In This Issue

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

Previous Issues

ACHORD Seen & Heard

Recent Publications

Abdelmoneim AS, Eurich DT, Senthilselvan A, Qiu W, Simpson SH. Dose-response relationship between sulfonylureas and major adverse cardiovascular events in elderly patients with type 2 diabetes. Pharmacoepidemiol Drug Saf. 2016 Oct;25(10):1186-1195. PMID: 27102581.

Beatty JA, Majumdar SR, Tyrell GJ, Marrie TJ, Eurich DT. Current Smoking and Reduced Mortality in Bacteremic Pneumococcal Pneumonia: A Population-Based Cohort Study. CHEST 2016;150(3):652:660. PMID: 27151328.

Benham JL, Eldoma M, Khokhar B, Roberts DJ, Rabi DM, Kline GA. Proportion of Patients with Hypertension Resolution Following Adrenalectomy for Primary Aldosteronism: A Systematic Review and Meta-Analysis. J Clin Hypertens (Greenwich). 2016;18(12):1205-1212. PMID: 27759187.

Blackburn DF, Evans CD, Eurich DT, Mansell KD, Jorgenson DJ, Taylor JG, Semchuk WM, Shevchuk YM, Remillard AJ, Tran DA, Champagne AP. Community Pharmacists Assisting in Total Cardiovascular Health (CPATCH): A Cluster-Randomized, Controlled Trial Testing a Focused Adherence Strategy Involving Community Pharmacies. Pharmacotherapy. 2016;36(10):1055-1064. PMID: 27581815.

Bowker SL, Savu A, Lam NK, Johnson JA, Kaul P. Validation of administrative data case definitions for gestational diabetes mellitus based on International Classification of Diseases (ICD) coding and the Canadian National Diabetes Surveillance System (NDSS) algorithm. Diabet Med 2017 34(1):51-55. PMID: 26555571.

Butalia S, Kaplan G, Khokhar B, and Rabi DM. Environmental Risk Factors and Type 1 Diabetes: Past, Present, and Future. Can J Diabetes. 2016;40(6):586-593. PMID: 27545597.

Butalia S, Gutierrez L, Lodha A, Aitken E, Zakariasen A and Donovan L. Short and long term outcomes of metformin in pregnancy: A systematic review and meta-analysis. Diabet Med. 2017;34(1):27-36. PMID: 27150509.

Eurich DT, Weir DL, Simpson SH, Senthilselvan A, McAlister FA. Risk of new-onset heart failure in patients using sitagliptin: a population-based cohort study. Diabet Med. 2016;33(5):621-63. PMID: 26206341.

Lo A, Lorenz K, Cor K, Simpson SH. Factors Affecting Number of Diabetes Management Activities Provided by Pharmacists. Can J Diabet 2016;40(6):535-542. PMID: 27373434.

Majumdar SR, Leslie WD, Lix LM, Morin SN, Johansson H, Oden A, McCloskey EV, Kanis JA. Longer Duration of Diabetes Strongly Impacts Fracture Risk Assessment: The Manitoba BMD Cohort. J Clin Endocrinol Metab. 2016;101(11):4489-4496. PMID: 27603908.

Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Asplenic patients and invasive pneumococcal disease — how bad is it these days? Int J Infect Dis. 2016;51:27-30. PMID: 27590561.

McAlister, FA, Youngson E, Eurich DT. Treated Glycosylated Hemoglobin Levels in Individuals with Diabetes Mellitus Vary Little by Health Status: A Retrospective Cohort Study. Medicine. 2016; 95(24): e3894. PMID: 27310986.

Nykiforuk C, McGetrick JA, Crick KC, Johnson JA. Check the Score: Field Validation of Street Smart Walk Score in Alberta, Canada. Prev Med 2016;4:532-539. PMID: 27752462.

Rabi DM, Padwal R. Intensive lowering of blood pressure: Should we SPRINT? CMAJ;188(15):1067-1068. PMID: 27378462.

Simpson SH, Lin M, Eurich DT. Medication Adherence Affects Risk of New Diabetes Complications: A Cohort Study. Ann Pharmacother. 2016;50(9) 741–746. PMID: 27307411.

Stolp S, Bottorff JL, Seaton CL, Jones-Bricker M, Oliffe JL, Johnson ST, Errey S, Medhurst K, Lamont S. Measurement and evaluation practices of factors that contribute to effective health promotion collaboration functioning: A Scoping Review. Eval Program Plann. 2016;61:38-44. PMID: 27915114.

Tereda T, Johnson JA, Norris C, Padwal R, Qiu W, Sharma A, Janzen W, Forhan M. Severe obesity is associated with increased risk of early complications and extended length of stay following coronary artery bypass graft surgery. J Am Heart Assoc 2016;30(5)967-70. PMID: 27250114.

Vallance J, Eurich DT, Gardiner P, Taylor L, Johnson ST. Associations of daily pedometer steps and self-reported physical activity with health-related quality of life: Results from the Alberta Older Adult Health Survey. J Aging Health. 2016; 28(4):661-674. 150 #3, PMID: 26486783.

Recent Presentations

Al Sayah F, Johnson JA, Ohinmaa A, Xie F, Bansback N. Health literacy and logical inconsistencies in health state valuations: Results from the Canadian EQ-5D-5L valuation study. [Poster Presentation] 33rd EuroQol Plenary Meeting, Berlin Sept 15-17, 2016.Eskin, M, Simpson SH, Eurich, DT, Impact of drug exposure definitions on observed association in pharmacoepidemiology research. Alberta Diabetes Institute (ADI) Research Day October 3, 2016, Edmonton, AB.

Eskin M, Simpson SH, Eurich DT. Assessing the effect of exposure definition on an observed association in population based pharmacoepidemiology studies of metformin in type 2 diabetes patients. Canadian Association for Population Therapeutics (CAPT) 2016 Annual Conference, Toronto, ON. October 17-18, 2016.Al Sayah F, Johnson JA, Ohinmaa A, Xie F, Bansback N. Health literacy and logical inconsistencies in health state valuations: Results from the Canadian EQ-5D-5L valuation study. [Oral Presentation] ISOQOL 23rd Annual Conference, Copenhagen, Denmark, October 19-22, 2016. Quality of Life Research 2016:25(Suppl 1):24(A102.4).

Al Sayah F, Johnson JA, Ohinmaa A. The performance of EQ-5D-5L and VR-12 in Assessing Mental Health. [Poster Presentation] ISOQOL 23rd Annual Conference, Copenhagen, Denmark, October 19-22, 2016. Quality of Life Research 2016:25(Suppl 1):94(A1018).

Al Sayah F, Qiu W, Xie F, Johnson JA. Comparative Performance of the EQ-5D-5L and SF-6D in Adults with Type 2 Diabetes. [Poster Presentation] ISOQOL 23rd Annual Conference, Copenhagen, Denmark, October 19-22, 2016. Quality of Life Research 2016:25(Suppl 1):132(A2103).


14th Annual ACHORD Retreat

March 2-3, 2017
Alumni House
University of Alberta Campus
Edmonton, Alberta, Canada


3rd Annual APERSU End User Meeting

November 15-16, 2017
Canmore, Alberta, Canada









Enhancing Alberta’s Infrastructure to Improve Surveillance, Quality of Health Care Delivery and Health Services Research for Diabetes

We are very excited to embark on an effort to re-establish and integrate elements of a comprehensive diabetes surveillance system to integrate administrative health data, clinical laboratory information, self-reported health status and self-care behaviours. This is a collaborative effort between ACHORD, Alberta Health Services, (particularly the Clinical Analytics unit) and the Diabetes, Obesity, Nutrition Strategic Clinical Network (DON SCN). Funding is provided by Alberta Health and coordinated through Alberta Innovates.

Over the past several years, ACHORD has led a number of activities supported by funding from Alberta Health, including the Alberta Diabetes Surveillance System (ADSS) and the Alberta’s Caring for Diabetes (ABCD) Project. The ADSS was established to capitalize on the administrative health data to report on trends of epidemiology, comorbidity and health care utilization of the diabetic population in Alberta. The ABCD project was multifaceted, including quality improvement initiatives within primary care, but also established a prospective cohort of adults living with type 2 diabetes. Funding for both the ADSS and ABCD projects ended in the past few years, but we have continued to follow the ABCD cohort of approximately 2000 adults, now almost 6 years after their initial enrolment. The ABCD cohort has provided rich information about patient-reported health behaviours and health outcomes. We have also linked this survey data with administrative data from Alberta Health, and continue to use these data for various research projects.

With this new collaboration, to begin in January 2017, we have proposed an expansion of the ABCD cohort, to increase the numbers, geographic scope and representativeness of the cohort, but also offer other forms of electronic data capture for the survey responses. Further, we propose to build an infrastructure to integrate patient reported outcomes into a comprehensive diabetes surveillance system, linking available clinical and administrative data sources available within the Clinical Analytics repository at AHS. We believe a comprehensive surveillance system like this would also support health services research and translation of findings for ongoing improvement in front-line diabetes care delivery. This enhanced infrastructure would build on the ABCD research project currently running at ACHORD, but will eventually be migrated into AHS, and stewarded by the DON SCN, to support enhanced surveillance, evaluation of quality of health care delivery, and serve as a rich health services research database for Alberta-based investigators.


Report from the Chair

Here we are, approaching the end of another year that seemed to pass by very quickly. As always, ACHORD Members have been very busy. Here is a quick update on what we have been doing since our last newsletter.The Alberta’s PROMs and EQ-5D Research and Support Unit (APERSU) continues to grow as more groups register to use the EQ-5D. We held the 2nd End User Meeting in November 2016 in Edmonton. We had a good turnout with a lot of local participants as well as provincial, national and international guests.  We received positive feedback on the content of the meeting. We held a Board of Directors and a Scientific Advisory Committee meeting on the second day of the End-User Meeting where we updated members on our activities and shared our Annual Report. As always, we gained excellent feedback from the members of both groups. The 3rd Annual End-User meeting will be held November 15 and 16, 2017 in Canmore.  We will update you when we have secured a venue.

This fall, ACHORD members presented our research at or attended the following conferences/meetings:

  • The European Association for the Study of Diabetes (EASD) Annual Meeting in Munich, Germany.
  • The EuroQol Foundation Annual Plenary in Berlin, Germany.
  • The International Society for Quality of Life Research (ISOQOL) Annual Meeting in Copenhagen, Denmark.
  • The Society for Medical Decision Making (SMDM) Meeting in Vancouver, British Columbia.
  • Canadian Association for Population Therapeutics (CAPT) Meeting in Toronto, Ontario.
  • The Canadian Diabetes Association (CDA) Annual Meeting in Ottawa.

We are holding the ACHORD Retreat in Edmonton in 2017, a change from our usual journey to Banff. The retreat will be held March 2 and 3, 2017 at Alumni House, University of Alberta Campus. We are happy to be hosting this year’s ACHORD retreat in conjunction with a Collaborative Research Summit hosted by the Diabetes Obesity and Nutrition Strategic Clinical Network.

Looking forward, ACHORD will be represented at the EuroQol Foundation mid-year meeting in Amsterdam; the Diabetes and Cancer Research Consortium (DCRC) will be held in Nyborg, Denmark, and the Canadian Agency for Drugs and Technologies in Health (CADTH) symposium in Ottawa.

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 spring on ACHORD’s activities. In the meantime, I would like to wish everyone a very safe and happy holiday season and all the best in 2017.


Project Update

Alberta Retired Teachers Association (ARTA) Diabetes Strategy

By: A Soprovich and JA Johnson

Project Summary

Over the past year, we’ve partnered with the Alberta Retired Teachers Association (ARTA), working on their diabetes strategy. Back in February 2016, we conducted a Health & Wellness survey, intended to assess current health and wellness behaviours, activities and risk factors among ARTA members. As well, we asked for consent to anonymously link survey responses with data from Alberta Health. This will enable us to examine health care utilization and enrich our understanding of the health of the ARTA membership. For those who reported having diabetes, we asked extra questions about their self-care activities, quality of clinical care and complications.

2,514 people completed the survey. Highlights include:
• Most ARTA respondents are healthy – 69% report being in Excellent or Very Good health;
• Most respondents reported eating healthy, exercising daily, and were vaccinated against influenza;
• Respondents have good social support and very high food security;
• Few respondents smoke or feel depressed;
• 66% of respondents are considered overweight or obese (according to BMI);
• 33% of respondents have diabetes or are at high risk for developing diabetes;
• 82% of respondents are taking prescription medications; the average number is 3;
• 40% of respondents reported having arthritis – the top chronic disease reported, followed by high lipids (25%), back problems (24%), and cataracts (23%).

Among those who reported having diabetes (approximately 11%):
• 74% reported having their eyes checked in the past year;
• only 48% reported a health professional had checked their feet for sores or irritation, and only 40% had their feet checked for loss of feeling in the past year.

These results will help inform ARTA health and wellness program planning and health benefit plans. Currently, we are revising the survey to administer in 2017, aiming to have more respondents.


Recent Literature from the ACHORD Journal Club (Paper discussed Wednesday, November 1, 2016; Commentary by Ben Dubois)

Pantalone KM, Wells BJ, Chagin KM, Ejzykowicz F, Yu C, Milinovich A, Bauman JM, Kattan MW, Rajpathak S, Zimmerman RS. Intensification of Diabetes Therapy and Time Until A1C Goal Attainment Among Patients With Newly Diagnosed Type 2 Diabetes Who Fail Metformin Monotherapy Within a Large Integrated Health System. Diabetes Care 2016;39(9):1527-34 PMID: 27519447


“Clinical inertia” has been used to describe the delay in the intensification of type 2 diabetes treatment among patients with poor glycemic control. Previous studies may have exaggerated the prevalence of clinical inertia by failing to adequately monitor drug dose changes and non-medication interventions. This project evaluated the intensification of diabetes therapy and hemoglobin A1c (A1C) goal attainment among patients with newly diagnosed type 2 diabetes when metformin monotherapy failed.

Study Methods and Summary of Findings

The electronic health record at Cleveland Clinic was used to identify patients with newly diagnosed type 2 diabetes between 2005 and 2013 who failed to reach the A1C goal after 3 months of metformin monotherapy. A time-dependent survival analysis was used to compare the time until A1C goal attainment in patients who received early intensification of therapy (within 6 months of metformin failure) or late intensification. The analysis was performed for A1C goals of 7% (n = 1,168), 7.5% (n = 679), and 8% (n = 429). The researchers concluded after analysis that a substantial number of patients with newly diagnosed type 2 diabetes fail to undergo intensification of therapy within 6 months of metformin monotherapy failure. Early intervention in patients when metformin monotherapy failed resulted in more rapid attainment of A1C goals.


We began our discussion with an overall explication of the study as no one in the group was familiar with this study. The discussion began to focus at first around the criteria for diabetes treatment and how there is a potential that the results in the study are found because of doctors not following the standard treatment plan for type 2 diabetes. There is a potential that the personal treatment plans for certain patients might be different, but it is tough to justify keeping a patient’s A1C value higher than it could be – there must be other contributing factors to anyone who does fall into that category (comorbidities, etc.) We discussed the possibility that the lack of progression in drug therapy is only one side of the equation – the patient may be less inclined to take up a lifestyle change to further their diabetes management, and may take a drug after only serious problems occur, or that the physician may be waiting for the patient to go and improve their lifestyle before they force a prescription on them. We also noted that the study says most patients in the three categories of A1C values did eventually get a therapy escalation within the bound of two years, so it was not as if there was no follow up at all, but the delay in escalation may lead to complications which could have been avoided.

This discussion was also used to highlight potential disconnects between treatment plans or guidelines and physicians. Another member noted that the data comes from period of economic downtime in the US which may contribute to incidence of diabetes in this population.

One major potential issue with this paper is the fact that it is sponsored by major drug manufacturers: Merck, NovoNordisk (all can be found at the end of the paper). A group member noted that Merck makes one of the most popular progression therapy drugs from metformin (Janumet – a metformin/sitagliptin combo drug) and in addition to it being popular, it is very safe and well tested. It is important to note this potential conflict of interest in a paper which suggests the addition of drug therapy as the manufacturer would prefer to increase output of their product.


Recent Presentations (cont)

McClure N, Al Sayah F, Ohinmaa A, Johnson JA. Estimating a minimally Important Difference of the EQ-5D-5L in Adults with Type 2 Diabetes. [Poster Presentation] ISOQOL 23rd Annual Conference, Copenhagen, Denmark, October 19-22, 2016. Quality of Life Research 2016:25(Suppl 1):133(A2107).

Nagase FN, Al Sayah F, Ohinmaa A, Johnson JA. Health-related quality of life of adults with type 2 diabetes reporting diabetic foot disease. ISOQOL 23rd Annual Conference, Copenhagen, Denmark, October 19-22, 2016. Quality of Life Research 2016:25(Suppl 1):133(A2109).

Al Sayah F, Johnson JA, Ohinmaa A, Xie F, Bansback N. Health literacy and logical inconsistencies in health state valuations: Results from the Canadian EQ-5D-5L valuation study. [Poster Presentation] 38th Annual North American Society for Medical Decision Meeting (SMDM), Vancouver, BC October 23-26, 2016.

Al Sayah F, Johnson JA, Ohinmaa A. The performance of EQ-5D-5L and VR-12 in Assessing Mental Health. [Oral Presentation] 38th Annual North American Society for Medical Decision Meeting (SMDM), Vancouver, BC October 23-26, 2016.

Finley CR, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich DT, Vandermeer B, Allan GM. What are the most common conditions in primary care? A systematic review. Campus Alberta Student Conference on Health, September 11, 2016, Calgary AB (oral presentation). International Forum on Public Health Education, Edmonton, AB November 2, 2016.


ACHORD Accolades

Congratulations to Fernanda Nagasse on successfully completing her Master of Science Oral Exam.

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