In This Issue

  • ACHORD Retreat Highlights
  • Report from the Chair
  • ACHORD and the International Diabetes & Cancer Research Consortium
  • Congratulations
  • Project Update
  • ACHORD Seen and Heard
  • Recent Literature
  • Events

Previous Issues


ACHORD Seen and Heard

Recent Publications

Imayama I, Plotnikoff RC, Courneya KS, Johnson JA. Determinants of quality of life in type 2 diabetes population: The inclusion of personality.  Quality of Life Research 2011 May;20(4):551-8.  PMID: 20978858.

Sligl WI, Majumdar SR.  How important is age in defining the prognosis of patients with community-acquired pneumonia? Curr Opin Infect Dis 2011 Apr;24(2):142-147.  PMID: 21252659.

Amed S, Vanderloo SE, Metzger D, Collet J, Reimer K, McCrea P, Johnson JA. Validation of diabetes case definitions using administrative claims data. Diabet Med 2011 Apr.;28(4):424-427.  PMID: 21392063.

Oreopoulos A, Fonarow GC, Ezekowitz JA, McAlister FA, Sharma AM, Kalantar-Zadeh K, Norris CM, Johnson JA, Padwal RS. Do Anthropometric Indices Accurately Reflect Directly Measured Body Composition in Men and Women With Chronic Heart Failure? Congestive heart failure (Greenwich, Conn) 2011 Mar.;17(2):90-92.  PMID: 21449998.

Eurich DT, McAlister FA. Wrongfully accused: metformin use in heart failure. Expert Rev Cardiovasc Ther 2011 Feb.;9(2):147-150.  PMID: 21453211.

Brien SE, Ronksley PE, Turner BJ, Mukamal KJ, Ghali WA. Effect of alcohol consumption on biological markers associated with risk of coronary heart disease: systematic review and meta-analysis of interventional studies. BMJ 2011;342:d636.  PMID: 21343206

Johnson JA, Bowker SL. Meta-analysis of trial data may support a causal role of hyperglycaemia in cancer. Reply to Yang XL, Ma RCW, Chan JCN [letter]. Diabetologia 2011;54(3):711-712.

Majumdar SR, Johnson JA, Bellerose D, McAlister FA, Russell AS, Hanley DA, Garg S, Lier DA, Maksymowych WP, Morrish DW, Rowe BH. Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study. Osteoporosis Int 2011;22(1):223-230.

Sligl WI, Eurich DT, Marrie TJ, Majumdar SR. Only Severely Limited, Premorbid Functional Status Is Associated With Short- and Long-term Mortality in Patients With Pneumonia Who Are Critically III A Prospective Observational Study. Chest 2011;139(1):88-94.  PMID: 20688920.

Majumdar SR, Eurich DT, Gamble J, Senthilselvan A, Marrie TJ. Oxygen Saturations Less than 92% Are Associated with Major Adverse Events in Outpatients with Pneumonia: A Population-Based Cohort Study. Clinical Infectious Diseases 2011;52(3):325-331.  PMID: 21217179.

Gamble JM, Eurich DT, Ezekowitz JA, Kaul P, Quan H, McAlister FA. Patterns of Care and Outcomes Differ for Urban vs. Rural Patients with Newly Diagnosed Heart Failure, Even in a Universal Health Care System. Circ Heart Fail. 2011 Mar 23. [Epub ahead of print] PMID: 21430285.

Johnson JA, Bowker SL. Intensive glycemic control and cancer risk in type 2 diabetes: A meta-analysis of major trials. Diabetologia 2011;54:25-31. PMID: 20959956

Eurich DT, Majumdar SR, McAlister FA, Tsuyuki RT, Johnson JA. Changes in labeling for metformin use in patients with type 2 diabetes and heart failure: documented safety outweighs theoretical risks. Open Medicine 2011;5(1):E33-34.

Simpson SH, Majumdar SR, Tsuyuki RT, Lewanczuk RZ, Spooner R, Johnson JA. Effect of adding pharmacists to the primary care team on blood pressure control in patients with type 2 diabetes: a randomized controlled trial (ISRCTN97121854). Diabetes Care 2011 Jan;34(1):20-6. PMID: 20929988.

Plotnikoff RC, Johnson ST, Karunamuni N, Boule NG. Physical activity related information sources predict physical activity behaviors in adults with type 2 diabetes. J Health Commun 2010 Dec.;15(8):846-858.  PMID: 21170787.

Shamseer L, Vohra S, Adams D, Johnson JA, Brown N, Jahnke N. Cochrane review: Antioxidant micronutrients for lung disease in cystic fibrosis. The Cochrane Library 2011 Dec 8;(12):CD007020. Review. PMID: 21154377.

Recent Presentations

Colmers IN, Bowker SL, Johnson JA. Insulin and cancer outcomes in patients with type 2 diabetes: A systematic review and meta-analysis of observational studies. Canadian Association for Population Therapeutics (CAPT) Annual Meeting, Ottawa, ON April 17-19, 2011. J Popul Ther Clin Pharmacol 2011;53:e202.

Gamble JM, Weir DL, Johnson JA, Eurich DT. “Streamlining drug coverage in Canada: An analysis of new drug products before and after the introduction of the Common Drug Review process.” Canadian Association for Population Therapeutics (CAPT) Annual Meeting, Ottawa, ON April 17-19, 2011. J Popul Ther Clin Pharmacol 2011;18:e187.

Lau D, Hu J, Majumdar SR, Storie DA, Rees SE, Johnson JA. Interventions to improve influenza and pneumococcal vaccinations in community-dwelling adults: a systematic review and meta-analysis. Canadian Association for Population Therapeutics (CAPT) Annual Meeting, Ottawa, ON April 17-19, 2011. J Popul Ther Clin Pharmacol 2011;13:e184.



3rd International Diabetes and Cancer Research Consortium

February 27-28, 2012
Manchester, UK

9th Annual ACHORD Retreat

March 8-9, 2012
The Banff Centre
Banff, Alberta, Canada







8th Annual ACHORD Retreat March 10-11, 2011

The 8th Annual ACHORD Retreat was held on March 10-11, 2011 at The Banff Centre. This is a very informal meeting that provides an opportunity for ACHORD investigators, collaborators and students to share research updates, and plan for continued growth of the ACHORD Research program. We welcomed two international guests this year; our guest speaker, Edwin Gale, Emeritus Professor, of the University of Bristol, Bristol, UK, and Outgoing Editor-in-Chief of Diabetologia and Bendix Carstensen, Senior Statistician with Steno Center in Copenhagen, Denmark. This is the third ACHORD Retreat that Bendix has joined us for.

Thank you to all who presented at the Retreat (which can be seen on our website,

  • Jeff Johnson on ACHORD activities (past, present & future) including accolades to celebrate ACHORD successes in the past year
  • Student Project Presentations by Ahmed Abdelmoneim, Fatima Al Sayah, Marni Armstrong, Isabelle Colmers, and Jongnam Hwang
  • Lisa Wozniak, Allison Soprovich on TeamCare Project and ABCD Evaluation
  • Steve Johnson on HEALD Project
  • Scot Simpson on Aspirin use in diabetes
  • Dean Eurich on Abnormal glucose levels in patients with pneumonia
  • Edwin Gale on Mind Parasites and Diabetes

Our physical activity this year was indoor bootcamp and was enjoyed by those who attended – it was a great workout!

Professor Gale and Steve Johnson also led a student breakout session where the students reviewed a “homework” assignment on publications and the peer review process. Based on his experience as Editor-in-Chief for Diabetologia, Professor Gale discussed his views on “How to be Rejected” with the students.

Thank you to everyone who attended the Retreat. As is the case every year, this event is a success because of those of you that attend. Thank you to Steve Johnson and Sherry Lydynuik for planning the event. Plans for the ACHORD Retreat 2012 at the Banff Centre are already underway; we are looking at March 8-9, 2012 as the dates for next year’s retreat, so mark those dates in your calendar!


Report from the Chair

Spring is upon us, looking forward to the warmer months ahead! A lot has happened since our last newsletter, so here is a quick update.

First, we recently welcomed a new post-doctoral fellow, Dr. Calypse Agborsangaya. Calypse completed his PhD in cancer epidemiology at the University of Tampere, Finland in January 2011. Calypse will be working on a variety of projects, including diabetes and cancer epidemiology.

You will see elsewhere in the newsletter, we hosted an International Diabetes and Cancer Research Consortium at the Banff Centre on March 8 & 9. Thank you to Samantha Bowker for her work in planning this conference and thank you to Allison Soprovich who volunteered to come and help out with the event. The ACHORD Retreat was held immediately following the Consortium on March 10 & 11; this event was well attended, informative and fun as well. We were fortunate to have Professor Edwin Gale as a guest at our retreat.

The Alberta’s Caring for Diabetes (ABCD) Project is continuing to advance. Our pilot interventions studies are in full swing in the partner PCNs. Work on the 2011 Alberta Diabetes Atlas is continuing to progress, we had a very productive ADSS Steering Committee Meeting at the 8th Annual ACHORD Retreat which gave us great feedback.

Annual spring research meetings are starting; JM Gamble, Isabelle Colmers and Darren Lau presented their research at the Canadian Association for Population Therapeutics (CAPT) Symposium in Ottawa in April.  JM and I will also attend the Canadian Association for Health Services and Policy Research (CAHSPR) Annual Conference in Halifax in May. Finally, Fatima Al Sayah, Dean Eurich and I will be presenting at the American Diabetes Association Conference in San Diego at the end of June.

I hope you all have a great spring, I look forward to updating you on the ACHORD news again in the summer!


ACHORD and the International Diabetes & Cancer Research Consortium

On March 8 & 9, 2011 ACHORD hosted a very successful 2nd meeting of the International Diabetes and Cancer Research Consortium (DCRC) at The Banff Centre. A central aim of the consortium is to develop joint work programs surrounding the topic of diabetes and cancer and, where possible, to analyze data derived from different databases in parallel. As such, the consortium enables discussions of consistent and optimal analytic approaches to various databases from around the world.

Thank you to all the participants who travelled from Denmark, Finland, Sweden, the United Kingdom, the United States, and various parts of Canada to attend this meeting! Presentations were given by Bendix Carstensen, Eero Pukkala, Sarah Wild, Jacob Maddams, Jeff Johnson, Talia Zhang, Laurie Habel, Sofia Gudbjornsdottir, and Carolyn Algire. For more information on the International DCRC, please see the ACHORD website:

We are grateful for the funding support for the Consortium meeting provided by the Canadian Institute for Health Research Institute of Nutrition, Metabolism and Diabetes – Meetings, Planning, and Development, The European Association for the Study of Diabetes, the Canadian Diabetes Association and the Institute of Health Economics to host this meeting.

Plans for a 3rd meeting of the International DCRC are currently underway, and the meeting is tentatively scheduled for February 27-28, 2012, in Manchester, United Kingdom.

Congratulations Jeff Johnson and Scot Simpson!

Congratulations to Jeff Johnson and Scot Simpson who were each awarded an Alberta Pharmacy Centennial Award of Distinction.  This once-a-century award has been bestowed to 103 people across Alberta for their contributions to pharmacy in Alberta. Click here for more information on the award.  Fantastic work Jeff and Scot, congratulations from us all!

Project Update: 03.04J Fee Code

In the past few years, the government of Alberta has introduced two specific health care policy initiatives intended to support and improve care for patients with multiple chronic diseases. The first initiative was the development of primary care networks (PCNs), encouraging family physicians (FPs) and other health care providers to organize into multidisciplinary teams to improve access to primary care services with an increased emphasis on the care of patients with chronic diseases. The second initiative was the introduction of a new health service code (HSC 03.04J) to compensate FPs for the time and effort involved in the development, implementation, and administration of a Comprehensive Annual Care Plan (CACP) for patients with multiple chronic conditions (for example, diabetes and hypertension or diabetes and depression).

In the fall of 2009, the research team comprised of Dr. Logan McLeod, Dr. Jeff Johnson, and Serena Humphries from ACHORD, and policy makers at Alberta Health and Wellness (AHW), embarked on a collaborative research project to evaluate HSC 03.04J. The “03.04J project”, lead by Dr. Logan McLeod, aims to evaluate how FPs have developed CACPs and used HSC 03.04J, how the introduction of 03.04J has interacted with PCNs, and ultimately whether the care for patients with multiple chronic diseases has improved.

The project will use a mixed methods approach to answer the defined research questions. We have planned analysis of the administrative claims data from AHW by looking at billing patterns from April 1, 2008 to March 31, 2011, representing one year before and two years after the introduction of HSC 03.04J. In addition, we plan to interview a sample of FPs to ask how: (i) they have used CACPs in their practices, (ii) any changes to their practice resulting from CACPs, and (iii) any suggestions they have for improving primary care coordination. Recruitment for physician interviews started in January 2011 with help from the Alberta College of Family Physicians.

Our mixed methods approach will provide a comprehensive analysis of how 03.04J has been utilized by FPs as well as revealing the process FPs went through to develop, implement, and administer CACPs. The results of the project will be used to inform AHW about how CACPs and HSC 03.04J have been used, and if any changes to either may improve patient care, chronic disease management, or primary care planning.

Recent Literature

Recent Literature from the ACHORD Journal Club (paper discussed Monday, January 17, 2011; Commentary by Isabelle Colmers):

Bosco JL, Antonsen S, Sørensen HT, Pedersen L and Lash TL. Metformin and incident breast cancer among diabetic women: A population-based case-control study in Denmark. Cancer Epidemiology, Biomarkers and Prevention 2011; 20(1):101-11.

What was the study about?

In addition to its glucose-lowering action for individuals with type 2 diabetes, metformin has recently been evaluated as a potential agent to reduce the risk of breast cancer. The current thinking is that metformin may have a protective effect against cancer via indirect (reducing hyperinsulinemia) or direct effects on cell growth and differentiation. Bosco and colleagues have added another observational study to the current body of evidence evaluating metformin’s role in modifying breast cancer risk. The study used population-based administrative databases from Denmark to conduct a nested case-control study evaluating the relationship between metformin use and breast cancer. Cases and controls were identified among women 50 years or older with type 2 diabetes living in northern Denmark from 1989 to 2008.

What were the results of the study?

Within the cohort of older (> 50 years) women with type 2 diabetes (n=4323), 3930 controls were matched by county of residence and sampled from a cancer-free risk set matched to each of the 393 incident breast cancer cases on their date of diagnosis. Use of metformin was associated with a decrease in breast cancer risk, compared to women using other glucose-lowering agents or diet and exercise to control their blood glucose (OR = 0.77, 95% CI = 0.61-0.99). This trend remained the same after adjusting for diabetes complications, clinical obesity, and important predictors of breast cancer (OR = 0.81, 95% CI = 0.63-0.96). For women with >5 years metformin use, a non-significant decrease in breast cancer was shown, compared to women using other glucose-lowering agents for >5 years (OR = 0.83, 95% CI = 0.56-1.22). When metformin monotherapy users were compared to non-metformin users, a similar association was observed (OR = 0.82, 95% CI = 0.64-1.05), however this observation was diminished when comparing metformin users to women using diet and exercise only to control their diabetes (OR = 0.87, 95% CI = 0.60-1.24).

What are the implications of the study?

This study adds to the growing body of evidence supporting the potential role of metformin in reducing breast cancer risk. Bosco and colleagues found a consistent decrease in risk of breast cancer among metformin users, although not always with statistical significance. The observations are consistent with the results of other studies. Additional factors must be considered when interpreting these findings. First, it is possible the apparent decrease in breast cancer risk among metformin users is attributable to an increased risk of cancer among insulin users. Indeed, insulin was noted as the most widely prescribed drug among study participants (58% of cases, 70% of controls) and may thereby magnify the protective effect observed in the metformin group. Second, confounding by indication may have been introduced by comparing metformin users to individuals who controlled their diabetic condition with diet and exercise alone. Diet and exercise is first line treatment in Denmark for individuals newly diagnosed with diabetes; women using drug therapy likely have a more severe form of diabetes. Third, if metformin indeed decreases breast cancer risk, it is unclear whether the effect is due to a reversal of cancer cell growth or a delay of cancer onset. A strength of the study is the nested case-control design, which retains the advantages of a cohort study such as temporal establishment of events and assurance that cases and controls came from the same source population. Overall, this study supports the hypothesized role of metformin in reducing breast cancer risk in older women with type 2 diabetes.

ACHORD Contact Information

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