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

Al Sayah FA, Williams B, Pederson JL, Majumdar SR, Johnson JA. Health literacy and nurses’ communication with type 2 diabetes patients in primary care settings. Nurs Res. 2014 Nov-Dec;63(6):408-17. PMID: 25350540

Al Sayah F, Majumdar SR, Egede LE, Johnson JA. Measurement properties and comparative performance of health literacy screening questions in a predominantly low income African American population with diabetes. Patient Educ Couns. 2014 Oct;97(1):88-95. PMID: 25082723

Amusat N, Beaupre L, Jhangri GS, Pohar SL, Simpson S, Warren S, Jones CA. Diabetes that impacts on routine activities predicts slower recovery after total knee arthroplasty: an observational study. J Physiother. 2014 Dec;60(4):217-23. PMID: 25443651

Bottorff JL, Seaton CL, Johnson ST, Caperchione CM, Oliffe JL, More K, Jaffer-Hirji H, Tillotson SM. An updated review of interventions that include promotion of physical activity for adult men. Sports Med. 2014 DOI 10.1007/s40279-014-0286-3.  PMID: 25430599

Butalia S, Patel AB, Johnson JA, Ghali WA, Rabi DM. Association between diabetic ketoacidosis hospitalizations and driving distance to outpatient diabetes centres in adults with type 1 diabetes mellitus. Can J Diabetes. 2014 Dec;38(6):451-5. PMID: 24821389

Butalia S, Lewin AM, Simpson SH, Dasgupta K, Khan N, Pilote L, Johnson JA, Ghali WA, Rabi DM. Sex-based disparities in cardioprotective medication use in adults with diabetes. Diabetol Metab Syndr. 2014 Nov 5;6(1):117. eCollection 2014. PMID: 25419242

Doherty C, Nickerson D, Southern DA, Kieser T, Appoo J, Dawes J, De Souza MA, Harrop AR, Rabi D; Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. Trends in postcoronary artery bypass graft sternal wound dehiscence in a provincial population. Can J Plast Surg. 2014 Fall;22(3):196-200.
PMID: 25332650

Johnson JA. The safety of sulfonylurea therapy in type 2 diabetes: have we reached the practical limits of our evidence base? Diabetologia 2015 58(1):1-3. PMID: 25322844

Johnson JA, Al Sayah F, Wozniak L, Rees S, Soprovich A, Qiu W, Chik CL, Chue P, Florence P, Jacquier J, Lysak P, Opgenorth A, Katon W, Majumdar SR. Collaborative Care Versus Screening and Follow-up for Patients With Diabetes and Depressive Symptoms: Results of a Primary Care-Based Comparative Effectiveness Trial. Diabetes Care. 2014 Dec;37(12):3220-6. PMID: 25315205

Padwal R, Lin M, Etminan M, Eurich DT. Comparative effectiveness of olmesartan and other angiotensin receptor blockers in diabetes mellitus: retrospective cohort study. Hypertension. 2014 May;63(5):977-83. PMID: 24535009

Seida JC, Mitri J, Colmers IN, Majumdar SR, Davidson MB, Edwards AL, Hanley DA, Pittas AG, Tjosvold L, Johnson JA. Clinical review: Effect of vitamin D3 supplementation on improving glucose homeostasis and preventing diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2014 Oct;99(10):3551-60. PMID: 25062463

Taylor LM, Johnson ST, Vallance JK, Stadnyk J, Basualdo-Hammond C. Food and physical activity behaviours of adults attending a prediabetes education class. Canadian Journal of Diabetes 2014 Dec;38(6):432–438. PMID: 24933108

Tricco AC, Ashoor HM, Antony J, Beyene J, Veroniki AA, Isaranuwatchai W, Harrington A, Wilson C, Tsouros S, Soobiah C, Yu CH, Hutton B, Hoch JS, Hemmelgarn BR, Moher D, Majumdar SR, Straus SE. Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. BMJ. 2014 Oct 1;349:g5459. PMID: 25274009

Warkentin LM, Majumdar SR, Johnson JA, Agborsangaya CB, Rueda-Clausen CF, Sharma AM, Klarenbach SW, Karmali S, Birch DW, Padwal RS. Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study. BMC Med. 2014 Oct 15;12(1):175. PMID: 25315502

Weaver RG, Hemmelgarn BR, Rabi DM, Sargious PM, Edwards AL, Manns BJ, Tonelli M, James MT. Association between participation in a brief diabetes education programme and glycaemic control in adults with newly diagnosed diabetes. Diabet Med. 2014 Dec;31(12):1610-4. PMID: 24890340

Weir DL, Johnson ST, Mundt C, Bray D, Taylor L, Eurich DT, Johnson JA. A primary care based healthy-eating and active living education session for weight reduction in the pre-diabetic population. Prim Care Diabetes. 2014 Dec;8(4):301-7. PMID: 24582002

Weir DL, McAlister FA, Senthilselvan A, Minhas-Sandhu JK, Eurich DT. Sitagliptin use in patients with diabetes and heart failure: a population-based retrospective cohort study. JACC Heart Fail. 2014 Dec;2(6):573-82. PMID: 24998080

Recent Presentations

Leslie WD, Morin SN, Lix LM, Majumdar SR. Does diabetes modify the effect of FRAX risk factors for major osteoporotic and hip fracture prediction? J Bone Miner Res. 2014. American Society of Bone and Mineral Research Annual Meeting, Houston, TX, September 12-15, 2014.

Gill RS, Majumdar SR, Agborsangaya C, Rueda-Clausen C, Birch DW, Karmali S, Klarenbach S, Sharma AM, Padwal RS. Weight loss and obesity-related outcomes of gastric bypass, sleeve gastrectomy, and gastric banding in patients enrolled in a population-based bariatric program: prospective cohort study. Can J Surg. 2014. Canadian Surgery Forum, Vancouver, BC, Sept 17-21, 2014. “Canadian Journal of Surgery Editor’s Choice Award” for best abstract presented at the annual scientific meeting.

Wozniak L, Johnson JA, McAlister FA, Beaupre LA, Bellerose D, Rowe BH, Majumdar SR. Patient perspectives on prescription treatments for osteoporosis: “It was recommended, not required.” Int J Qual Methods. 2014. Presented at the 20th Annual Qualitative Health Research Conference, Victoria, BC, Oct 21-23, 2014.

Johnson ST, Lytvyak E, Eurich DT, Taylor L, Johnson JA, Vallance J. Ambulatory activity and diabetes risk from the Alberta older adult health behaviour (ALERT) study. Canadian Diabetes Association Professional Conference, Winnipeg, MB, October 22-25, 2014.

Johnson ST, Lier D, Soprovich A, Mundt C, Johnson JA. Cost-effectiveness of increasing physical activity in primary care. Canadian Diabetes Association Professional Conference, Winnipeg, MB, October 22-25, 2014.

Johnson ST, Mundt C, Boule N, Bell G, Vallance J, Taylor L, Johnson JA. Improved functional status following the aquatic physical exercise for arthritis and diabetes (APEXD) study. Canadian Diabetes Association Professional Conference, Winnipeg, MB, October 22-25, 2014.

Johnson ST, Mundt C, Soprovich A, Wozniak L, Qiu W, Plotnikoff R, Johnson JA. Increase in daily steps after an exercise specialist led lifestyle intervention for adults with type 2 diabetes in primary care: a controlled implementation trial. Canadian Diabetes Association Professional Conference, Winnipeg, MB, October 22-25, 2014.




12th Annual ACHORD Retreat

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


Hold the Date


14th Symposium of the International Diabetes Epidemiology Group (IDEG)

Dec 5-6, 2015 (Sat-Sun)
Marriott Pinnacle Downtown Hotel – Vancouver, Canada


IDEG is now accepting abstract submissions for the meeting in 2015.

IDEG logoSubmit an Abstract:

Submission Deadline: July 31, 2015
Notification of Acceptance: Early September 2015











Congratulations Dr. Dean Eurich!

Congratulationsto Dr. Dean Eurich on receiving a Canada Research Chair Tier II in Chronic Disease Prevention and Management. Dean is one of three professors in the School of Public Health that hold this prestigious award. This award will enable Dean to continue his research on how to improve the quality and efficiency of care for people living with chronic diseases.

Dean also holds a Population Health Investigator award from Alberta Innovates-Health Solutions (formerly Alberta Heritage Foundation for Medical Research) and a New Investigator Award from Canadian Institutes of Health Research.

For more information on the Canada Research Chair program, please click here.

Report from the Chair

Hello everyone! It has been a very busy fall. Here is a quick update on what we have been doing since our last newsletter.

ACHORD members have been busy preparing for various upcoming conferences in 2015, especially those with abstract deadlines early in the new year. Some conferences ACHORDians have recently attended are: Canadian Diabetes Association Annual Conference (CDA) in Winnipeg, the 2014 Qualitative Health Research Conference both held in October and the Accelerating Primary Care Conference (APCC) held in November.

An important update to let you know about is that as of December 31, I will be stepping down from my position as Scientific Director of the Diabetes, Obesity and Nutrition Strategic Clinical Network (DON SCN) as of December 31. I enjoyed this inaugural and challenging position and am pleased with progress we made, and especially the role our SCN has played in strengthening or establishing new programs of research in the province. However, I felt it was important to return my full attention to our research agenda with ACHORD, and will be working hard in the coming months to secure ongoing funding for ACHORD.

We bid farewell to two employees in November, Dr. Serena Humphries and Dr. Calypse Agborsangaya. Serena stepped down from her position as Assistant Scientific Director of the Diabetes, Obesity and Nutrition Strategic Clinical Network to accept a position as a Research Associate in the Department of Family Medicine. Calypse has stepped down from his position of Research Associate to accept a position as an epidemiologist with Alberta Health. We are sorry to see them go, but wish them all the best in their new roles.

We have been busy creating reports and presentations from the various Alberta’s Caring for Diabetes (ABCD) project activities in the past few months. The ABCD cohort continues to collect data from the 2040 participants with type 2 diabetes in Alberta. We have completed measurements for year 1 and year 2 and are half way through year 3 survey assessment for the ABCD cohort study, with retention of more than 80% of our 2040 participants. We will be working with Alberta Health in the near future to link the cohort survey data to administrative healthcare utilization data. Further, several analyses using the cohort data have been conducted and presented at national and international conferences, including: diabetic foot disease, self-care and clinical monitoring; diabetes distress, depressive symptoms and risk of severe hypoglycemia; and health literacy and health-related quality of life.

The accelerometer sub-study of ABCD cohort study participants was undertaken to more objectively assess physical activity levels, sleep quality and food intake. To date, approximately 185 people have augmented their cohort study survey data with more detailed assessments of these aspects of their lives via accelerometer and 3-day food record. Ongoing analysis will provide further insight into relationship and significance of these lifestyle variables on various health and quality of life outcomes.

The primary paper describing the clinical outcomes from our TeamCare study was published in November in Diabetes Care. We are working on our cost-effectiveness analysis for the interventions studied in the TeamCare study and we hope to share those results in the near future. We also recently finished the cost-effectiveness analysis of the HEALD study, and presented these results at the CDA meeting in Winnipeg. We estimated HEALD to cost $340 per participant to implement, and the difference in total costs (HEALD + health care resources) between the groups was $102 per participant. The resulting incremental cost-effectiveness ratio was $111 per 1000 steps/day. This is less than our estimated threshold, indicating HEALD may be cost-effective. Policymakers, such as those working in Alberta Health Services and managing Primary Care Networks, must now determine the societal value of an additional 1000 steps/day.

Finally, I would like to highlight two upcoming meetings that may be of interest to those of you involved in research. Canada is hosting the next International Diabetes Federation (IDF) World Diabetes Congress (WDC) in Vancouver in November 2015. Related to this, the International Diabetes Epidemiology Group (IDEG) is hosting a satellite symposium to WDC, also in Vancouver on December 5-6, with a trainee workshop on December 7, 2015. I have had the pleasure of working with the international organizing committee and chairing our local organizing committee for IDEG 2015. The call for abstracts is out, and I encourage everyone to consider contributing to these international meetings, and in particular the IDEG symposium.

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 spring with more on ACHORD’s activities.


Project Update

TeamCare results published in Diabetes Care – patients improved their depressive symptoms

By: JA Johnson, F Al Sayah, L Wozniak, S Rees, A Soprovich, W Qiu, SR MajumdarWe are pleased to share that recently, the ABCD project TeamCare intervention results were published in Diabetes Care. People with type-2 diabetes are more likely to develop symptoms of depression, yet less than 50% are recognized and a minority received adequate treatment.  We found that screening and collaborative care are more effective for treating patients with type-2 diabetes and depressive symptoms than non-screening and usual methods of care. The School of Public Health highlighted these results for World Diabetes Day on November 14.

As part of the TeamCare intervention, we screened nearly 2,000 patients in 4 Primary Care Networks, and found that 1 in 4 had depressive symptoms. We followed two groups: an active-control group and a collaborative care treatment group. Patients who received care in the collaborative care model showed greater improvements.  For example, recovery from depressive symptoms occurred in 61% of patients while only 44% of active control group patients achieved recovery.

Both groups showed improvement compared to a similar group of people with type-2 diabetes from our ABCD cohort. These people had depressive symptoms, but were not identified as such to their family physician. Our findings suggest that if additional resources are available, the greatest improvements in depressive symptoms for people with type-2 diabetes could be achieved through collaborative TeamCare.

We are currently working on the cost-effectiveness analysis for the intervention or two groups. We hope to share those results in the near future.


Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, November 4, 2014; Commentary by Jenelle Pederson)

Kivimäki M, Virtanen M, Kawachi I, et al. Long working hours, socioeconomic status, and the risk of incident type 2 diabetes: a meta-analysis of published and unpublished data from 222,120 individuals. Lancet Diabetes & Endocrinology 2014. Published online Sept 25. DOI:10.1016/S2213-8587(14)70178-0. PMID: 25265244

Rationale for the study

It is unclear how working hours effect health among individuals. Long working hours may be associated with type 2 diabetes, a highly prevalent and burdensome disease. Studies suggest that working long hours is associated with diabetes risk factors and cardiovascular disease, a complication of type 2 diabetes. Recent findings suggest that the association between working hours and cardiovascular disease may be moderated by socioeconomic status (SES), leaving individuals working lower status jobs at increased risk. This study evaluates the hypothesis that long working hours is more strongly associated to incident type 2 diabetes among individuals in low SES occupations than those who work in high SES occupations.

Summary of the study

The study was a random-effects meta-analysis of 4 published cohorts and 19 unpublished cohorts from the USA, Europe, Japan, and Australia retrieved by a systematic search of PubMed and Embase up to April 30, 2014 and supplemented by individual-level data from open-access data archives and the Individual-Participant-Data Meta-Analysis in Working-Populations Consortium. Eligibility criteria were: English language, cohort design, effect of working hours or overtime on incident diabetes, individual-level exposure and outcomes data, and information for relative risks (RRs), odds ratios (ORs), and hazard ratios (HRs). In individual participant data (IPD), long working hours was defined as > 55 hrs/wk and normal working hours (reference) as 35-40 hrs/wk; SES was defined by occupation title. Authors used working hour categories from published studies that were closest to IPD definitions. Diabetes was identified by blood testing, or records from health registers or self-reports. I2 statistic assessed heterogeneity. Effect-modification was assessed by stratifying study-specific analyses and pooled study-specific estimates by low, intermediate, and high SES. Covariates were age, sex, smoking, BMI, physical activity, and alcohol consumption, and shift work. In IPD, ORs approximated RR and were combined with HRs. For published estimates, ORs and HRs were regarded as relative risk ratios.


1664 published studies were identified and 222,120 men and women were included. Among these, 4963 incident cases of diabetes occurred over 1.7 million person-years (incidence 29 per 10,000 person-years (PY). Mean follow-up was 7.6 yrs and mean diabetes incidence was 28.8 per 10,000 PY (range 9-87, 70% of variation due to differences in age and sex distributions, follow-up duration, and diabetes ascertainment). Minimally adjusted summary risk ratio for long working hours compared to normal hours was 1.07 (95% CI 0.89-1.27, difference of 3 per 10,000 PY) with significant heterogeneity (I2=53%, p=0.0016). Relative risks were similar for unpublished and published studies. Once stratified by SES, the risk ratio for working long hours compared to normal hours in the low SES group was 1.29 (95% CI 1.06-1.57, difference of 13 per 10 000 PY) with no heterogeneity (I2=0%, p=0.6981) and was null in the high SES group (1.00, 95% CI 0.80-1.25, I2=10%, p=0.3377; pinteraction=0·0965, pone-tailed=0·0483). The association between long working hours and diabetes in the intermediate SES group was marginal (1.13, 0.88-1.44, difference of 4 per 10 000 PY). The association in the low SES group was robust to multivariable-adjustment (risk ratio 1.26, 95% CI 1·02–1·56, difference of 12 per 10 000 PY). Sensitivity analysis found no evidence of reverse causation.


The findings support the original hypothesis that long working hours is more strongly associated to developing type-2 diabetes among low socioeconomic status workers with almost 30% greater risk than normal working hours. Overall, this is a sophisticated design and well-written report. The review updates previous studies, including a meta-analysis of 453 incident diabetes cases where no overall association between work stress and diabetes was found but SES was not considered. In taking account of SES patterns, the review also offers a potential explanation for conflicting results among single studies of working hours and diabetes.

The use of unpublished individual-level data in systematic reviews can raise questions on reliability, but advantages include large sample size, reduced publication bias, and control for confounders. The authors offer a good discussion on mechanisms underlying the association between working hours and diabetes. They suggest working hours may be a marker for other unmeasured risk factors, such as low pay or financial burden among low SES workers, where the risk seen in low SES workers results from residual confounding. Authors also considered indirect effects since working hours might displace health restorative behaviours like sleep and physical activity.

Further questions may include whether covariates like BMI are adequate proxies for unhealthy behaviours, the role of depressive symptoms and sleep disturbances, or differences in resiliency to stress among SES groups.


Meet the Student

Maxim Eskin, BPharm with honours

Training Program:  MSc Health Policy Research

School of Public Health, University of Alberta

Maxim was born and raised in Kaluga, Russian Federation. He was an EMT- Paramedic for almost 5 years, but got tired of “action” and decided to change direction to pharmaceutical studies. Maxim received his B Pharm with honours.

As a project for his bachelor degree, Maxim participated in the “Study of Pharmacist Intervention in Diabetes Treatment”. After graduation, Max worked as a retail pharmacist for 3 years, his last position was as a Pharmacy Manager.

Max’s main interests are Pharmacoepidemiology, Pharmacovigilance and Drug Interactions. He possesses a strong background in Clinical Pharmacology and Medical Treatment of Chronic Diseases. Max is currently pursuing his Masters degree under the direction Drs. Dean Eurich and Scot Simpson. Max is also doing an internship in the Medicine Shoppe Pharmacy in order to obtain his Canadian pharmacist license.

Outside of work, Max enjoys sports, especially basketball and has a hobby of learning languages.


Recent Presentations (Cont)

Wozniak L, Soprovich AL, Rees SE, Al Sayah F, Majumdar SR, Johnson JA. Contextualizing the Effectiveness of a Collaborative Care Model for Diabetes & Depression in Primary Care: A Qualitative Study. Canadian Diabetes Association Professional Conference, Winnipeg, MB, October 22-25, 2014.

Wozniak L, Soprovich AL, Mundt C, Johnson JA, Johnson ST. Contextualizing the Effectiveness of a Lifestyle Intervention in Primary Care: A Qualitative Assessment. Canadian Diabetes Association Professional Conference, Winnipeg, MB, October 22-25, 2014.

Warkentin LM, Majumdar SR, Johnson J, Agborsangaya C, Rueda-Clausen C, Sharma A, Klarenbach SW, Karmali S, Birch DW, Padwal RS. Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study. Obesity. 2014; 22: S93. Presented at the 32nd Annual Scientific Meeting of the Obesity Society, Boston MA, Nov 2-7, 2014. Obesity Week 2014. “Top Ten Abstract Award” for work presented at the annual scientific meeting.

Wozniak L, Soprovich A, Frank L, Johnson ST, Majumdar SR, Johnson JA. Impact of organizational stability on adoption of quality-improvement interventions for diabetes in primary care settings. Accelerating Primary Care Conference, Edmonton, AB November 23-25, 2014.

ACHORD Accolades

Congratulations to:

Bushra Khokhar on successfully completing her Master of Science degree under the supervision of Dr. Doreen Rabi

Dean Eurich on receiving a Canada Research Chair Tier II Award

Ronald Gill et al. for receiving the Canadian Journal of Surgery Editor’s Choice Award at the Canadian Surgery Forum in Vancouver

Lindsey Warkentin et al. for receiving the Obesity Week 2014 Top Ten Abstract Award at the 32nd Annual Meeting of the Obesity Society in Boston


Other ACHORD News

Farewell to Calypse Agborsangaya and Serena Humphries

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