The Year in Review
Mesages from the Chairs of DES and C&SS
Maureen Clement, Aileen Knip
Obesity and Metabolic Syndrome in Football Players
An expert panel recently reported that obesity is “the single greatest threat to public health in this century” and urged Americans to reduce their caloric intake and increase their physical activity (1). We are in worse physical shape than any previous generation. We are more sedentary and heavier. The terms crisis, epidemic and war on obesity are routinely used to describe our society’s health problems. Extensive scientific research during the past century has highlighted the short- and long-term benefits of physical activity and the dangers of a sedentary lifestyle. However, the likelihood of a positive change in behaviour in the general population with regard to diet and exercise appears bleak (2).
Joel Camilo, John H. Helzberg
2011 Canadian Diabetes Association, Young Scientist Award Winner, Minna Woo MD PhD
The National Research Council of the Canadian Diabetes Association (CDA) is pleased to announce that Dr. Minna Woo is the 2011 recipient of the CDA Young Scientist Award. The CDA established the Young Scientist Award in 1987 for the purpose of encouraging, by appropriate recognition, outstanding research conducted in Canada by young scientists (not past their 45th birthday) in the field of diabetes.
Jovita Sundaramoorthy, C. Bruce Verchere
Christmas, Santa Claus, Sugarplums and the Grinch
‘Twas the night before Christmas, when all through the house, Not a creature was stirring, not even a mouse. The stockings were hung by the chimney with care, In hopes that Saint Nicholas soon would be there. The children were nestled all snug in their beds, While visions of sugarplums danced in their heads. From “A Visit from St. Nicholas” by Clement Clarke Moore, 1823 These lines are probably the best-known verses from the poem written by American Clement Clarke Moore in the 19th century. Many scholars arguably believe that this poem may have inspired the popularity of the larger-than-life Santa Claus.
D.C.W. Lau
Self-Reported Health Beliefs, Lifestyle and Health Behaviours in Community-Based Patients with Diabetes and Hypertension
OBJECTIVE: This study describes self-reported health and lifestyle behaviours and health risk beliefs among community patients diagnosed with type 2 diabetes and hypertension. METHODS: Patients with both type 2 diabetes and hypertension were recruited from community family practices across 3 Canadian Maritime provinces. Patients completed a survey targeting health risk beliefs, and health and lifestyle behaviours. Analyses examined differences in patient beliefs by age and sex, as well by health and lifestyle behaviour. RESULTS: Overall, 90.8% of patients believed that controlling both blood pressure and blood glucose were important, particularly women (p<0.01), and 92.8% felt that having both conditions put them at high risk for cardiovascular problems. Older patients reported higher antihypertensive medication adherence (p<0.0001). Most (90.8%) believed that prescription drug use was most helpful for controlling blood pressure, and this belief was associated with medication adherence (p<0.0001). Overall, patients who believed in the benefits of a given lifestyle behaviour were more likely to demonstrate the behaviour. CONCLUSION: The majority of patients surveyed were knowledgeable about their increased risk for cardiovascular problems. Patient lifestyle behaviours tended to mirror their health beliefs. These results provide important insight into the health beliefs and lifestyle behaviours of patients who receive the majority of their care in the community.
Beverley Lawson, Kristine Van Aarsen, Celeste Latter, Wayne Putnam, Nandini Natarajan, Frederick Burge
Prevalence of Metabolic Syndrome Among College Football Linemen
OBJECTIVE: To determine the prevalence of metabolic syndrome among Canadian amateur football players. METHODS: University football players from Saskatchewan were invited to participate in this study. Each subject underwent screening for blood pressure using a BpTRU monitor, and serum cholesterol and fasting blood glucose using a Cholestech LDX analyzer. Waist circumference was recorded and body composition was measured by dual-energy x-ray absorptiometry. Results were compared between linemen and non-linemen using independent sample t-tests for continuous data and chi-square for dichotomous variables. RESULTS: Out of 39 players who consented to participate, 14% of linemen (3/21) and no non-linemen satisfied metabolic syndrome criteria. Compared to non-linemen, linemen had a higher waist circumference (108.0 vs. 82.9 cm; p<0.001), higher total body fat composition (26.4% vs. 11.2%; p<0.001), lower mean high-density lipoprotein cholesterol (0.93 vs. 1.12 mmol/L; p=0.021) and higher fasting blood glucose (5.22 vs. 4.77 mmol/L; p<0.001). CONCLUSION: Despite their young age and participation in an elite-level athletic program, many collegiate-level football linemen had features of metabolic syndrome. Although our study focused on a single team, we suspect these trends may be consistent across the country.
Kerry Mansell, David Blackburn, Bart Arnold, Terra Arnason
Type 2 Diabetes in Vulnerable Populations: Community Healthcare Providers’ Perspectives on Health Service Needs and Policy Implications
OBJECTIVES: To identify a) ways of enhancing health services for vulnerable populations with type 2 diabetes, taking into account the social determinants of health; and b) health and social policy approaches to reducing the incidence of type 2 diabetes and improving its management. METHODS: Focus groups were held with 18 community healthcare providers at 3 community health centres in Toronto, Ontario. RESULTS: Community healthcare providers’ perspectives were organized under 3 themes: a) the compounding effects of social factors on the health of people with diabetes; b)the need for responsive support at multiple levels; and c) barriers to change. Participants showed a good understanding of the impact of social determinants of health on patients’ lives, and they had many ideas about prevention/health promotion and strategies to enhance health services. They seemed less aware of the important role that political advocacy can play. CONCLUSION: Assessment of the policy environment and political advocacy through coalition-building with communities and other health and social sector service providers should become part of healthcare professionals’ education and responsibility. Adequate income and access to proper resources would help with the prevention and optimal management of diabetes.
F. Beryl Pilkington, Isolde Daiski, Elizabeth Lines, Toba Bryant, Dennis Raphael, Mihaela Dinca-Panaitescu, Serban Dinca-Panaitescu
Exposure to Alternative Healthcare Providers and Adherence to Guidelines among Patients with Diabetes
OBJECTIVES: Diabetes is increasing in prevalence across Canada. In the continuously evolving primary care landscape, practitioners from varied training paths are claiming rights to care for patients, including those with diabetes. Little is known about patient exposure to complementary and alternative medicine (CAM) providers, or about such providers’ use of guideline-based monitoring and treatment recommendations. The purpose of this study was to examine compliance with 4 recommendations (influenza vaccination, eye examination, glycated hemoglobin measurement and foot exam) by patients with diabetes who use CAM providers compared to those who exclusively use primary care physicians. METHODS: We analyzed data on 7209 patients with diabetes using the Canadian Community Health Survey. Patients with exposure to CAM providers were compared with individuals who were exposed to a family physician only. Multivariate logistic regression was conducted adjusted for age, sex, duration of diabetes, insulin/oral antihyperglycemic agent use and education. RESULTS: Approximately 4% of persons had been exposed to CAM providers in the preceding year. The odds ratio for receiving influenza vaccination among those exposed to a CAM provider was 0.94 (95% CI 0.74–1.17). The odds ratios for eye examinations in the preceding 24 months, and for foot examinations and glycated hemoglobin tests in the preceding 12 months were 1.02 (95% CI 0.69–1.48), 1.18 (0.83–1.67) and 1.09 (95% CI 0.71–1.66), respectively. CONCLUSION: Our results did not show statistical significance in any of the 4 outcomes analyzed. This study supports others suggesting that persons using CAM providers do so to complement traditional medical care, rather than as an alternative to such care.
Matthew O. Wiens, Brian E. Grunau
Management of Unmet Needs in Type 2 Diabetes Mellitus: The Role of Incretin Agents
The leading cause of morbidity and mortality in type 2 diabetes mellitus is cardiovascular disease. There is a need for type 2 diabetes therapies that act in concert with available agents to provide adequate glycemic control without causing hypoglycemia and weight gain, which are associated with increases in cardiovascular risk. Incretin-based agents—dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists—are the newest class of antihyperglycemic therapies. Liraglutide and exenatide, glucagon-like peptide-1 receptor agonists recently approved in Canada, have been shown to effectively lower blood glucose levels while also having beneficial effects on body weight and systolic blood pressure. The objective of this article is to review and discuss incretin-based agents, with a focus on their effects on blood glucose control, body weight and cardiovascular risk factors in patients with type 2 diabetes. Relevant data were obtained by literature search using the EMBASE, MEDLINE and PubMed databases.
Ronald M. Goldenberg
Volume 35 Author, Title and Keyword Indexes
Volume 35 Author, Title and Keyword Indexes
Congrès annuel 2011 du conseil professionnel de Diabète Québec
Moving Up a Level
Diabetes is characterized by insulin deficiency. In type 1 diabetes, loss of insulin production may be rapid and profound with life-threatening consequences. In type 2 diabetes, loss of insulin production is slower, but progressive and relentless (1). In type 1 diabetes with almost total loss of insulin production, intensive management with basal-bolus insulin or insulin pump therapy is recommended by the Canadian Diabetes Association clinical practice guidelines (2). At the time of diagnosis of type 2 diabetes, about 50% of maximal insulin-producing ability has been lost, and this loss continues at a rate of approximately 5% per year. When insulin production declines to approximately 20% of maximum (±6 years from diagnosis), the individual with diabetes becomes metabolically unstable, glucose levels and glycated hemoglobin (A1C) start to rise into double digits, and insulin is required to restore control.
J. Robin Conway MD, Sarah Capes MD FRCP
De l’intensification de l’insulinothérapie
Le diabète est caractérisé par une carence insulinique. En présence de diabète de type 1, la baisse de la production d’insuline peut être rapide et marquée, ce qui peut menacer le pronostic vital. En présence de diabète de type 2, la baisse de la production d’insuline est plus lente, mais progressive et implacable1. Contre le diabète de type 1, dans lequel la perte de la production d’insuline est presque totale, les lignes directrices de pratique clinique de l’Association canadienne du diabète préconisent un traitement intensif, soit une insulinothérapie basale-bolus ou l’utilisation d’une pompe à insuline2. Au moment du diagnostic de diabète de type 2, la production d’insuline correspond à environ 50 % de la production maximale; la production d’insuline continue par la suite de baisser au rythme d’environ 5 % par année. Quand la production d’insuline n’est plus que d’environ 20 % de la production maximale (environ 6 ans après le diagnostic), le métabolisme de la personne diabétique devient instable, la glycémie et le taux d’hémoglobine glycosylée (HbA1c) épassent le cap des 10 % et une insulinothérapie s’impose pour rétablir l’équilibre.
J. Robin Conway MD, Sarah Capes MD FRCP
Insulin Therapy: Taking Care to the Next Level
Why bother? Why bother, indeed. As the decision to intensify management is being made, it must be remembered that diabetes is a progressive disease that can be managed by achieving well-established glucose targets. Recent major clinical trials have emphasized the importance of reaching these targets to help prevent the long-term vascular complications of diabetes. The United Kingdom Prospective Diabetes Study (UKPDS) (1) examined the benefit of intensive glucose management from the moment of diagnosis and provided some of the most valuable information we have on the long-term management of type 2 diabetes. Similarly, the Diabetes Control and Complications Trial (DCCT) (2) in type 1 diabetes emphasized the value of reaching glucose targets in preventing vascular complications. The subsequent long-term follow-up of these studies, the UKPDS legacy study (3) and the Epidemiology of Diabetes Interventions and Complications (EDIC) trial (4), both emphasized the benefit of early, aggressive management of both type 1 and type 2 diabetes in preventing or delaying vascular complications.
Stuart Ross MB ChB FRACP FRCP(C)
A Practical Guide to Insulin Pump Management in Adults In and Around Hospital
Insulin pumps have become increasingly more prevalent in the management of diabetes in recent years. Currently in North America, about 20% to 30% of patients with type 1 diabetes mellitus are pump users (1). As a result, non-diabetes specialists are encountering these patients throughout the healthcare system, including the inpatient setting. Ideally, hospital personnel knowledgeable in insulin pump therapy should be available to assist patients, and medical and nursing staff (2). However, many institutions currently lack this resource. This article is designed to help non-diabetes specialists manage patients on pump therapy in and around hospital.
Jia Jia Ren MD, Robyn L. Houlden MD FRCPC
Production of materials has been made possible through a financial contribution from the Public Health Agency of Canada.
© 2012 Copyright Canadian Diabetes Association