In This Issue

  • ADSS Interactive Website
  • Report from the Chair
  • Project Update
  • ACHORD Seen and Heard
  • Recent Literature
  • Meet the Trainees
  • Student Accolades
  • Events

Previous Issues

ACHORD Seen and Heard

Recent Publications

Butalia S, Leung AA, Ghali WA, Rabi DM.  Aspirin effect on the incidence of major adverse cardiovascular events in patients with diabetes mellitus: a systematic review and meta-analysis. Cardiovasc Diabetol. 2011 Apr 1;10:25. PMID: 21453547

Southern DA, Izadneghadar M, Humphries KH, Gao M, Wang F, Knudtson ML, Graham MM, Ghali WA. Trends in wait times for cardiac revascularization. Can J Cardiol. 2011 Mar-Apr;27(2):262.e21-7. PMID: 21459277

Gamble JM, Eurich DT, Ezekowitz JA, Kaul P, Quan H, McAlister FA. Patterns of care and outcomes differ for urban versus rural patients with newly diagnosed heart failure, even in a universal healthcare system. Circ Heart Fail. 2011 May 1;4(3):317-23. PMID: 21430285

Lyons K, Majumdar SR, Ezekowitz JA. The Unrecognized Burden of Osteoporosis-Related Vertebral Fractures in Patients with Heart Failure. Circ Heart Fail. 2011 May 10. PMID:21558449

Abou-Setta AM, Beaupre LA, Rashiq S, Dryden DM, Hamm MP, Sadowski CA, Menon MR, Majumdar SR, Wilson DM, Karkhaneh M, Mousavi SS, Wong K, Tjosvold L, Jones CA. Comparative Effectiveness of Pain Management Interventions for Hip Fracture: A Systematic Review. Ann Intern Med. 2011 May 16. [Epub ahead of print] PMID: 21576514

Metcalfe A, Lail P, Ghali WA, Sauve RS. The association between neighbourhoods and adverse birth outcomes: a systematic review and meta-analysis of multi-level studies. Paediatr Perinat Epidemiol. 2011 May;25(3):236-45. PMID: 21470263

Evans CD, Watson E, Eurich DT, Taylor JG, Yakiwchuk EM, Shevchuk YM, Remillard A, Blackburn D. Diabetes and cardiovascular disease interventions by community pharmacists: a systematic review. Ann Pharmacother. 2011 May;45(5):615-28. PMID: 21558487

Althaus F, Paroz S, Hugli O, Ghali WA, Daeppen JB, Peytremann-Bridevaux I, Bodenmann P. Effectiveness of interventions targeting frequent users of emergency departments: a systematic review. Ann Emerg Med. 2011 Jul;58(1):41-52.e42. PMID: 21689565

Tang KL, Eurich DT, Minhas-Sandhu JK, Marrie TJ, Majumdar SR. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. Arch Intern Med. 2011 Jul 11;171(13):1193-8. PMID: 21518934

McMurtry MS, Lewin AM, Knudtson ML, Ghali WA, Galbraith PD, Schulte F, Norris CM, Graham MM. The Clinical Profile and Outcomes Associated With Coronary Collaterals in Patients With Coronary Artery Disease. Can J Cardiol. 2011 Jul 8. [Epub ahead of print] PMID: 21742466

Eurich DT, Majumdar SR, McAlister FA, Tsuyuki RT, Johnson JA. Levels of Evidence needed for changing indications, contraindications and food and drug administration labeling: the case of metformin. Arch Intern Med 2011 June 13; 171(11):1042-3. PMID: 21670379.

Currie CJ, Johnson JA. The safety profile of exogenous insulin in people with type 2 diabetes: justification for concern. Diabetes Obes Metab 2011 Jul 7, doi: 10.1111/j. 1463-1326.2011.01469.x [Epub ahead of print]. PMID: 21736688.

Johnson JA, Bowker SL, Richardson K, Marra C. Time-varying incidence of cancer after the onset of type 2 diabetes: Evidence of potential detection bias. Diabetologia 2011Jul 12. [Epub ahead of print]. PMID: 21748485.

Simpson SH, Gamble JM, Mereu L, Chambers T.  Effect of Apsirin Dose on Mortality and Cardiovascular Events in People with Diabetes: A meta analysis. J Gen Intern Med. 2011 Jun 7. [Epub ahead of print] PMID: 21647746  This article was also highlighted on Global Edmonton Health Matters on July 5 and U of A Express News.

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.

Johnson JA, Bowker SL, Marra C, Richardson K. Time−Varying Incidence of Cancer after the Onset of Type 2 Diabetes: Evidence of Potential Surveillance Bias. [Oral Presentation] 71st American Diabetes Association Scientific Sessions, San Diego, California June 24-28, 2011.

Eurich DT, McAlister F, Majumdar S, Tsuyuki R, Tjosvold E, Weir D, Vanderloo S, Johnson JA. Safety and Effectiveness of Metformin in Patients with Diabetes and Heart Failure: Systematic Review. 71st American Diabetes Association Scientific Sessions, San Diego, California June 24-28, 2011.


Student Accolades

Congratulations to the following students on being recipients of various awards:

Pharmaceutical Policy Research Collaboration Fellowship (PPRC) was awarded to JM Gamble.  For more information on the fellowship, click here.

CAPT Travel Award (sponsored by the Canadian Association for Population Therapeutics [CAPT] for travel to partipate in the CAPT Annual Symposium in Ottawa, April, 2011) was awarded to the following students:

Isabelle Colmers

JM Gamble

Darren Lau

ADI Trainee Travel Award (sponsored by the Alberta Diabetes Institute for travel to international meetings) was awarded to Fatima Al Sayah for travel to the American Diabetes Association Annual Conference in San Diego in June, 2011.



3rd International Diabetes and Cancer Research Consortium

February 27-28, 2012
Brussels, Belgium

9th Annual ACHORD Retreat

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





News from the Alberta Diabetes Surveillance System (ADSS)

We are excited to introduce to you the Alberta Diabetes Surveillance System Interactive Website at:

This is a tool that can be used to generate timely information about diabetes in Alberta. Now, individuals across the province can query information about diabetes, it’s complications and even health care utilization for any number of cities, towns and Health Zones across Alberta. This information will further assist health care planning and resource allocation in addition to informing health care practitioners and policy-makers about their local populations.

For a short video introduction to the website, please click on the YouTube link below:

We hope that you will all enjoy trying out the website and that you’ll find it a very useful resource!

For questions or for more information, please contact the ADSS Project Manager at:

Report from the Chair

Here is a quick update on what we have been busy with in ACHORD over the past few months.

There were many spring research meetings attended by various ACHORD Students and researchers. JM Gamble, Darren Lau and Isabelle Colmers presented their research at the Canadian Association for Population Therapeutics Symposium in Ottawa in April; JM and I also attended the Canadian Association for Health Services and Policy Research Annual Conference in Halifax in May. In June Fatima Al Sayah, Sonia Butalia, Dean Eurich and I each presented at the American Diabetes Association Annual Meeting in San Diego. Calypse Agborsangaya attended the 11th Cambridge Diabetes Seminar (CDS 2011) held at Clare College in Cambridge, UK in early July.

We are continuing our work on diabetes and cancer, with a recent renewal of our CIHR grant on this topic. We are working with colleagues at UBC to undertake analyses with the linked BC health data. I am also continuing work with our International Diabetes and Cancer Consortium; I was in Copenhagen in April in follow up to meet with our colleagues there. Plans are underway for collaborations with colleagues in Scotland too; we plan to meet at the upcoming EASD meeting in Lisbon in September.

The Alberta’s Caring for Diabetes (ABCD) Project continues to keep us busy as it advances. We are well into the enrolment and follow up for the TeamCare and HEALD interventions. Partnerships with the various PCN’s are going well; the ABCD team is actively working with staff at all of the PCN to keep things running smoothly. And finally, work on the Alberta Diabetes Surveillance System (ADSS) is in full swing, with plans to bring you the 2011 Alberta Diabetes Atlas this fall. We have just released our on-line, interactive web-site, which will make dissemination of ADSS information even more efficient!

I hope you all have a great summer and are able to enjoy some time off with family. I look forward to updating you on the ACHORD news again later this year!


Project Update

Health Literacy and Health Outcomes in Diabetes: A Canadian Study

Al Sayah F, Williams B, Majumdar S, & Johnson JA

Why this study is needed?

By 2016, 2.4 million Canadians are expected to have diabetes, a disease that requires complex self-care management and advanced health literacy skills.  Inadequate heath literacy has been reported to be a stronger predictor of a persons’ health than age, income, employment status, education level, and race, and is associated with a wide range of adverse direct and indirect effects on health outcomes.  In Canada, 60% of adults have inadequate health literacy; however, we lack information on how this affects the health of those with diabetes.  For that, this study will identify the predictors of inadequate health literacy in adult Canadians with type 2 diabetes, and explore how it affects several components of diabetes management and outcomes.

How are we going to conduct this study?

This study is guided by an integrative model of health literacy, and will be based on data from “Alberta’s Caring for Diabetes” (ABCD) project.  One of the main studies within the ABCD project is a cohort study that explores different aspects of diabetes care and outcomes.  Data for this cohort study will be collected through a mail-out survey addressing general socio-demographics, medical history, self-care and health behaviors, comorbidities and complications, depressive symptoms, health literacy, self-efficacy, diabetes-related problems, and general health status and health-related quality of life.  Participants for this study will be recruited from Primary Care Networks in Alberta, and the target sample size is 5000.  The cohort survey data will be linked with the Alberta Diabetes Surveillance System database, and will be analyzed using several statistical methods including bivariate statistical analyses, multiple regression analyses, and structural equation modeling.

What would the findings of this study add?

The findings of this study will improve our understanding of the predictors of health literacy and its association with several components of diabetes care and health outcomes, and thus the factors that influence the health of Albertans with diabetes.  This in turn will provide more direction to health researchers and stakeholders in planning and designing disease management and care delivery strategies based on people’ needs.  Subsequently, this would enhance access to and utilization of health care services, improve self-care management behaviors, improve overall patient outcomes, and prevent “preventable” adverse outcomes and costs.  The proposed model would also be applicable to other chronic conditions with similar self-care management demands and care delivery processes.


Recent Literature from the ACHORD Journal Club

(paper discussed Monday, July 18, 2011; Commentary by Robin Lau):

Zeng, F., et al. The impact of value-based benefit design on adherence to diabetes medications: a propensity score-weighted difference in difference evaluation. Value in Health, 13(6), 846-852. PMID: 20561344

What was the study about?

Many drugs are often not taken as prescribed, which may lead to undesirable clinical outcomes including suboptimal control of chronic disease or unnecessary hospitalizations. This study evaluated a value-based benefit design (VBBD) on its ability to increase adherence by promoting optimal consumptions of high value treatments for chronic diseases, such as diabetes drugs. The VBBD aim is to align drug adherence to high value drugs through adjustment of patient copayment. Patient contributions are based on the potential for clinical benefit; lower copayments are established for individuals who will benefit the most and higher copayments are established for individuals who will benefit the least. The study used pharmacy claims data from MedImpact Healthcare Systems, Inc., Health Alliance Medical Plans’ (HAI) Pharmacy benefits management company. The authors used a propensity-score weighted difference-in-difference method. A weighted logistics model was used to predict the effects of VBBD on adherence.

What were the results of the study?

Inclusion into the study required patients to have at least one diabetes medication claim from January 1, 2005 to December 31, 2007. Case group (n=71) included members enrolled in the Carle Clinical plan who had VBBD implemented, and the control group (n=5038) included members in HAI’s commercial managed care section. After propensity score weighting there were no statistical differences in baseline copayment, days of supply, and copayment per 30 days of supply. The results show that after the implementation of VBBD, the average copayment per 30 day supply of diabetes medication decreased from $15.3 to $10.1 and 14 increased from $14.6 to $15.1 in the case and control groups, respectively. The proportion of adherent patients in the case group increased from 75.3% to 82.6% and in the control group decreased from 79.1% to 78.5%. The authors conclude that VBBD resulted in a 36.1% reduction in copayment in the case group and a 30% decrease in the number of non-adherent patients.

What are the implications of the study?

The study addresses the issues of adherence to diabetes medication, which has been a critical challenge to diabetes management. Zeng and colleagues suggest that decreasing copayments may have an effect on adherence rates, which may result in improved clinical outcomes. However, there are several limitations that must be considered when interpreting the results. First, the outcome of adherence is not necessarily the most appropriate outcome as the majority of patients where already good adherers and therefore it may have been difficult to show an improvement on a population level. Measuring glucose control or other diabetes related quality indicators would have added considerable strengths to this study. Second, it is questionable whether improved adherence to glucose lowering therapies would translate into clinical benefit. Third, the clinical importance of the results are not clear, especially given the authors secondary analysis where they found a mere 1.2% difference between groups. Finally, the propensity score model did not predict the groups very accurately (c-statistic 0.664). Overall, this study supports VBBD but the magnitude of benefit for adherence to diabetes medications may not be clinically meaningful.


Meet the Trainees:

Calypse Agborsangaya, PhD

Training Program:  Post Doctoral Fellow, Department of Public Health Sciences, U of A

Calypse completed his undergraduate studies in 2002 at the University of Buea, Cameroon, with a bachelor degree in Microbiology and Medical Laboratory Technology. Click here to read more.

Marni Armstrong, BSc (Kinesiology), CSEP-CEP

Training program: PhD in Cardiovascular Sciences, University of Calgary

Marni grew-up on Vancouver Island, and completed her bachelor degree in Kinesiology at Simon Fraser University in Burnaby, BC. Click here to read more.


Fatima Al Sayah, BSN, MS

Training Program: PhD in Interdisciplinary Graduate Studies in public health sciences at the School of Public Health (home department), and nursing at the Faculty of Nursing (joint department), University of Alberta.

Fatima was born and raised in Lebanon in the Middle East. In 2005, she graduated with a Bachelor of Science degree in nursing from the Lebanese University, and in 2007, she obtained a Master of Science degree in nursing with focus on chronic disease management from the American University of Beirut.  Click here to read more.

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