9, 2022. http://dx.doi.org/10.17269/s41997-022-00669-x.
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Abstract Objective Studies have highlighted the inequities between the Indigenous and non-Indigenous populations with respect to the burden of cardiovascular disease and prevalence of predisposing risks resulting from historical and ongoing impacts of colonization. The objective of this study was to investigate factors associated with cardiovascular disease (CVD) within and specific to the Indigenous peoples living in Toronto, Ontario, and to evaluate the reliability and validity of the resulting model in a similar population. Methods The Our Health Counts Toronto study measured the baseline health of Indigenous community members living in Toronto, Canada, using respondent-driven sampling. An iterative approach, valuing information from the literature, clinical insight and Indigenous lived experiences, as well as statistical measures was used to evaluate candidate predictors of CVD (self-reported experience of discrimination, ethnic identity, health conditions, income, education, age, gender and body size) prior to multivariable modelling. The resulting model was then validated using a distinct, geographically similar sample of Indigenous people living in Hamilton, Ontario, Canada. Results The multivariable model of risk factors associated with prevalent CVD included age, diabetes, hypertension, body mass index and exposure to discrimination. The combined presence of diabetes and hypertension was associated with a greater risk of CVD relative to those with either condition and was the strongest predictor of CVD. Those who reported previous experiences of discrimination were also more likely to have CVD. Further study is needed to determine the effect of body size on risk of CVD in the urban Indigenous population. The final model had good discriminative ability and adequate calibration when applied to the Hamilton sample. Conclusion Our modelling identified hypertension, diabetes and exposure to discrimination as factors associated with cardiovascular disease. Discrimination is a modifiable exposure that must be addressed to improve cardiovascular health among Indigenous populations.
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Shin, Saeha, Li Bai, Tor H. Oiamo, Richard T. Burnett, Scott Weichenthal, Michael Jerrett, Jeffrey C. Kwong, et al. "Association Between Road Traffic Noise and Incidence of Diabetes Mellitus and Hypertension in Toronto, Canada: A Population‐Based Cohort Study." Journal of the American Heart Association 9, no. 6 (March 17, 2020). http://dx.doi.org/10.1161/jaha.119.013021.
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Background Exposure to road traffic noise has been linked to cardiometabolic complications, such as elevated blood pressure and glucose dysregulation. However, epidemiologic evidence linking road traffic noise to diabetes mellitus and hypertension remains scarce. We examined associations between road traffic noise and the incidence of diabetes mellitus and hypertension in Toronto, Canada. Methods and Results Using the Ontario Population Health and Environment Cohort, we conducted a retrospective, population‐based cohort study of long‐term residents of Toronto, aged 35 to 100 years, who were registered for provincial publicly funded health insurance, and were without a history of hypertension (n=701 174) or diabetes mellitus (n=914 607). Road traffic noise exposure levels were assessed by the equivalent continuous A‐weighted sound pressure level (dBA) for the 24‐hour day and the equivalent continuous A‐weighted sound pressure level for the night (11 pm –7 am) . Noise exposures were assigned to subjects according to their annual residential postal codes during the 15‐year follow‐up. We used random‐effect Cox proportional hazards models adjusting for personal and area‐level characteristics. From 2001 to 2015, each interquartile range increase in the equivalent continuous A‐weighted sound pressure level (dBA) for the 24‐hour day (10.0 dBA) was associated with an 8% increase in incident diabetes mellitus (95% CI, 1.07–1.09) and a 2% increase in hypertension (95% CI, 1.01–1.03). We obtained similar estimates with the equivalent continuous A‐weighted sound pressure level for the night (11 pm –7 am) . These results were robust to all sensitivity analyses conducted, including further adjusting for traffic‐related air pollutants (ultrafine particles and nitrogen dioxide). For both hypertension and diabetes mellitus, we observed stronger associations with the equivalent continuous A‐weighted sound pressure level (dBA) for the 24‐hour day among women and younger adults (aged <60 years). Conclusions Long‐term exposure to road traffic noise was associated with an increased incidence of diabetes mellitus and hypertension in Toronto.
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Gucciardi, Enza, Erica Reynolds, Grace Karam, Heather Beanlands, Souraya Sidani, and Sherry Espin. "Group-based storytelling in disease self-management among people with diabetes." Chronic Illness, July 2, 2019, 174239531985939. http://dx.doi.org/10.1177/1742395319859395.
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ObjectiveWe explored the underlying mechanisms by which storytelling can promote disease self-management among people with type 2 diabetes.MethodsTwo, eight-session storytelling interventions were delivered to a total of eight adults with type 2 diabetes at a community health center in Toronto, Ontario. Each week, participants shared stories about diabetes self-management topics of their choice. Using a qualitative descriptive approach, transcripts from each session and focus groups conducted during and following the intervention were coded and analyzed using NVivo software. Through content analysis, we identified categories that describe processes and benefits of the intervention that may contribute to and support diabetes self-management.ResultsOur analysis suggests that storytelling facilitates knowledge exchange, collaborative learning, reflection, and making meaning of one’s disease. These processes, in turn, could potentially build a sense of community that facilitates peer support, empowerment, and active engagement in disease self-management.ConclusionVenues that offer patients opportunities to speak of their illness management experiences are currently limited in our healthcare systems. In conjunction with traditional diabetes self-management education, storytelling can support several core aspects of diabetes self-management. Our findings could guide the design and/or evaluation of future story-based interventions.
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de Leiva-Hidalgo, Alberto, and Alejandra de Leiva-Pérez. "On the occasion of the centennial of insulin therapy (1922–2022), II-Organotherapy of diabetes mellitus (1906–1923): Acomatol. Pancreina. Insulin." Acta Diabetologica, December 31, 2022. http://dx.doi.org/10.1007/s00592-022-02014-7.
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Abstract Aims The general objective has been the historiographical investigation of the organotherapy of diabetes mellitus between 1906 and 1923 in its scientific, social and political dimensions, with special emphasis on the most relevant contributions of researchers and institutions and on the controversies generated on the priority of the "discovery" of antidiabetic hormone. Methods We have analyzed the experimental procedures and determination of biological parameters used by researchers during the investigated period (1906–1923): pancreatic ablation techniques, induction of acinar atrophy with preservation of pancreatic islets, preparation of pancreatic extracts (PE) with antidiabetic activity, clinical chemistry procedures (glycemia, glycosuria, ketonemia, ketonuria, etc.). The field investigation has included on-site and online visits to cities, towns, buildings, laboratories, universities, museums and research centers where the reported events took place, obtaining documents, photographic images, audiovisual recordings, as well as personal interviews complementary to the documentation consulted (primary sources, critical bibliography, reference works). The documentary archival sources have been classified according to theme, including those consulted in situ with those extracted online and digitized copies received mainly by email. Among the many archives contacted, those listed below have been most useful and have been consulted on site and on repeated visits: National Library of Medicine-Historical Archives (Bethesda, MD, USA); Archives, University of Toronto and Thomas Fisher Rare Books Library (Toronto, Ontario, Canada); Francis A. County Library of Medicine, Harvard University (Boston, Mass, USA); Zentralbibliothek der Humboldt-Universität (Berlin, DE), Geheimarchiv des Preuβischen Staates (Berlin, DE); Landesamt für Bürger—und Ordnungsangelegenheiten (LABO) (Berlin, DE); Arhivele Academiei Române şi Universitǎții Carol Davila (Bucharest, RO). Main results and conclusions A) The European researchers Zülzer (Z Exp Path Ther 23:307–318, 1908) and Paulescu (CR Seances Soc Biol Fil 85:558, 1921) meet the requirements of the priority rule in the discovery of the antidiabetic hormone. B) Factors of socioeconomic and political nature related with the First World War and the inter-war period delayed the process of purification of the antidiabetic hormone in Europe. C) The Canadian scientist J. Collip, University of Alberta, temporarily assimilated to the University of Toronto, and the American chemist and researcher G. Walden, with the expert collaboration of Eli Lilly & Co., were the main authors of the purification process of the antidiabetic hormone. D) The scientific evidence, reflected in the heuristics of this research, allows to assert that the basic investigation carried out by the Department of Physiology of the University of Toronto, directed by the Scottish J. Macleod, in conjunction with the clinical research undertaken by the Department of Medicine of the University of Toronto (W. Campbell, A. Fletcher, D. Graham) made it possible in record time the successful treatment of patients with what was until then a deadly disease.
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Bruno, Brigida A., Karen Guirguis, David Rofaiel, and Catherine H. Yu. "Is Sociodemographic Status Associated with Empathic Communication and Decision Quality in Diabetes Care?" Journal of General Internal Medicine, January 1, 2022. http://dx.doi.org/10.1007/s11606-021-07230-5.
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Abstract Objective To assess the relationship between empathic communication, shared decision-making, and patient sociodemographic factors of income, education, and ethnicity in patients with diabetes. Research Design and Methods This was a cross-sectional study from five primary care practices in the Greater Toronto Area, Ontario, Canada, participating in a randomized controlled trial of a diabetes goal setting and shared decision-making plan. Participants included 30 patients with diabetes and 23 clinicians (physicians, nurses, dietitians, and pharmacists), with a sample size of 48 clinical encounters. Clinical encounter audiotapes were coded using the Empathic Communication Coding System (ECCS) and Decision Support Analysis Tool (DSAT-10). Results The most frequent empathic responses among encounters were “acknowledgement with pursuit” (28.9%) and “confirmation” (30.0%). The most frequently assessed DSAT components were “stage” (86%) and knowledge of options (82.0%). ECCS varied by education (p=0.030) and ethnicity (p=0.03), but not income. Patients with only a college degree received more empathic communication than patients with bachelor’s degrees or more, and South Asian patients received less empathic communication than Asian patients. DSAT varied with ethnicity (p=0.07) but not education or income. White patients experienced more shared decision-making than those in the “other” category. Conclusions We identified a new relationship between ECCS, education and ethnicity, as well as DSAT and ethnicity. Limitations include sample size, heterogeneity of encounters, and predominant white ethnicity. These associations may be evidence of systemic biases in healthcare, with hidden roots in medical education.
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Rajeswaran, Vamana, Lisa Alexander, Raad Alwithenani, Diana Jaskolka, Shirine Usmani, Susan Tran, Sarah Khan, Paul Yip, and Geetha Mukerji. "MON-118 Reducing Unnecessary Repeat HbA1c Testing in a Tertiary Academic Hospital." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.1779.
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Abstract Background Glycated hemoglobin (HbA1c) is a surrogate marker of glycemia over the preceding three months, where the last 30 days contributes to 50% of the value (1). Therefore guidelines often recommend repeating HbA1c only after 3 months in most situations (2), but repeat testing of HbA1c is often conducted earlier when not warranted (3). We aimed to conduct a Quality Improvement (QI) initiative to reduce unnecessary repeat testing of HbA1c at a large tertiary care academic hospital in Toronto, Ontario by 50% by May 2020. Methods: The Model for Improvement Quality Improvement (QI) framework was used in the design of the QI project to reduce repeat HbA1c. Problem characterization was conducted to understand root causes and iterative Plan-Do-Study-Act cycles were used to develop a change intervention. Unnecessary HbA1c tests were the primary outcome and defined as repeat HbA1c testing within 60 days; the top three specialities that ordered unnecessary HbA1c tests were targeted for education prior to implementation of the change intervention. Results: Baseline data on all HbA1c tests in 2018 revealed repeat testing in approximately 10% of 15,290 HbA1c tests, with estimated potential savings of more than $11,000 based on the provincial reimbursement rate. The top 3 ordering specialities targeted for education included Nephrology (n=410 repeat HbA1c tests), Cardiology (n=246 repeat HbA1c tests), and Endocrinology (n=136 repeat HbA1C tests). Root cause analysis revealed that providers often ordered repeat HbA1c tests due to being unaware of prior results and a knowledge gap of testing recommendations. A laboratory forced function will be implemented on December 1, 2019 to cancel any repeat HbA1c tests within 60 days and calls to the lab to add HbA1c testing will be tracked. Conclusions: Repeat HbA1c testing is frequent in hospital settings and can be an important target for QI efforts. A forced function to cancel processing of repeat HbA1c may be an appropriate QI intervention to reduce repeat testing to promote high-value care. Ongoing data analysis will be conducted to assess the impact of this intervention. References (1) Goldstein DE, Little RR, Lorenz RA, Malone JI, Nathan D, Peterson CM, Sacks DB. Tests of Glycemia in Diabetes. Diabetes Care 2004;27(7): 1761-1773. (2) Berard LD, Siemens R, Woo V. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Monitoring Glycemic Control. Can J Diabetes 2018;42(Suppl 1):S47-S53. (3) Chami N, Simons JE, Sweetman A, Don-Wauchope AC. Rates of inappropriate laboratory test utilization in Ontario. Clinical Biochemistry 2017;50: 822-827.
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Abbas, Minan, Denice Feig, and Geetha Mukerji. "SUN-636 Gaps in Quality of Delivery of Post-Partum Care in Preconception Counselling for Pregnant Women with Pre-Existing Diabetes at a Large Academic Tertiary Centre." Journal of the Endocrine Society 4, Supplement_1 (April 2020). http://dx.doi.org/10.1210/jendso/bvaa046.1500.
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Abstract BACKGROUND: Women with pre-existing diabetes are at increased risk of serious adverse pregnancy outcomes compared with the general maternity population including congenital anomaly, stillbirth and neonatal death. The 2018 Diabetes Canada Clinical Practice Guidelines (DC CPG) on Diabetes in Pregnancy recommend that women with pre-existing diabetes are provided with postpartum and preconception counseling by their diabetes healthcare team, as this is associated with improved maternal and fetal outcomes. OBJECTIVE: To evaluate the quality of physican counselling of post-partum management and pre conception advice for women with pre-existing diabetes who receive their intrapartum care at Mount Sinai Hospital Diabetes in Pregnancy Clinic in Toronto Ontario. METHODS: Eligible patients were pregnant women with pre-existing Type 1 and Type 2 diabetes who were followed in pregnancy until their 6 weeks postpartum clinic visit. Consecutive baseline chart review of patients between June 2018 - June 2019 was performed to audit documentation of physician counselling of DC CPG recommendations at the 6 week post-partum visit. Key components of the recommendations included: 1) targeting an HbA1c of <7% pre-pregnancy, 2) folic acid supplementation and neural tube defect prevention, 3) weight management and optimization of BMI, 4) contraceptive measures and family planning, 5) information regarding outcomes and risks for mother and baby 6) yearly retinal exam. RESULTS: Results of our chart review found that 42% (n=50) of women with pre-existing diabetes who received their intrapartum care at our clinic returned for their 6 week postpartum visit between June 2018-June 2019. Audit of the 6 week post-partum clinic note found that less than 20% of women had physician documentation of counselling on two or more key components of the DC CPG recommendations (1-6). CONCLUSION: There is a large gap in women attending postpartum appointments and there are significant gaps in physician documentation of counselling among women with pre-existing diabetes. Further analysis will be conducted in order to determine if there is a patient knowledge gap regarding counselling recommendations and a quality improvement project will be undertaken to close this gap.
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"Reviews : Choice Menus: An Easy Guide With Recipes for Healthy Every day Meal Planning, by Marjorie Hollands and Margaret Howard (1993). Canadian Diabetes Associa tion, National Office, Attention: Coor dinator of Special Projects, 15 Toronto Street. Toronto, Ontario M5C2R1. 128 pages. Price: $19.95." Diabetes Educator 21, no. 1 (February 1995): 84. http://dx.doi.org/10.1177/014572179502100117.
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Kim, Philip, Brenda Coleman, Jeffrey C. Kwong, Agron Plevneshi, Kazi Hassan, Karen Green, Shelly A. McNeil, et al. "Burden of severe illness associated with laboratory-confirmed influenza in adults aged 50-64 years, 2010/11 to 2016/17." Open Forum Infectious Diseases, December 26, 2022. http://dx.doi.org/10.1093/ofid/ofac664.
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ABSTRACT Background Understanding the burden of influenza is necessary to optimize recommendations for influenza vaccination. We describe the epidemiology of severe influenza in 50-64-year-old residents of metropolitan Toronto and Peel region, Canada, over seven influenza seasons. Methods Prospective population-based surveillance for hospitalization associated with laboratory-confirmed influenza was conducted from 9/2010-8/2017. Conditions increasing risk of influenza complications were as defined by Canada’s National Advisory Committee on Immunization. Age-specific prevalence of medical conditions was estimated using Ontario health administrative data. Population rates were estimated using Statistics Canada data. Results Over 7 seasons, 1,228 hospitalizations occurred in patients aged 50-64 years: 40% due to A(H3N2), 30% A(H1N1), and 22% influenza B. The average annual hospitalization rate was 15.6, 20.9 and 33.2/100,000 in 50-54, 55-59, and 60-64-year-olds; average annual mortality was 0.9/100,000. Overall, 33% of patients had received current season influenza vaccine; 963 (86%) had ≥1 underlying condition increasing influenza complication risk. The most common underlying medical conditions were chronic lung disease (38%) and diabetes mellitus (31%); 25% of patients were immunocompromised. The average annual hospitalization rate was 6.1/100,000 in those without and 41/100,000 in those with any underlying condition, and highest in those with renal disease or immunocompromise (138 and 281/100,000 respectively). The case fatality rate in hospitalized patients was 4.4%; median length of stay was 4 days (IQR 2-8). Conclusions The burden of severe influenza in 50-64-year-olds remains significant despite our universal publicly funded vaccination program. These data may assist in improving estimates of the cost-effectiveness of new strategies to reduce this burden.
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Marzolini, Susan, Karen Fong, David Jagroop, Jennifer Neirinckx, Jean Liu, Rina Reyes, Sherry L. Grace, Paul Oh, and Tracey J. F. Colella. "Eligibility, Enrollment, and Completion of Exercise-Based Cardiac Rehabilitation Following Stroke Rehabilitation: What Are the Barriers?" Physical Therapy, October 7, 2019. http://dx.doi.org/10.1093/ptj/pzz149.
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Abstract Background People after stroke benefit from comprehensive programs for the prevention of secondary effects, including cardiac rehabilitation (CR), yet there is little understanding of eligibility for exercise and barriers to use. Objective The aim of this study was to examine eligibility for CR; enrollment, adherence, and completion; and factors affecting use. Design This was a prospective study of 116 consecutive people enrolled in a single outpatient stroke rehabilitation (OSR) program located in Toronto, Ontario, Canada. Methods Questionnaires were completed by treating physical therapists for consecutive participants receiving OSR and included reasons for CR ineligibility, reasons for declining participation, demographics, and functional level. CR eligibility criteria included the ability to walk ≥100 m (no time restriction) and the ability to exercise at home independently or with assistance. People with or without hemiplegic gait were eligible for adapted or traditional CR, respectively. Logistic regression analyses were used to examine factors associated with use indicators. Results Of 116 participants receiving OSR, 82 (70.7%) were eligible for CR; 2 became eligible later. Sixty (71.4%) enrolled in CR, and 49 (81.7%) completed CR, attending 87.1% (SD = 16.6%) of prescribed sessions. The primary reasons for ineligibility included being nonambulatory or having poor ambulation (52.9%; 18/34 patients) and having severe cognitive deficits and no home exercise support (20.6%; 7/34). Frequently cited reasons for declining CR were moving or travel out of country (17.2%; 5/29 reasons), lack of interest (13.8%; 4/29), transportation issues (10.3%; 3/29), and desiring a break from therapy (10.3%; 3/29). In a multivariate analysis, people who declined CR were more likely to be women, less compliant with OSR, and not diabetic. Compared with traditional CR, stroke-adapted CR resulted in superior attendance (66.1% [SD = 22.9%] versus 87.1% [SD = 16.6%], respectively) and completion (66.7% versus 89.7%, respectively). The primary reasons for dropping out were medical (45%) and moving (27%). Limitations Generalizability to other programs is limited, and other, unmeasured factors may have affected outcomes. Conclusions An OSR-CR partnership provided an effective continuum of care, with approximately 75% of eligible people participating and more than 80% completing. However, just over 1 of 4 eligible people declined participation; therefore, strategies should target lack of interest, transportation, women, and people without diabetes. An alternative program model is needed for people who have severe ambulatory or cognitive deficits and no home exercise support.