In This Issue

  • Project Highlight
  • Report from the Chair
  • Recent Literature
  • ACHORD Seen and Heard
  • Meet the Students
  • Events

ACHORD Seen and Heard

Recent Publications

Bowker SL, Johnson JA. Diabetes, cancer and the role of glucose-lowering therapies. Canadian Diabetes Association 2010;23(2):10-12.

Gamble JM, Eurich DT, Johnson JA. A comparison of drug coverage in Alberta before and after the introduction of the National Common Drug Review Process. Healthcare Policy 2010;6(2): e117-e144.

Gamble JM, Eurich DT, Marrie TJ, Majumdar SR. Admission Hypoglycemia and Increased Mortality in Patients Hospitalized with Pneumonia. Am J Med. 2010;123: 556 [e11-e16] PubMed PMID: 20569764.

Imayama I, Plotnikoff RC, Courneya KS, Johnson JA. Determinants of quality of life in type 2 diabetes population: the inclusion of personality. Qual Life Res. 2010 Oct 27. PubMed PMID:20978858.

Johnson JA. Reflections on self-monitoring of blood glucose: Why do we recommend the things we do? [Invited Commentary]. CPJ 2010;143(5):216-217.

Johnson JA, Bowker SL. Intensive glycaemic control and cancer risk in type 2 diabetes: a meta-analysis of major trials. Diabetologia. 2010 Oct 20. PubMed PMID:20959956.

Law E, Simpson SH. Aspirin use rates in diabetes: a systematic review and cross-sectional study. Can J Diabetes 2010;34:211-7.

MacDonald MR, Eurich DT, Majumdar SR, Lewsey JD, Bhagra S, Jhund PS, Petrie MC, McMurray JJV, Petrie JR, McAlister FA. Treatment of Type 2 Diabetes and Outcomes in Patients with Heart Failure: A Nested Case-Control Study from the United Kingdom General Practice Research Database. Diabetes Care 2010; 33(6): 1213-1218. PubMed PMID: 20299488

Ng E, McGrail K, Johnson JA. Hospitalization risk in a type 2 diabetes cohort. Stats Can Catalogue 2010;21(3):1-7.

Oreopoulos A, Kalantar-Zadeh K, McAlister FA, Ezekowitz JA, Fonarow GC, Johnson JA, Norris CM, Padwal RS. Comparison of direct body composition assessment methods in patients with chronic heart failure. J Card Fail. 2010 Nov; 16 (11) :867-72. PubMed PMID:21055650.

Padwal RS, Majumdar SR, Klarenbach S, Birch DW, Karmali S, McCargar L, Fassbender K, Sharma AM. The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES) study: background, design and rationale. BMC Health Serv Res. 2010 Oct 8; 10:284. PubMed PMID:20932316; PubMed Central PMCID: PMC2964692.

*Patel AB, Tu JV, Waters NM, Ko DT, Eisenberg MJ, Huynh T, Rinfret S, Knudtson M, Ghali WA. Access to primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in Canada: a geographic analysis. Open Medicine. 2010;1(1):13. (Subject of an editorial)

Butalia S, Rabi DM. To test or not to test? Self-monitoring of blood glucose in patients with type 2 diabetes managed without insulin. Open Medicine, 2101; 4(2).

Simpson SH, Majumdar SR, Tsuyuki RT, Lewanczuk RZ, Spooner R, Johnson JA. Effect of Adding Pharmacists to Primary Care Teams on Blood Pressure Control in Patients with Type 2 Diabetes: A Randomized Controlled Trial (ISRCTN97121854). Diabetes Care. 2010 Oct 7; PubMed PMID:20929988.

Shurraw S, Majumdar SR, Thadhani R, Wiebe N, Tonelli M, Alberta Kidney Disease Network. Glycemic control and the risk of death in 1,484 patients receiving maintenance hemodialysis. Am J Kidney Dis. 2010 May; 55 (5) :875-84. PubMed PMID:20346561.(selected for commentary in Journal Watch)

Southern DA, Roberts B, Edwards A, Dean S, Norton P, Svenson LW, Larsen E, Sargious P, Lau DC, Ghali WA. Validity of administrative data claim-based methods for identifying individuals with diabetes at a population level. Can J Public Health. 2010 Jan-Feb; 101 (1) :61-4. PubMed PMID:20364541.

Recent Presentations

Asadi L, Eurich DT, Gamble JM, Minhas JK, Marrie TJ, Majumdar SR. Adherence to Antibiotic Guidelines and Use of Macrolides Reduced Mortality in 2973 Outpatients with Pneumonia. 48th Annual Meeting of IDSA, Vancouver, BC October 21-24, 2010.

Eurich DT. Lies, Damned Lies, and Population Based Studies. The Alberta Canadian Society of Hospital Pharmacists Annual General Meeting. Edmonton, AB; October 16th, 2010.

Eurich DT, Majumdar SR, Gamble JM, Minhas JK, Senthilselvan A, Marrie TJ. Short-Term Morbidity and Mortality of 3186 Outpatients with Pneumonia: Population-Based Cohort Study. 48th Annual Meeting of IDSA, Vancouver, BC October 21-24, 2010.

Eurich DT. Using Lab values and Other Objective Measurements to benefit Your Patients: A focus on Patients with Diabetes. Shoppers Drug Mart Pharmacy Conference 2010, Calgary, AB, November 14, 2010.

Gamble JM, Johnson JA, McAlister FA, Eurich DT. Quantifying the Impact of Drug Exposure Misclassification Due to Restrictive Drug Coverage in Administrative Databases: A Simulation Study. Alberta Diabetes Institute Research Day. October 5th, 2010, Edmonton, AB. Also presented at School of Public Health, INSIGHTS ’10 INSIGHTS: A Focus on Public Health Research, Edmonton, AB November 10, 201.

Johnson JA. ADSS Update. Alberta Aboriginal Diabetes Health Stakeholder Meeting, Commerce Place, Edmonton, AB, September 8, 2010.

Johnson JA.  Diabetes Surveillance in Canada: Applications for Children and Youth. Center for Disease Control/National Institutes of Health Workshop on Childhood Diabetes Surveillance, Atlanta, Georgia, October 13, 2010.

Johnson JA. ADSS Update. Alberta Aboriginal Diabetes Health Stakeholder Meeting, Commerce Place, Edmonton, AB, September 8, 2010.

Johnson JA. How much is enough? Testing your Blood Sugar in Type 2 Diabetes. Panel Member, CADTH Café Scientifique, Royal Alberta Museum, Edmonton, AB October 26, 2010.

Johnson JA. Landscape of Diabetes in Alberta. Alberta Diabetes Foundation/Alberta Diabetes Institutes Symposium, Mayfield Inn, Edmonton, AB November 13, 2010.

Johnson ST.  Physical Activity & Type 2 Diabetes: A tough pill to swallow. Cardiac Wellness Institute of Calgary’s Climbing to New Heights in the Prevention of Heart Disease Conference, RimRock Hotel, Banff, AB, October 2, 2010.

McLeod LC. The Effect of Physician Supply on the Mix of Generalist and Specialist Services Used. University of Alberta, Department of Economics, Edmonton, AB, November 10, 2010.

McLeod LC. The Effect of Physician Supply on the Mix of Generalist and Specialist Services Used. University of Manitoba, Department of Economics, Winnipeg, MB, November 26, 2010.

Previous Issues

 Alberta’s Caring for Diabetes (ABCD)

Our work on the Alberta’s Caring for Diabetes (ABCD) project switched into high gear over the fall.  The goal of the ABCD project is to improve the quality and efficiency of care for people with diabetes in Alberta, with a primary focus of supporting primary care in non-metro areas.   As a part of the ABCD project, we have partnered with four non-metro Primary Care Networks (PCNs) including Alberta Heartland PCN, Camrose PCN, Leduc, Beaumont, and Devon PCN, and St. Albert and Sturgeon PCN.  We are pleased to welcome our Primary Care Network (PCN) partners on board.

For the ABCD project, we are piloting the implementation of two quality improvement interventions for people living with type-2 diabetes within the four PCNs.  The two interventions are Healthy Eating and Active Living for Diabetes (HEALD), a 24-week lifestyle program for people newly diagnosed with diabetes focused on walking, and TeamCare, a collaborative team-based model to improve depressive symptoms among people with type-2 diabetes.  Patients will be recruited into the two interventions through PCN-based diabetes registries in a unique way.  People with type-2 diabetes will be mailed a short survey, which includes the PHQ-8 screening tool for depression.  Those patients scoring >=10, indicating depressive symptoms, will be invited to join the TeamCare intervention.  Those patients who score <10 and are newly diagnosed will be invited to join the HEALD intervention.  And those patients who score <10 and are not newly diagnosed will be mailed a longer survey to be followed as part of the Cohort Study.

Over the fall, PCN staff were hired and trained in the two interventions.   Several of the PCNs have already started mailing and receiving the recruitment surveys, as well as seeing patients for both HEALD and TeamCare.

This pilot phase for these interventions will last approximately two years, with the cohort following patients for five years.  During this time, the ABCD team will work closely with the PCNs to evaluate the two interventions extensively.

For more information, please contact Sandra Rees, by phone (780) 248-1412 or by email srees@ualberta.ca

Report from the Chair

Christmas is quickly approaching, hard to believe that another year is nearly over.  As usual, we have been very busy since our last newsletter; here is a quick update.

We welcomed new trainees in September: Isabelle Colmers started her Masters in Epidemiology, Fatima Al Sayah transferred from Nursing and is now doing her PhD Health Services Research; both Fatima and Isabelle are working with me as their supervisor.   Ahmed Abdelmoneim started his PhD in Pharmacy under Scot Simpson’s supervision in September.   Robin Lau left in late August to take courses in health economics at York University in UK, he will return next year.

Congratulations to Darren Lau and JM Gamble who both successfully completed their PhD Candidacy Exams in November!  Congratulations also goes to Dr. Lauren Bresee and Saskia Vanderloo who celebrated their convocation from the U of A last month.  Saskia has been working as a Research Assistant with ACHORD but has decided to move back to Ontario to take a position with PHAC, so we will be saying goodbye in mid-December. We wish you all the best Saskia, we know you will do well.

The Alberta’s Caring for Diabetes (ABCD) Project has really been picking up steam in the past few months, as we have reported elsewhere in this newsletter.  The Alberta Diabetes Surveillance System staff are busy preparing for the 2011 Alberta Diabetes Atlas due out next November.  We were happy to welcome Stephanie Balko back, who returned in October from maternity leave.  And speaking of babies, Clark and Tanya Mundt welcomed their first child, a boy, Warrick Rudy, in November. Congratulations to Clark and Tanya!

The past few months have been busy with travel with ongoing research and dissemination activities.  In September I attended the EuroQol Plenary in Athens and the EASD Meeting in Stockholm.  In October the CDA Annual Meeting was in Edmonton with many of us attending that meeting.  I was pleased to be part of a panel in October for the CADTH Café Scientifique on Self-Monitoring of Blood Glucose held in Edmonton.  I also participated in an international discussion on diabetes surveillance in youth in Atlanta, sponsored by the US CDC.

In the coming months Dean Eurich and I will be presenting at ADI Research in Progress.  January is also a busy time for the students as we prepare abstracts for the national and international research meetings later in the year.

I’d like to wish everyone a safe and happy holiday season and all the best in the New Year! Looking forward to updating you all in the New Year!

Recent Literature from the ACHORD Journal Club

(paper discussed Monday Nov 01, 2010; Commentary by Fatima Al Sayah):

Olson et al. Screening for Diabetes and Pre-diabetes with proposed A1c-based diagnostic criteria. Diabetes Care 2010; 33 (10), 2184-9. PubMed PMID:20639452

What was the study about?

This study was about evaluating the International Expert Committee (IEC) and the American Diabetes Association (ADA) proposed A1C diagnostic criteria for diabetes and pre-diabetes, compared with the oral glucose tolerance test (OGTT) criteria as a gold standard around the world.  IEC proposed an A1C value of ≥6.5% for the diagnosis of diabetes and 6.0-6.4% for “high risk” of progression to diabetes.  Similarly, ADA proposed a value of A1C of ≥6.5% for the diagnosis of diabetes, but decreased the lower limit of A1C to 5.7% for the highest risk to progress to diabetes.  The researchers used three datasets to compare normoglycemia, dysglycemia (pre-diabetes), and diabetes identified by the proposed criteria with standard OGTT criteria.  The datasets were from the Screening for Impaired Glucose Tolerance (SIGT) study (N = 1581), National Health and Nutrition Examination Survey (NHANES) III (N = 2014), and NHANES 2005-2006 (N = 1111), giving a total of 4706 subjects.  Based on the ADA OGTT-based diagnostic criteria, subjects were grouped as normal glucose tolerance, pre-diabetes and diabetes.  The discriminative effectiveness of A1C was the main focus of this study.

What were the results of the study?

Using OGTT results, 5.8% of the combined study subjects had new diabetes, and 36% had pre-diabetes.  However, categorization based on A1C was different from that of OGTT: based on IEC criteria, 2.3% of study subjects were categorized as diabetes and 6.2% were high risk; similarly, 2.3% were categorized as diabetes based on ADA criteria, however, 19.5% were at high risk.  Compared with an OGTT, A1C testing resulted in more normal, and fewer high risk and diabetes classifications with both the IEC and ADA criteria.  The rates of correct and incorrect misclassification showed that the use of both ADA and the IEC A1C-criteria would result in more false-positive and false-negative categorizations than with the OGTT criteria for both pre-diabetes and diabetes. Additionally, the IEC criteria generated more false-negative and fewer false-positive results than the ADA criteria.  Extrapolating the NHANES 2005-2006 findings to the non-Hispanic American adult population, A1C testing would incorrectly identify diabetes in 6.5 million (false positive and false negative results).  ROC curve analyses were performed to assess alternative cutoffs, and showed that the differential screening categorizations by A1C (both the IEC and ADA criteria) versus OGTT was the same with a higher fasting plasma glucose level for normal glucose tolerance, and thus was independent of cut-off values.  Moreover, the study showed that the impact of A1C-based criteria differs by race.  The IEC and ADA A1C-criteria would identify more false-negative results and fewer false-positive results in non-Hispanic whites than blacks.

What are the implications of the study?

The study showed that both the IEC and ADA A1C-based diagnostic criteria have limitations for use in screening for diabetes and pre-diabetes.  They both have high specificity but low sensitivity, intrinsic inaccuracy even with alternate cut-offs, and discrepant performance in different racial groups.  In interpreting the results of this study, it is important to take into consideration a number of factors.  First, the OGTT and A1C tests are intrinsically different and they measure different aspects of glycemic control and metabolism.  Additionally, there are inter-individual variations in the A1C at the same level of glycemia due to a number of known biological factors and inter-racial variations; all of which could have influenced the discriminatory ability of A1C in screening for diabetes and pre-diabetes, and contributed to the results seen in this study.  Second, cost-effectiveness issues are to be considered.  A1C test is easier and faster than an OGTT to administer, more applicable especially in screening settings (such as primary care clinics), and less expensive; however, it is less effective.  Choosing between more effective-high cost test and less effective-low cost test, particularly for the purposes of screening a large number of people for a relatively high prevalent condition, sets a controversy in the trade-off between effectiveness and cost.  Finally, OGTT is a world wide used diagnostic test, and thus, it is crucial to consider the global applicability of a test that would replace it in the screening and diagnosis of diabetes and pre-diabetes, with the associated inter-racial variations.

Meet the Students

Isabelle Colmers, BScH, BA

Isabelle was raised in Edmonton, Alberta and after living in France for a year, moved to Kingston, Ontario to pursue her undergraduate training at Queen’s University.  During her studies, Isabelle conducted research in neurophysiology and became interested in endocrine modulation.  She also took courses in public health and became very interested in the population-level approach to studying disease.  She graduated in 2009 with a BSc Honours in Life Sciences (SSP) and a BA in French Studies and returned to Edmonton to work at the Canadian Obesity Network.

Isabelle’s combined appreciation for quantitative population-level research and interest in endocrine regulation led her to pursue an MSc in Epidemiology at the University of Alberta.  She is honoured to train under the supervision of Dr. Jeffrey Johnson and is excited to be part of the ACHORD research group.  Her Masters’ work will focus on the relationship between glucose-control therapies and cancer outcomes in individuals with type 2 diabetes mellitus.

Outside of school, Isabelle coaches a synchronized swimming team and lifeguards at the YMCA.  She volunteers as a “Big Sister” and has a very sweet 8-yr-old “Little Sister”.  In her free time, Isabelle loves back-country hiking, running outdoors, Ashtanga yoga and cooking.

Ahmed Abdelmoneim, BPharm

Ahmed was born in Cairo, Egypt, but was raised in Kuwait where he obtained his BPharm Degree from Kuwait University in 2007.  Ahmed always had a passion for medical research since his undergraduate degree presenting many papers and attending many conferences around the world.  After working for a brief period as pharmacist, Ahmed realized that he should continue with his passion for research.  Soon after, he pursued a MSc. Degree in Pharmaceutical Sciences at the University of Manitoba under the supervision of Dr. Lavern Vercaigne.  In September 2010 he joined the ACHORD group as a PhD student under the supervision of Dr. Scot Simpson to work on projects investigating the cardiovascular outcomes associated with the use of sulfonylureas in diabetic patients.

Ahmed’s current research interests are optimizing the safe and effective use of medications for diabetes and cardiovascular disease, measuring pharmacist integration into primary care settings and evaluating clinical interventions that can improve prescribing and patient medication taking behavior.  His ultimate career goal is to work in academia and lead a team of researchers to contribute to the clinical science while supervising and teaching new generations of students.

Ahmed is excited to collaborate with ACHORD researchers who come from a variety of scientific backgrounds.  He believes that working in such an interdisciplinary environment represents a unique opportunity to provide him with the required tools and necessary skills to develop as an independent researcher.

ACHORD Events

International Diabetes and Cancer Research Consortium Meeting

March 8-9, 2011
The Banff Centre
Banff, Alberta, Canada

8th Annual ACHORD Retreat

March 10-11, 2011
The Banff Centre
Banff, Alberta, Canada

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