In This Issue

  • Report from the Chair
  • Project Update
  • ACHORD Seen & Heard
  • Recent Literature
  • Meet the Students
  • ACHORD Accolades
  • Events

Previous Issues

ACHORD Seen & Heard

Recent Publications

Agborsangaya CB, Lahtinen M, Cooke T, Johnson JA. Comparing the EQ-5D-3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual Life Outcomes 2014;12:74. PMID: 24885017.

Alsabbagh MH, Lemstra M, Eurich DT, Lix LM, Wilson TW, Watson E, Blackburn DF. Socioeconomic status and nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Value Health. 2014 Mar;17(2):288-96. PMID: 24636389.

Campbell-Scherer DL, Asselin J, Osunlana AM, Fielding S, Anderson R, Rueda-Clausen CF, Johnson JA, Ogunleye A, Cave A, Manca D, Sharma AM. Implementation and evaluation of the 5As framework of obesity management in primary care: design of the 5As Team (5AsT) randomized control trial. Implementation Science 2014;9:78. PMID: 24947045.

Cornish SM, Johnson ST. Systemic cytokine response to three bouts of eccentric exercise. Results in Immunology. 2014 24;4:23-9. PMID: 24809007.

Dang TT, Eurich DT, Weir DL, Marrie TJ, Majumdar SR. Rates and risk factors for recurrent pneumonia in patients hospitalized with community-acquired pneumonia: population-based prospective cohort study with 5-years of follow-up. Clin Infect Dis. 2014; 59: 74-80. PMID: 24729503.

Dasgupta K, Quinn RR, Zarnke KB, Rabi DM, Ravani P, Daskalopoulou SS, Rabkin SW, Trudeau L, Feldman RD, Cloutier L, Prebtani A, Herman RJ, Bacon SL, Gilbert RE, Ruzicka M, McKay DW, Campbell TS, Grover S, Honos G, Schiffrin EL, Bolli P, Wilson TW, Lindsay P, Hill MD, Coutts SB, Gubitz G, Gelfer M, Vallée M, Prasad GV, Lebel M, McLean D, Arnold JM, Moe GW, Howlett JG, Boulanger JM, Larochelle P, Leiter LA, Jones C, Ogilvie RI, Woo V, Kaczorowski J, Burns KD, Petrella RJ, Hiremath S, Milot A, Stone JA, Drouin D, Lavoie KL, Lamarre-Cliche M, Tremblay G, Hamet P, Fodor G, Carruthers SG, Pylypchuk GB, Burgess E, Lewanczuk R, Dresser GK, Penner SB, Hegele RA, McFarlane PA, Khara M, Pipe A, Oh P, Selby P, Sharma M, Reid DJ, Tobe SW, Padwal RS, Poirier L; Canadian Hypertension Education Program. The 2014 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention and treatment of hypertension. Can J Cardiol. 2014 30(5):485-501. PMID: 24786438.

Gamble JM, Hall JJ, Marrie TJ, Sadowski CA, Majumdar SR, Eurich DT. Medication Transitions and Polypharmacy in Older Adults Following Acute Care. Ther Clin Risk Manag. 2014 Mar 19;10:189-96. PMID: 24672243.

Ghosh M, Majumdar SR. Antihypertensive medications, bone mineral density, and fractures: a review of old cardiac drugs that provide new insights into osteoporosis. Endocrine 2014 46(3):397-405. PMID: 24504763.

Kolber MR, Lau D, Eurich DT, Korownyk C. Effectiveness of the trivalent influenza vaccine. Can Fam Phys. 2014 Jan;60(1):50 PMID: 24452561.

Leslie WD, Aubry-Rozier B, Lix LM, Morin SN, Majumdar SR, Hans D. Spine bone texture assessed by trabecular bone score (TBS) predicts osteoporotic fractures in men: The Manitoba Bone Density Program. Bone. 2014 Jul 2;67C:10-14. PMID: 24998455.

Leslie WD, Majumdar SR, Lix LM, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA. Can change in FRAX score be used to “treat to target”? A population‐based cohort study. J Bone Miner Res. 2014 May;29(5):1074-80. PMID: 24877235.

Manns B, Braun T, Edwards A, Grimshaw J, Hemmelgarn B, Husereau D, Ivers N, Johnson J, Long S, McBrien K, Naugler C, Sargious P, Straus S, Tonelli M, Tricco A, Yu C; Alberta Innovates; Health Solutions Interdisciplinary Chronic Disease Collaboration. Identifying strategies to improve diabetes care using the knowledge-to-action cycle. CMAJ Open. 2013 1(4):E142-50. PMID: 25077116.

Majumdar SR, McAlister FA, Johnson JA, Weir DL, Bellerose D, Hanley DA, Russell AS, Rowe BH. Critical impact of patient knowledge and bone density testing on starting osteoporosis treatment after fragility fracture: secondary analyses from 2 controlled trials. Osteoporos Int. 2014 25(9)2173-2179. PMID: 24803330.

Majumdar SR. Implementation research in osteoporosis: an update. Curr Opin Rheumatol. 2014 26(4):453-7. PMID: 24841231.

McAlister FA, Majumdar SR, Padwal RS, Fradette M, Thompson A, Buck B, Dean N, Bakal JA, Tsuyuki R, Grover S, Shuaib A. Case management for blood pressure and lipid level control after minor stroke: PREVENTION randomized controlled trial. CMAJ. 2014 186(8):577-84. Erratum in CMAJ. 2014 186(9):698. PMID: 24733770.

Murphy GK, McAlister FA, Weir DL, Tjosvold L, Eurich DT. Cardiovascular Medication Utilization and Adherence among Heart Failure Patients in Rural and Urban Areas: A Retrospective Cohort Study. BMC Public Health. 2014 Jun 2;14(1):544. PMID: 24888355.

Tran BX, Ohinmaa A, Kuhle S, Johnson JA, Veugelers PJ. Life course impact of school-based promotion of healthy eating and active living to prevent childhood obesity. PLOS One. 2014 9(7):e102242. PMID: 25025581.

Schaefer L, Plotnikoff RC, Majumdar SR, Mollard R, Woo M, Sadman R, Rinaldi RL, Boulé N, Torrance B, Ball GD, Veugelers P, Wozny P, McCargar L, Downs S, Lewanczuk R, Gleddie D, McGavock J. Outdoor Time Is Associated with Physical Activity, Sedentary Time, and Cardiorespiratory Fitness in Youth. J Pediatr. 2014 Sep;165(3):516-21. PMID: 25043155.

Vallance JK, Eurich DT, Gardiner P, Taylor LM, Stevens GA, Johnson ST. Utility of telephone survey methods in population-based health studies of older adults: An example from the Alberta Older Adult Health Behavior (ALERT) Study. BMC Public Health. 2014 May 22;14:486. PMID: 24884997.

Warkentin LM, Majumdar SR, Johnson JA, Agborsangaya CB, Rueda-Clausen C, Sharma AM, Klarenbach SW, Birch DW, Karmali S, McCargar L, Fassbender K, Padwal RS. Predictors of Health-related quality of life in 500 severely obese patients. Obesity (Silver Spring). 2014; 22(5):1367-72. PMID: 24415405.

Yang J, Nijjar A, Quan H, Shah BR, Rabi D, Ignaszewski A, Khan NA. Utilization of health resources in South Asian, Chinese and white patients with diabetes mellitus. Prim Care Diabetes. 2014 8(2):165-70. PMID: 24289947.

 

Recent Presentations

Wozniak L, Soprovich A, Rees S, Al Sayah F, Majumdar SR, Johnson JA. Contextualizing the Effectiveness of a Collaborative Care Model for Diabetes and Depression in Primary Care: A Qualitative Assessment. CAHSPR Conference 2014, Toronto, ON May 12-15, 2014.

Taylor L, Johnson S, Eurich DT, Gardiner P, Stevens G, Vallance J. Utility of telephone survey methods in population-based health studies of older adults: An example from the Alberta Older Adult Health Behavior (ALERT) Study. International Society for Behavioral Nutrition and Physical Activity, San Diego, California United States. May 21-24, 2014.

Taylor L, Johnson S, Eurich DT, Gardiner P, Vallance J. Comparing two screening tools used to identify adults at risk for diabetes: An example from the Alberta Older Adult Health Behavior (ALERT). International Society for Behavioral Nutrition and Physical Activity, San Diego, California United States. May 21-24, 2014.

Eurich DT.  Launching a Successful Career – Panel Member, CIHR Institute of Cardiology and Respiratory Health Young Investigators’ (YI) Forum, Edmonton, AB, May 28, 2014.

 

Events

12th Annual ACHORD Retreat

March 19-20, 2015
The Banff Centre
Banff, Alberta, Canada

 

 

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Report from the Chair

Hello everyone! I hope everyone had a chance to take time off and enjoy our beautiful summer! Here is a quick update on what we have been doing since our last newsletter.

ACHORD members have been busy preparing for various conferences in the coming months. I have been invited to speak at the Campus Alberta Student Conference on Health (CASCH) 2014 in Banff and will be attending back-to-back meetings of the European Association for the Study of Diabetes (EASD) and EuroQol Group in September. Other conferences ACHORDians will be attending are: Canadian Diabetes Association Annual Conference in Winnipeg and the 2014 Qualitative Health Research Conference in October.

We said goodbye to Daniala Weir at the end of June; Daniala successfully completed her Masters with Dean Eurich and is now starting her PhD at McGill University.  We really enjoyed hosting two visiting research students over the summer. Marjolein Zanders, a PhD student from the Eindhoven Cancer Registry in the Netherlands and part of our international Diabetes and Cancer Research Consortium (DCRC), was with us from April to July. Stephanie Bearman, an AIHS-funded summer student, worked with Nonsi Mathe, Hayford Avedzi and Steve Johnson on dietary assessments from our HEALD and ABCD studies from May to August. We will also say goodbye to our receptionist, Haley Breedlove, in mid-September. We bid them all farewell, but will stay in touch and wish them the best of luck in future endeavours!

As the new school term is starting, we are excited to welcome our new cohort of research trainees, some of whom are highlighted in this newsletter. I look forward to working with all of these new students.

The Alberta’s Caring for Diabetes (ABCD) Project activities remain exciting. With recruitment finalized for the ABCD cohort, we are pleased to report the baseline characteristics of participants: the average age was 64 years, 45% were female, and 90% were caucasian, with average diabetes duration of 12 years. Most (88%) reported two or more chronic conditions in addition to diabetes, and 18% screened positive for depressive symptoms. We report on a sub-study of cohort participants in the Project Update featured in this newsletter. With this cohort, we look forward to exploring the multi-dimensional and dynamic nature of diabetes care and complications long term. Additionally, the collected data will contribute to broader scientific literature and help to identify local benchmarks and targets for intervention strategies. This in turn will help to guide policies and resource allocation related to the care and management of adults with type-2 diabetes in Alberta.

With our main interventions (TeamCare and HEALD) complete, we are undertaking economic evaluations for both, which involve linkage of our trial data with administrative data from Alberta Health and Alberta Health Services. Also under the ABCD umbrella, the PROACTIVE study, is looking at the progression of depressive symptoms from hospital discharge to 90 days post discharge. Over 400 patients have been recruited, with one-third having type-2 diabetes. We look forward to reporting more results of these projects in the coming months.

I hope the information in our newsletter is informative, and if you have any questions about our activities, please do not hesitate to contact us. I look forward to updating you in the winter with more on ACHORD’s activities.

 

Project Update

Examining the role of diet, physical activity, sleep and sedentary behaviours within the ABCD cohort

By Mundt C, Mathe N, Johnson STDiabetes self-management includes careful consideration of diet and physical activity. With the aid of guidelines developed by the Canadian Diabetes Association, recommendations for diet and physical activity are conveyed through health professionals in primary care settings. Unfortunately, many people with type 2 diabetes have difficulty meeting these recommendations placing them at greater risk for complications such as heart disease, blindness and amputations. And, only now are we beginning to understand the risks associated with being overly sedentary and the role that sleep plays in the development of diabetes-related complications. The aim of this study is to find out more about how people with diabetes are managing important lifestyle behaviours that are considered modifiable. By doing this, we can figure out why some people with type 2 diabetes develop complications and why others don’t. To collect this information we will ask approximately 10% of those people who are already participating in the ABCD cohort (N=200) to wear an accelerometer on their waist during waking hours and then on their wrist during sleep for seven days in a row. During three of those seven days, study participants will write down everything they eat in a diet diary. The information gathered from this study will be linked with information being gathered on other self-care behaviours (from the ongoing ABCD cohort survey) and health care utilization (from linked Alberta Health administrative data). We expect to complete our data collection before November 2014.

 

Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, June 3, 2014; Commentary by Karly Achtymichuk)

Lexis CH, van der Horst IC, Lipsic E, et al. Effect of Metformin on Left Ventricular Function After Acute Myocardial Infarction in Patients Without Diabetes: The GIPS-III Randomized Clinical Trial. JAMA.2014;311(15):1526-1535. doi:10.1001/jama.2014.3315.  

Rationale for the study
After a myocardial infarction (MI), a relatively common and serious complication is deterioration in left ventricular function and subsequent heart failure. It was hypothesized that following an acute MI, the drug metformin may be cardioprotective through limiting the size of the infarct and preventing adverse remodeling of the heart. The objective of this study was to evaluate the effect of metformin on left ventricular function in a population of patients without diabetes who presented with ST-segment elevation myocardial infarction (STEMI).

Summary of the study
This study was a prospective, single-center, double-blind, randomized, placebo-controlled trial from the University Medical Center Groningen in the Netherlands through January 1, 2011 to May 26, 2013. Inclusion criteria included: patients with STEMI treated by percutaneous coronary intervention with implantation of at least 1 stent with a diameter of at least 3 mm within 12 hours of symptoms; exclusion criteria included: age <18 years, previous MI, known diabetes, need for coronary artery bypass graft (CABG) surgery, renal dysfunction and contraindications for magnetic resonance imaging (MRI). Patients were randomized to either the experimental group, receiving metformin 500mg twice daily for 4 months, or the placebo group, receiving a visually matched placebo. 380 patients were enrolled, 191 in the experimental group and 189 in the placebo group. The primary outcome was left ventricular ejection fraction, measured by MRI 4 months after the MI. The primary analysis was done by intention-to-treat.

Results
275 of the 380 patients underwent MRI at 4 months; reasons for not undergoing MRI included claustrophobia, contraindications for MRI and CABG surgery. There was no statistically significant difference in left ventricular ejection fraction at 4 months between the 2 groups (53.1%, 95% CI 51.6-54.6% in the metformin group and 54.8%, 95% CI 53.5-56.1% in the placebo group, p-value=0.10). A sensitivity analysis which adjusted for age, sex, baseline NT-proBNP and myocardial blush grade did not change the results. The principal secondary efficacy measure, NT-proBNP concentration at 4 months, did not significantly differ between the 2 groups (median 167ng/L, IQR 65-393ng/L in the metformin group and median 167ng/L, IQR 74-375ng/L in the placebo group, p-value=0.66). Other secondary endpoints, including major adverse cardiac events (MACE), creatinine concentration and glycated hemoglobin were not significantly different between the 2 groups.

Discussion
The authors concluded that metformin did not have an effect on left ventricular function at 4 months post MI, and therefore their results do not support the use of metformin in this setting. Overall the study was well-designed and well-run. The original hypothesis had the potential to be a very effective strategy, as metformin is a cheap, available and relatively safe medication. Unfortunately no benefit was shown.

The primary outcome, left ventricular ejection fraction, was measured on patients at 4 months post MI. A baseline measure was not done. Ideally we would have both a baseline measure and a repeat measure at 4 months, allowing us to calculate the change in ejection fraction. This was not done for feasibility reasons. Not having a baseline measure can bias results away from the null; however, in this study there was no difference shown between the groups anyways.

Other questions included whether metformin was administered soon enough after the percutaneous coronary intervention and at a high enough dose. These can be questions for future study.

 

Meet the Students

Christopher Chen, BSc Pharmacy

Training Program:  MSc Clinical Epidemiology

School of Public Health, University of Alberta

Christopher graduated from the University of Alberta with a BSc. in Pharmacy in 2014. During his undergraduate years, Chris has gained research experience in cardiac pharmacology, medicinal chemistry and pharmacy practice. However, it is Chris’ interest in translational research, enthusiasm towards research methodology and a desire to obtain a high quality of research training that attracted him to ACHORD. While at ACHORD, Chris hopes to further elucidate the connection between cancer, diabetes and hypoglycemic therapy.

Chris is also a pharmacist for Rexall, loves to play soccer and wagers that his beloved Dallas Stars will compete in the Stanley Cup Finals before he graduates.

 

Dax Rumsey, MD

Training Program:  MSc Clinical Epidemiology, School of Public Health, University of Alberta

Hi, my name is Dax G. Rumsey. Born and raised in Torbay, Newfoundland and Labrador, I completed a BSc (Joint Honours) in Biology and Psychology at Memorial University of Newfoundland. I then went on to receive my Doctor of Medicine (M.D.) at Memorial, as well. The next step of my training was a residency in paediatrics at the University of Saskatchewan in Saskatoon. After that, I did a fellowship in paediatric rheumatology at the Hospital for Sick Children in Toronto. I now plan to work part time as a paediatric rheumatologist at the Stollery Children’s Hospital in Edmonton. I also plan to work toward my MSc in clinical epidemiology through the School of Public Health at the University of Alberta, starting this September 2014. My main supervisor will be Dr. Dean Eurich.

Throughout medical school and my residencies, I have had the opportunity to care for many patients and their families. These experiences have helped me to appreciate the people behind the diseases that we treat. They have inspired in me a deep desire to help further our collective medical knowledge in any way that I can.

For my thesis, I intend to study outcomes of juvenile idiopathic arthritis (JIA) in Canada using the Research in Arthritis in Canadian Children (ReACCh) database, a large database of prospectively collected data from a national observational study of children with newly diagnosed JIA. There are over 1500 patients enrolled from 16 centers across the country, making it the largest database of longitudinal data on children with JIA. The data has been completely collected and cleaned. There are several important questions to be asked related to modeling of disease outcomes and predictors of outcomes, etc. I look forward to working with Dean and others in the School of Public Health, the University of Alberta, and beyond.

Outside of work, my beautiful wife, Rachel, and I have three wonderful children. As practicing Catholics, God is at the center of our lives. We enjoy spending time together and being active.

 

Danielle Thiel, BSc

Training Program: MSc Epidemiology

School of Public Health, University of Alberta

Danielle grew up in Regina, SK. She graduated from Lakehead University in Thunder Bay, ON in 2014 with a Bachelor of Science in Applied Bio-Molecular Science. During her time at Lakehead, Danielle had the opportunity to become involved in two different research projects, both relating to environmental microbiology. Working in the lab sparked Danielle’s interest in research as a potential career option. Danielle also took courses relating to public health, and became interested in the population-level approach to studying diseases. She decided to step away from bench science, and pursue a Master of Science degree in Epidemiology at the University of Alberta. Danielle is fortunate to train under the supervision of Dr. Jeff Johnson and is excited to work with the ACHORD group. Her research will be around health outcomes in diabetes populations, focusing on lifestyle factors.

Danielle is also an avid long distance runner, and is a member of the U of A cross country and track and field teams. In her spare time, she enjoys camping, downhill skiing and spending time at the cottage.

 

Recent Presentations (Cont)

Asche CV, Hippler SE, Eurich DT.  Review of Models used in Economic Analyses of New Oral Treatments for Type-2 Diabetes Mellitus. ISPOR 19th Annual International Meeting, Palais des Congres de Montreal, Montreal, QC, May 31- June 4, 2014.  Value in Health; Volume 17; Issue 3.

Mladenovic A, Wozniak L, Plotnikoff R, Johnson JA, Johnson ST. Social support, self-efficacy and motivation in the journey through HEALD. American Diabetes Association 74th Scientific Sessions, San Francisco, CA, June 13-17, 2014.

Wozniak L, Soprovich A, Rees S, Al Sayah F, Majumdar SR, Johnson JA. Contextualizing the Effectiveness of a Collaborative Care Model for Diabetes and Depression in Primary Care: A Qualitative Assessment. American Diabetes Association 74th Scientific Sessions, San Francisco, CA, June 13-17, 2014.

Seida JC, Mitri J, Colmers I, Majumdar SR, Davidson MB, Edwards AL, Hanley DA, Pittas AG, Tjosvold L, Johnson JA. Effect of Vitamin D Supplementation on Improving Glucose Homeostasis and Preventing Diabetes: A Systematic Review. American Diabetes Association 74th Scientific Sessions, San Francisco, CA, June 13-17, 2014.

Eurich DT, Weir DL, Simpson S, Senthilselvan A, McAlister FA. Risk of New Onset Heart Failure in Patients using Sitagliptin. 74th Scientific Sessions for the American Diabetes Association, San Francisco USA. June 13-17, 2014.

Eurich DT. Broken Promises: Metformin and Cardiovascular Outcomes. International Symposium on Metabolism, Diet, and Chronic Disease: The Perspective of Cancer and Cardiovascular Disease Prevention. Rome, Italy, June 23, 2014

ACHORD Accolades

Congratulations to:

Daniala Weir on successfully completing her MSc Final Exam

Karly Achtymichuk on receiving a CIHR Masters Award

Chris Chen on receiving a CIHR Masters Award

Danielle Thiel on receiving an ADI Graduate Student Award

Jeff Johnson on receiving a University of Saskatchewan Alumni of Influence from the College of Pharmacy and Nutrition

Other ACHORD News

Congratulations to Fatima Al Sayah and Hisham Hussein on their marriage in August 

Farewell to Daniala Weir, Haley Breedlove, Marjolein Zanders and Stephanie Bearman

ACHORD Contact Information

Phone Numbers: General Inquiries: 780-248-1010 | Fax : 780-492-7455
Address:
University of Alberta | 2-040 Li Ka Shing Centre for Health Research Innovation | Edmonton, AB, T6G 2E1
Email
: achord@ualberta.ca