In This Issue

  • Report from the Chair
  • Project Update
  • ACHORD Seen and Heard
  • Recent Literature
  • Meet the Trainee
  • Meet the Staff
  • Student Accolades
  • Events

Previous Issues

ACHORD Seen and Heard

Recent Publications

Lau RS, Ohinmaa A, Johnson JA. Predicting the future burden of Diabetes in Alberta from 2008 to 2035. Can J Diabetes 2011;35(3):274-281.

Boulé NG, Robert C, Bell GJ, Johnson ST, Bell RC, Lewanczuk RZ, Gabr RQ, Brocks DR. Metformin and Exercise in Ty Type 2 Diabetes: Examining treatment modality interactions. Diabetes Care. 2011 Jul;34(7):1469-74. PMID: 21602430

Oster RT, Johnson JA, Hemmelgarn BR, King M, Balko SU, Svenson LW, Crowshoe L, Toth EL. Recent epidemiologic trends of diabetes mellitus among status Aboriginal adults. CMAJ 2011;183(12):E803-8. PMID: 21788417

Plotnikoff RC, Lippke S, Johnson ST, Hugo K, Rodgers W, Spence JC. Awareness of Canada’s Physical Activity Guide to Healthy Active Living in a large community sample. Am J Health Promot. 2011 May-Jun;25(5):294-7. PMID: 21534830

Plotnikoff RC, Pickering MA, Glenn N, Doze SL, Reinbold-Matthews ML, McLeod LJ, Lau DC, Fick GH, Johnson ST, Flaman L. The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. J Phys Act Health. 2011 Sep;8(7):944-54. PMID: 21885885

Simpson SH, Gamble JM, Mereu L, Chambers T. Effect of aspirin dose on mortality and cardiovascular events in people with diabetes: a meta-analysis. J Gen Intern Med. 2011 Nov;26(11):1336-44. PMID: 21647746

Kieser TM, Lewin AM, Graham MM, Martin BJ, Galbraith PD, Rabi DM, Norris CM, Faris PD, Knudtson ML, Ghali WA; APPROACH Investigators. Outcomes associated with bilateral internal thoracic artery grafting: the importance of age. Ann Thorac Surg. 2011 Oct;92(4):1269-75; discussion 1275-6.PMID: 21958771

Rabi DM, Daskalopoulou SS, Padwal RS, et al. The 2011 Canadian Hypertension Education Program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy. Can J Cardiol. 2011 Jul-Aug;27(4):415-433.e1-2. English, French. PMID: 21801975

Clement FM, Ghali WA, Rinfret S, Manns BJ. Economic evaluation of increasing population rates of cardiac catheterization. BMC Health Serv Res. 2011 Nov 24;11(1):324. PMID: 22115423

Clement FM, Manns BJ, Brownell B, Faris PD, Graham MM, Humphries K, Love M, Knudtson ML, Ghali WA. A multi-region assessment of population rates of cardiac catheterization and yield of high-risk coronary artery disease. BMC Health Serv Res. 2011 Nov 24;11(1):323. PMID: 22115358

Aitken EM, Powelson SE, Reaume RD, Ghali WA. Involving Clinical Librarians at the Point of Care: Results of a Controlled Intervention. Acad Med. 2011 Dec;86(12):1508-1512. PMID: 22030761

Patel AB, Quan H, Faris P, Knudtson ML, Traboulsi M, Li B, Ghali WA. Temporal associations of early patient transfers and mortality with the implementation of a regional myocardial infarction care model. Can J Cardiol. 2011 Nov;27(6):731-8. PMID: 22014858

Januel JM, Couris CM, Luthi JC, … Ghali WA, Colin C, Burnand B; International Methodology Consortium for Coded Health Information (IMECCHI). [ICD-10 adaptation of 15 Agency for Healthcare Research and Quality patient safety indicators]. Rev Epidemiol Sante Publique. 2011 Oct;59(5):341-50. French. PMID: 21899967

Li P, Stelfox HT, Ghali WA. A prospective observational study of physician handoff for intensive-care-unit-to-ward patient transfers. Am J Med. 2011 Sep;124(9):860-7. PMID: 21854894

Januel JM, Luthi JC, Quan H, Borst F, Taffé P, Ghali WA, Burnand B. Improved accuracy of co-morbidity coding over time after the introduction of ICD-10 administrative data. BMC Health Serv Res. 2011 Aug 18;11:194.PMID: 21849089

Ma IW, Brindle ME, Ronksley PE, Lorenzetti DL, Sauve RS, Ghali WA. Use of simulation-based education to improve outcomes of central venous catheterization: a systematic review and meta-analysis. Acad Med. 2011 Sep;86(9):1137-47. Review.PMID: 21785310

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 Sep;27(5):581-8. PMID: 21742466

Shurraw S, Hemmelgarn B, Lin M, Majumdar SR, Klarenbach S, Manns B, Bello A, James M, Turin TC, Tonelli M; for the Alberta Kidney Disease Network. Association Between Glycemic Control and Adverse Outcomes in People With Diabetes Mellitus and Chronic Kidney Disease: A Population-Based Cohort Study. Arch Intern Med. 2011 Nov 28;171(21):1920-1927. PMID: 22123800

Recent Presentations

Gamble JM, McAlister FA, Johnson JA, Eurich DT. Quantifying the Impact of Drug Exposure Misclassification Due to Restrictive Drug Coverage in Administrative Databases: A Simulation Cohort Study. Abstracts of the 27th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, 14-17 August 2011, Chicago, IL. Pharmacoepidemiol Drug Saf 2011; (Suppl 1):S255.

Gamble JM, McAlister FA, Johnson JA, Eurich DT. Misclassifying Drug Exposure Data within Administrative Databases: An Ecologic Approach. Abstracts of the 27th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, 14-17 August 2011, Chicago, IL. Pharmacoepidemiol Drug Saf 2011; (Suppl 1):S255.

Lau D, Hu J, Majumdar SR, Storie DA, Rees SE, Johnson JA. Interventions to increase influenza and pneumococcal vaccinations in community-dwelling adults: a systematic review and meta-analysis. 27th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Chicago, IL,14-17 August 2011. Pharmacoepidemiol Drug Saf 2011;20(Suppl 1):S361.

Bowker SL, Richardson K, Marra CA, Johnson JA. Time-varying risk of breast cancer after onset of type 2 diabetes: Evidence of detection bias in post-menopausal women. 47th EASD Annual Meeting, Lisbon, Portugal, September 12-16, 2011. Diabetologia 2011;54(Suppl. 1):S99.

Majumdar SR, McAlister FA, Johnson JA, Bellerose D, Siminoski K, Hanley DA, Ibrahim Q, Lier D, Lambert RG, Russell AS, Rowe BH. Controlled trial of two interventions to increase osteoporosis treatment in patients with “incidentally” detected vertebral fractures on chest radiographs (NCT00388908). American Society of Bone and Mineral Research Annual Meeting, San Diego, CA, September 16-20, 2011. J Bone Miner Res. 2011; 26 (suppl 1): S74.

Wozniak L, Soprovich A, Rees S, Johnson ST, Mundt C, Johnson, JA. Connecting Research with Practice: Implementation Evaluation of the Alberta’s Caring for Diabetes Project. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):27.

Colmers IN, Bowker SL, Tjosvold LA, Johnson JA. Insulin Use and Cancer Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Observational Studies. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):60.

Colmers IN, Bowker SL, Johnson JA. Thiazolidinediones and Cancer Incidence in Individuals With Type 2 Diabetes: A Systematic Review and Meta-Analysis. [Oral Presentation]. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):2.

Bowker SL, Richardson K, Marra CA, Johnson JA. Time-Varying Risk of Breast Cancer After Onset of Type 2 Diabetes: Evidence of Detection Bias in Post-Menopausal Women. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):60.

Agborsangaya C, Lahtinen M, Lau D, Cooke T, Johnson JA. Multimorbidity and its association with health status among people with diabetes. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):64.

Johnson JA, Rabi DM, Balko SU, Hugel G. Increased Male-Female disparity in diabetes prevalence with increasing income. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):59.

Nerenberg KA, Kaul P, Johnson JA. Risk of Preeclampsia in Pregnant Women with Gestational Diabetes in Alberta. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):11.

Manns BJ, Tonelli M, Zhang J, Campbell DJT, Johnson JA, Sargious P, Lewanczuk R, Laupacis A, McBrien K, Clement F, Ayyalasomayajula B, Hemmelgarn B. The Impact of Alberta’s Primary Care Networks on the Care and Outcomes of Patients with Diabetes. Canadian Diabetes Association Annual Meeting October 26-29, 2011, Toronto, ON. Can J Diabetes 2011;35(Abstract Suppl):20.






Report from the Chair

Another year is quickly coming to an end and, as always, we have been very busy in ACHORD! Here is a quick update on what we have been doing since our last newsletter. First, I should say that we have welcomed a few new faces to the ACHORD group, some of whom are introduced to you in this newsletter.

A major highlight for the fall was the release of the Alberta Diabetes Atlas 2011 in mid-October. This was the third major report we prepared under the ADSS. This latest version of the Atlas included for the first time data on gestational diabetes in Alberta, as well as information on the use of laboratory tests for managing and monitoring people with diabetes in the province. You can read more on the Atlas on our ADSS website. I also encourage you to explore the interactive website for the ADSS data – we have provided a YouTube video tutorial on how to use the website, narrated by Stephanie Balko, our ADSS project manager. You can register on the website, then create your own, local, diabetes surveillance reports!

The Alberta’s Caring for Diabetes (ABCD) project is still going strong. Patients with type 2 diabetes being supported by the pilot interventions in our partner PCN are being followed up over the next year. The ABCD Cohort study is now underway, with surveys being mailed out to people with type 2 diabetes around the province. We held ABCD Advisory Committee and Implementation & Evaluation Steering Committee meeting in November. As always, these meetings give us further direction and input given by its members is most valuable. We are beginning to ramp up activities in evaluation and dissemination, particularly as the Strategic Clinical Networks within AHS become established in the next few months.

ACHORD members participated in many conferences/meetings were attended in late summer/early fall. JM Gamble, Darren Lau and I travelled to Chicago to attend the 27th Annual International Society for Pharmacoepidemiology (ISPE) Meeting in August. September took Samantha Bowker and I to Lisbon, Portugal to attend the 47th European Association for the Study of Diabetes (EASD) Annual Meeting. Samantha presented some of our ongoing work on diabetes and cancer, and I met with the Diabetes and Cancer Research Consortium Steering Committee. ACHORD investigators and trainees were out in full force at the Canadian Diabetes Association Annual Conference in Toronto in October. I was also invited to take part in a very interesting meeting on metformin and neoplasia at the Banbury Center, Cold Spring Harbor Laboratories in New York following the CDA Conference. Michael Pollak from McGill and James Watson from Cold Spring Harbor organized the meeting. It isn’t every day you get to meet a Nobel Prize winner, let along the co-discoverer of DNA, so that was quite a thrill for me.

As the holidays draw closer, we are beginning to plan some of our ACHORD activities for the New Year.  With numerous grant submissions to CIHR in the fall, we are anxious to hear the results of those reviews by the end of January, and get those new research projects underway.  Planning is underway for our 9th Annual ACHORD Retreat in March; our theme this year is “policy relevant research”.  I am also preparing for the upcoming meeting for the international Diabetes and Cancer Research Consortium in Brussels in February.

I hope you all have wonderful holiday season and are able to enjoy some time to relax with friends and family. I look forward to updating you on the ACHORD news again in the New Year!


Project Update

Analysis of drug coverage before and after the implementation of Canada’s Common Drug Review

Gamble JM, Weir D, Johnson JA, & Eurich DT

Publicly funded drug plans in Canada are responsible for a substantial proportion of total drug expenditures and represent the second largest component of health care spending in our country. The Common Drug Review (CDR) was introduced in Canada to provide participating publically funded drug plans with a transparent, rigorous, and consistent approach for assessing the clinical and cost-effectiveness of new drugs. This switch from an individual jurisdiction-based review to a centralized drug review process for new drug products was a major shift in how drugs were evaluated for reimbursement in the public drug plans. To illustrate the potential implications of the CDR policy reform we conducted a detailed pan-Canadian comparison of drug coverage uptake for 198 new drug approvals within the period 5 years before and after the introduction of the CDR.

We observed a decline in the proportion of new drugs listed after the introduction of the CDR for both participating and non-participating provinces (81.1% to 71.3%, p<0.01 for all plans, except Ontario and Quebec [p=0.07]. There are likely many factors beyond the CDR contributing to this decline, including the large amount of clinical and economic uncertainty for may new drugs. The results of this study suggest that the CDR has contributed to a streamlining of the drug review process especially for smaller provinces; therefore, providing quicker access to new drugs for many patients. Although the time to listing for newly approved drugs remained relatively stable for most provinces after the CDR was introduced, we observed a significant decrease in the median time to listing in New Brunswick (255 days), Prince Edward Island (691 days), and Newfoundland and Labrador (385 days). We also observed a significant variation in the agreement between the listing decisions made by public drug plans and the listing recommendations made by the CDR.

Overall, the project has important patient and policy relevance regarding the potential consequences of drug policy reforms and their implementation. Moreover, it is of direct relevance to all Canadians who rely on our publicly funded drug plans for reimbursement of their drugs, as well the drug plans that participate in CDR. This study was recently published in the November 22nd, 2011 issue of the Canadian Medical Association Journal.


Recent Literature from the SPH PhD Journal Club

(paper discussed Thursday, October 27, 2011; Commentary by Robin Lau):

Ormond, B. A., Spillman, B. C., Waidmann, T. A., Caswell, K. J., & Tereshchenko, B. (2011). Potential national and state medical care savings from primary disease prevention. [Research Support, Non-U.S. Gov’t]. Am J Public Health, 101(1), 157-164. PMID: 21088270

What was the study about?

The study is about the cost saving of diabetes and hypertension primary prevention strategies and their 3 associated conditions (heart disease, stroke, and renal disease), specifically risk reduction strategies aimed at modifying unhealthy lifestyles. The effects of primary prevention were modeled out using the Medical Expenditure Panel Survey Household Component Data (MEPS-HC) (2003-2005) to estimate the short run and medium run effects of primary prevention strategies on excess medical costs from diabetes and hypertension by comparing actual medical care expenditure and disease patterns to predicted expenditure and disease patterns. The Current Populations Surveys (CPSs) were used to model out state level estimation. The primary prevention strategy was assumed to have a 1-time reduction on incidence of diabetes and hypertension which was sustained over time.

What were the results of the study?

Results suggest primary prevention strategies would save nearly 9 billion dollars in the short run by reducing the prevalence of uncomplicated diabetes and hypertension prevalence by 5% and primary prevention strategies would save 24.7 billion dollars annually in the medium run by reducing the comorbidities and selected related conditions.

What are the implications of the study?

The authors conclude that primary prevention strategies or risk reduction strategies at the population level has the potential for short run and medium run cost savings for private and public payers. The authors did not consider the implications of severity of disease, costs of the intervention or specify the type of interventions that could achieve the assumed level of disease reduction resulting in cost savings.


Meet the Trainee:

Bushra Khokhar, BSc

Training Program:  Master’s of Community Health Sciences, Epidemiology, Department of Community Health Sciences, University of Calgary

Bushra completed her Bachelors of Science degree in Cell and Molecular Biology at Winona State University, in Minnesota.  She subsequently began working at Mayo Clinic – Rochester, Minnesota after graduation for nearly five years in the Division of Endocrinology, Diabetes and Nutrition primarily focusing on the role of protein turnover, mitochondrial function and insulin resistance in type 2 diabetes, with a special focus on populations with genetic predisposition to the disease as they age.

Eventually she decided to move away from bench science to pursue a master’s degree in Epidemiology at University of Calgary. Keeping in line with her primary interest in type 2 diabetes, she is currently pursuing her thesis under Dr. Doreen Rabi’s supervision.

Bushra is eager to meet and collaborate with fellow ACHORD members, learn and grow in this interdisciplinary environment as she trains for her new career path.


Meet the Staff:

Weiyu Qiu, MSc Epidemiology and Mathematics

Data Analyst

Weiyu Qiu was born and grew up in Nanjing, China, a beautiful historic city which does not lack modern elements. Weiyu completed her BSc degree in Applied Mathematics in 2007 at Huazhong University of Science & Technology, Wuhan, China. During her undergraduate study, she gradually discovered her true interest and talent, which brought her to Canada to finish an MSc degree in Statistics at University of Alberta in 2009. Then her desire to spread statistics in health related applications promoted her completion of another MSc degree in Epidemiology at University of Alberta in 2011.

Joining the ACHORD right after her graduation makes Weiyu call herself “a lucky girl”. The job perfectly satisfies her passion in applying statistical methodologies to epidemiologic and biostatistical issues in health sciences, and also allows her to keep close to the friends she made in Edmonton during the past four years. For her spare time, reading, traveling, and photography are the top three things on her list. She also loves what most people think Chinese are good at: table tennis and badminton, but unfortunately, no Chinese Kungfu.


Student Accolades

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

ADI Trainee Travel Award (sponsored by the Alberta Diabetes Institute for travel to meetings) was awarded to Calypse Agborsangaya and Isabelle Colmers to attend the Canadian Diabetes Association (CDA) Annual Meeting in Toronto in October, 2011.  Isabelle was also receipient of a PHS Travel Award for travel to the CDA Meeting.

Isabelle Colmers was awarded the Best Master’s Oral Presentation at the School of Public Health Insights Day held on November 16, 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


ACHORD Christmas Party Photos


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