In This Issue

  • Report from the Chair
  • Project Update
  • ACHORD Seen & Heard
  • Recent Literature
  • ACHORD Accolades
  • Events

Previous Issues

ACHORD Seen & Heard

Recent Publications

Agborsangaya CB, Majumdar SR, Sharma AM, Gregg EW, Padwal RS. Multimorbidity in a prospective cohort: prevalence and associations with weight loss and health status in severely obese patients. Obesity (Silver Spring). 2015 Mar;23(3):707-12. PMID: 25682926

Al Sayah F, Majumdar SR, Egede LE, Johnson JA. Associations between Health Literacy and Health Outcomes in a Predominantly Low-Income African-American Population with Type 2 Diabetes. J Health Communication 2015;20(5):581-588. PMID: 25826448

Bagshaw SM, Stelfox HT, Johnson JA, McDermid RC, Rolfson DB, Tsuyuki RT, Ibrahim Q, Majumdar SR. Long-term association between frailty and health-related quality of life among survivors of critical illness: a prospective multicenter cohort study. Crit Care Med. 2015 May;43(5):973-82. PMID: 25668751

Brennan SL, Yan L, Lix LM, Morin SN, Majumdar SR, Leslie WD. Sex- and age-specific associations between income and incident major osteoporotic fractures in Canadian men and women: a population-based analysis. Osteoporos Int. 2015 Jan;26(1):59-65. PMID: 25278299

Dang TT, Majumdar SR, Marrie TJ, Eurich DT. Recurrent pneumonia: a review with focus on clinical epidemiology and modifiable risk factors in elderly patients. Drugs Aging. 2015 Jan;32(1):13-9. PMID: 25491559

Gamble JM, Johnson JA, McAlister FA, Majumdar SR, Simpson SH, Eurich DT. Limited impact of drug exposure misclassification from non-benefit thiazolidinedione drug use on mortality and hospitalizations from Saskatchewan, Canada: a cohort study. Clin Ther. 2015 Mar 1;37(3):629-42. PMID: 25596665

Huang Y, Abdelmoneim AS, Light P, Qiu W, Simpson SH. Comparative cardiovascular safety of insulin secretagogues following hospitalization for ischemic heart disease among type 2 diabetes patients: a cohort study. Journal of Diabetes & Its Complications 2015;29:196-202. PMID: 25534984

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

Kaul P, Savu A, Nerenberg KA, Donovan LE, Chik CL, Ryan EA, Johnson JA. Impact of gestational diabetes mellitus and high maternal weight on the development of diabetes, hypertension and cardiovascular disease: a population-level analysis. Diabet Med. 2015;32(2):164-73 PMID: 25407209

Leslie WD, Majumdar SR, Morin SN, Lix LM. Why does rate of bone density loss not predict fracture risk? J Clin Endocrinol Metab. 2015 Feb;100(2):679-83. PMID: 25611114

Levin D, Bell S, Sund R, Hartikainen SA, Tuomilehto J, Pukkala E, Keskimaki I, Badrick E, Renehan AG, Buchan I, Bowker SL, Minhas-Sandhu JK, Zafari Z, Marra C, Johnson JA, Stricker BH, Uitterlinden AG, Hofman A, Ruiter R, Keyser de CE, MacDonald TM, Wild SH, McKeigue PM, Colhoun HM, on behalf of the Scottish Diabetes Research Network Epidemiology Group and the Diabetes and Cancer Research Consortium. Pioglitazone and bladder cancer risk: a multi-population pooled, cumulative exposure analysis. Diabetologia 2015;58:493-504. PMID: 25481707

Mann MC, Hobbs AJ, Hemmelgarn BR, Roberts DJ, Ahmed SB, Rabi DM. Effect of oral vitamin D analogs on mortality and cardiovascular outcomes among adults with chronic kidney disease: a meta-analysis. Clin Kidney J. 2015 Feb;8(1):41-8. PMID: 25713709

Mathe N, Van der Meer L, Agborsangaya CB, Murray T, Storey K, Johnson JA, Loitz CC, Johnson ST. Prompted awareness and use of Eating Well with Canada’s Food Guide: a population-based study. J Hum Nutr Diet. 2015;28(1):64-71. PMID: 24580728

McAlister FA, Youngson E, Padwal RS, Majumdar SR. Similar outcomes among general medicine patients discharged on weekends. J Hosp Med. 2015 Feb;10(2):69-74. PMID: 25537769

Rowe BH, Villa-Roel C, Majumdar SR, Abu-Laban RB, Aaron SD, Stiell IG, Johnson JA, Senthilselvan A (for the AIR Investigators). Rates and Correlates of Relapse Following Emergency Department Discharge for Acute Asthma: A Canadian 20-Site Prospective Cohort Study. Chest 2015;147(1):140-9.  PMID: 25340825

Sahnan A, Simpson SH. Effect of an experiential exercise in diabetes management on pharmacy students’ fear and perceived pain of injection and fingertip lancing. Am J Pharm Educ 2015;79:Article 5. PMID: 25741021

Simpson SH, Lee J, Choi S, Vandermeer B, Abdelmoneim AS, Featherstone TR. Mortality risk among sulfonylureas: a systematic review and network meta-analysis. Lancet Diabetes Endocrinol. 2015;3(1):43-51 PMID: 25466239

Skeldon SC, Kozhimannil KB, Majumdar SR, Law MR. The Effect of Competing Direct-to-Consumer Advertising Campaigns on the Use of Drugs for Benign Prostatic Hyperplasia: Time Series Analysis. J Gen Intern Med. 2015 Apr;30(4):514-20. PMID: 25338730

Walker RL, Chen G, McAlister FA, Campbell NR, Hemmelgarn BR, Dixon E, Ghali W,Rabi D, Tu K, Jette N, Quan H; Hypertension Outcome and Surveillance Team. Relationship between primary care physician visits and hospital/emergency use for uncomplicated hypertension, an ambulatory care-sensitive condition. Can J Cardiol. 2014 Dec;30(12):1640-8. PMID: 25475466


13th Annual ACHORD Retreat

March 9-11, 2016
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




12th Annual ACHORD Retreat

The 12th Annual ACHORD Retreat was held on March 19-20, 2015 at the Banff Centre. As in past years, this informal meeting provides an opportunity for ACHORD investigators, collaborators and trainees to share research activities, and plan for continued growth of the ACHORD group.

Thank you to all who presented at the Retreat:
– Sandra Rees on the Alberta Gestational Diabetes Priority Setting Partnership Project
– Sonia Butalia on Environmental Risk Factors for Type 1 Diabetes
– Trainee presentations from Hayford Avedzi, Jenelle Pederson, Travis Featherstone, Qendresa Beka, Danielle Thiel and Chris Chen
– Dean Eurich, Sal Salamani and Lisa Wozniak on the RADAR Project. Dean also presented accolades celebrating ACHORD successes for both students and faculty in the past year
– Jeff and Steve Johnson gave an update on the results of the ABCD TeamCare and HEALD projects, with the presentation of a YouTube video summarizing the engaged scholarship activities of the ABCD project.

As we typically do, we held an organized physical activity this year, a guided yoga class. The class was enjoyed by those who attended. Unfortunately, due to the beautiful weather and scenery in Banff, we had an underwhelming turnout with only 5 ACHORD yogis participating!

Thank you to everyone who attended the 12th Annual Retreat. As is the case every year, this event is a success because of those of you that attend. Special thanks to Sherry Lydynuik who helped Jeff Johnson in planning this year’s ACHORD retreat.

Report from the Chair

Hello everyone! Winter seems to have gone quickly and we are (finally) back in spring weather again! Here is a quick update on what we have been doing since our last newsletter.

As noted elsewhere in our newsletter, we have just held another successful research retreat in Banff. This important event gives our trainees a chance to present some of their ongoing research, leading up to papers and presentations at larger meetings. ACHORD members have had success with abstracts being accepted for various upcoming conferences. Some conferences ACHORDians will be attending in the coming months are CADTH, CAHSPR, and the ADA Annual Meeting in Boston.

With some project funding coming to an end, we will bid farewell to another employee in April, Clark Mundt. We are sorry to see him go, but wish him all the best in his new role.

We had our final Advisory Committee and Implementation and Evaluation Steering committees meeting for the Alberta’s Caring for Diabetes (ABCD) project in January and are currently finalizing our end-of-grant report to Alberta Health. Despite the end of the main project activities, the ABCD cohort continues to collect data from the 2040 people with type 2 diabetes in Alberta who have been taking part in the study since 2010. We have completed measurements for year 1 and year 2 and most of year 3 with retention of more than 80% of our participants. We have submitted data requests to Alberta Health 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; health literacy and health-related quality of life, among others. Several manuscripts have been submitted for publication, and many are underway, and we will continue to explore funding to keep the ABCD cohort running into the future.

We are also excited to see the data emerging from our first sub-study of ABCD cohort study participants, which was undertaken to more objectively assess physical activity levels, sleep quality and food intake. Data from 201 participants who agreed to supplement their cohort study survey data with more detailed assessments of these aspects of their lives by wearing an accelerometer over a 7-day period, and completing a 3-day food record is currently underway. Our results will provide insight into how we measure these behaviours through surveys, and the significance of these lifestyle variables on various health and quality of life outcomes.

Our cost-effectiveness analysis for the interventions studied in the TeamCare study is almost complete and those results should soon be available. We also hope to publish an ABCD-specific supplemental package with a peer reviewed journal later this year. The planned manuscripts will describe the ABCD cohort design and descriptive statistics, challenges reaching people with type 2 diabetes through registries, adoption of the ABCD quality-improvement by PCNs, and the implementation and perceived effectiveness of the main interventions (HEALD, TeamCare).

Finally, a reminder that Canada is hosting the next International Diabetes Federation (IDF) World Diabetes Congress (WDC) in Vancouver in November, 2015. And 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 am working with the international organizing committee and chairing our local organizing committee for IDEG 2015. The call for abstracts is out (see the link in this newsletter and on our website), and I encourage everyone to consider contributing to 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 late summer/early fall with more on ACHORD’s activities.

Project Update

RADAR (Reorganizing the Approach to Diabetes through the Application of Registries)

By: DT Eurich, L Wozniak and S Salamani

The impact of diabetes on First Nations (FN) is well known and is compounded by limited community front-line health care. The RADAR study (Reorganizing the Approach to Diabetes through the Application of Registries), aims to improve clinical care of clients with diabetes through the use of an integrated diabetes registry/electronic medical records system and centralized care coordinator service that will support front-line community health workers in transforming care for FN diabetes patients (e.g. identify and manage care gaps, manage and coordinate referrals, provide education). One large FN community has already been recruited from each of Alberta’s 3 treaty areas. A comprehensive assessment of the program will be completed based on the RE-AIM framework which was designed to assess health interventions beyond effectiveness to include multiple criteria to determine public health impact and transferability. The framework consists of five dimensions: Reach into the target population; Effectiveness of the intervention; Adoption by target settings, institutions and staff; Implementation, including consistency and cost of delivery; and Maintenance of intervention effects over time. The project is innovative as it involves public (the communities), academia (U of A) and private sector (Okaki Health Intelligence) partnerships to improve the care for FN diabetes patients.

Recent Literature from the ACHORD Journal Club

(Paper discussed Tuesday, April 7, 2015; Commentary by Jessica Beatty)

Hermanns N, Schmitt A, Gahr A, Herder C, Nowotny B, Roden M, Ohmann C, Kruse J, Haak T, Kulzer B. Effect of a Diabetes-Specific Cognitive Behavioral Treatment Program (DIAMOS) for Patients With Diabetes and Subclinical Depression: Results of a Randomized Controlled Trial. Diabetes Care. 2015 Apr;38(4):551-60. doi: 10.2337/dc14-1416. PMID: 25605812

Rationale for the study

Approximately 10% of diabetic patients fulfill the criteria for major depression, while almost 20% of diabetic patients are affected by subclinical depression. Similar to depression, subclinical depression is associated with poor prognosis including diabetes complication, disability, and early mortality. DIAMOS (Diabetes Motivation Strengthening) is a new intervention program designed to aid patients in integrating diabetes into their daily life by reducing diabetes-related distress and to develop coping skills regarding diabetes distress. The objective of this study was to determine whether DIAMOS could reduce depression symptoms in diabetics more effectively than standard diabetes education.

Summary of the study

This study was a monocenter, prospective, randomized trial with two treatment groups. Participants were recruited at a German inpatient diabetes center. Eligibility criteria included: diabetes mellitus, elevated depression symptoms, (Center for Epidemiologic Studies Depression Scale [CES-D] score ≥ 16), age ≥ 18 and ≤ 70 years, sufficient German skills, and written informed consent. Exclusion criteria included: major depression, current schizophrenia/psychotic disorder, bipolar disorder, current use of antidepressants, ongoing psychotherapy, being bedridden, and under guardianship. Both interventions consisted of five lessons (90 min each). The control group (CG) intervention was conducted by diabetes educators while the DIAMOS intervention was delivered by certified psychologists. The primary outcome was a reduction in depressive symptoms (using the CES-D) at a 12-month follow up session. Outcomes were analysed using repeated measures ANOVAs and the primary analysis was done by intention-to-treat. 214 eligible patients were randomized and a total of 33 patients were lost to follow-up.


After the 12-month follow-up there was a significant reduction of depressive symptoms (CES-D score) in the DIAMOS group compared with the CG (Difference of 3.9 [95% CI 0.6–7.3], P = 0.021) following a per protocol analysis. A similar result was seen with the intention to treat protocol. For the secondary outcomes, there was no statistical difference for HbA1c, inflammatory biomarkers, and the WHO-5, EQ-5D, AADQ, DTSQ, SDSCA scores between the groups. The DIAMOS group did have a significant reduction in PHQ-9, PAID, and DDS scores compared to the CG.


The authors conclude that the DIAMOS program was more efficient in treating subclinical depression and diabetes distress than the diabetes education alone. Strengths included their power analysis and sample size, and limitations include having a high proportion of type 1 diabetics in the study, which may affect the transferability of their findings to type 2 diabetics.

Furthermore, there were significant discrepancies between the two groups at baseline including a higher proportion of type 1 diabetics in the CG. Therefore, their randomization may not have been effective. Additionally, it was unclear as to how the authors analyzed their results using the repeated measures ANOVAs.

Other questions include the cost-efficiency of the program and how improving depression symptoms can lead to improving glycemic control. These can be questions for future study.

Recent Publications (cont)

Wang S, Majumdar SR, Padwal R. BMI, annual blood pressure measurements, and mortality in patients with obesity and hypertension: a retrospective cohort study. Blood Press Monit. 2015;20(1):32-8 PMID: 25243712

Weir DL, Majumdar SR, McAlister FA, Marrie TJ, Eurich DT. The impact of multimorbidity on short-term events in patients with community-acquired pneumonia: prospective cohort study. Clin Microbiol Infect. 2015 Mar;21(3):264.e7-264.e13. PMID: 25658532

Zanders MM, Haak HR, van Herk-Sukel MPP, van de Poll-Franse LV, Johnson JA. Impact of cancer on adherence to glucose lowering drugs in individuals with diabetes. Diabetologia 2015 May;58(5):951-60. PMID: 25638246

Recent Presentations

Chan AW, Mercier P, Schiller D, Eurich DT, Broadhurst D, Sawyer MB. Urinary metabolomics of gastric cancer. ASCO Gastrointestinal Cancers Symposium, San Francisco, USA. January 15-17, 2015.Johnson JA. A Canadian Value Set for the EQ-5D-5L: One Answer, More Questions. 2015 CADTH Symposium, Saskatoon, SK, April 12-14, 2015.

ACHORD Accolades

Congratulations to:

Marni Armstrong on successfully completing her PhD Oral Examination

Karly Achtymichuk on receiving an Alberta Innovation and Advanced Education Graduate Student Scholarship

Sandra Rees on being named the 2015 University of Alberta School of Public Health Robert Wood Johnson Award Winner

Other ACHORD News

Congratulations to Samantha Bowker on her engagement to Tim Stanistreet

Congratulations to Ahmed Abdelmoneim on his marriage to Dalia Hassaballah

Congratulations to Jashu, Neek and Sahiba Sandhu on the birth of Kishan

Congratulations to Allison, Curtis and Hannah Soprovich on the birth of Kane

Farewell to Clark Mundt

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