{"title":"What Can We Learn From Studying Diabetes in Diverse Populations?","authors":"Elizabeth A.C. Sellers MD, MSc, FRCPC","doi":"10.1016/j.jcjd.2024.01.003","DOIUrl":"10.1016/j.jcjd.2024.01.003","url":null,"abstract":"","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandra Berezowsky MD , Nir Melamed MD , Beth Murray-Davis PhD , Joel Ray MD , Sarah McDonald MD , Jon Barrett MD , Michael Geary MD , Elena Colussi-Pelaez MB, BCh, BAO , Howard Berger MD
{"title":"Impact of Antenatal Care Modifications on Gestational Diabetes Outcomes During the COVID-19 Pandemic","authors":"Alexandra Berezowsky MD , Nir Melamed MD , Beth Murray-Davis PhD , Joel Ray MD , Sarah McDonald MD , Jon Barrett MD , Michael Geary MD , Elena Colussi-Pelaez MB, BCh, BAO , Howard Berger MD","doi":"10.1016/j.jcjd.2023.12.002","DOIUrl":"10.1016/j.jcjd.2023.12.002","url":null,"abstract":"<div><h3>Background</h3><p>Many of the adverse outcomes<span> of gestational diabetes mellitus (GDM) are linked to excessive fetal growth, which is strongly mediated by the adequacy of maternal glycemic management. The COVID-19 pandemic led to a rapid adoption of virtual care models. We aimed to compare glycemic management, fetal growth, and perinatal outcomes before and during the COVID-19 pandemic.</span></p></div><div><h3>Methods</h3><p>A retrospective cohort study was conducted between 2017 and 2020. Singleton pregnancies complicated by GDM were included in the study. The cohort was stratified into “before” and “during” COVID-19 subgroups, using March 11, 2020, as the demarcation time point. Women who began their GDM follow-up starting March 11, 2020, and thereafter were allocated to the COVID-19 era, whereas women who delivered before the demarcation point served as the pre–COVID-19 era. The primary outcome was the rate of large-for-gestational-age (LGA) neonates. Secondary outcomes included select maternal and neonatal adverse outcomes.</p></div><div><h3>Results</h3><p>Seven hundred seventy-five women were included in the analysis, of which 187 (24.13%) were followed during the COVID-19 era and 588 (75.87%) before the COVID-19 era. One hundred seventy-one of the 187 women (91.44%) followed during COVID-19 had at least 1 virtual follow-up visit. No virtual follow-up visits occurred before the COVID-19 era. There was no difference in the rate of LGA neonates between groups on both univariate (5.90% vs 7.30%, p=0.5) and multivariate analyses, controlling for age, ethnicity, parity, body mass index<span>, gestational weight gain<span>, chronic hypertension, smoking, and hypertensive disorders in pregnancy (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 0.49 to 2.51, p=0.80). In the multivariate analysis, there was no difference in composite neonatal outcome between groups (GDM diet: aOR 1.40, 95% CI 0.81 to 2.43, p=0.23; GDM medical treatment: aOR 1.20, 95% CI 0.63 to 2.43, p=0.5).</span></span></p></div><div><h3>Conclusions</h3><p>After adjusting for differences in baseline variables, the combined virtual mode of care was not associated with a higher rate of LGA neonates or other adverse perinatal outcomes in women with GDM. Larger studies are needed to better understand the specific impact of virtual care on less common outcomes in pregnancies with GDM.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138566296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dried Blood Spot Test for Glycated Hemoglobin Measurement in Pediatric Diabetes Care","authors":"Mallory McNiven MD , Netusha Thevaranjan MD, MSc , Daphne Yau MD, MSc , James Robertson MD , Oluwafemi Oluwole PhD , Joshua Buse PhD , Mark Inman MD, FRCPC","doi":"10.1016/j.jcjd.2023.10.401","DOIUrl":"10.1016/j.jcjd.2023.10.401","url":null,"abstract":"<div><h3>Background</h3><p><span>The dried blood spot (DBS) card is a novel collection method for measuring </span>glycated hemoglobin<span><span> (A1C) in individuals with diabetes mellitus. The potential benefits of DBS specimens compared with traditional phlebotomy include a reduction in required total blood volume, reduced procedural pain, and an ability for self-initiated collection. DBS cards for A1C measurement have been validated in the adult population, but there is a paucity of </span>pediatric data.</span></p></div><div><h3>Methods</h3><p>The aim of this study was to validate the use of A1C measurement by DBS cards in comparison to venous A1C and to identify potential barriers to implementing this novel approach. Venous and DBS card A1C samples were collected simultaneously from 62 patients at their local laboratory and transported to the central provincial lab for analysis. Correlation analyses compared venous and DBS A1C with data rescaling performed to account for the DBS–venous interassay difference.</p></div><div><h3>Results</h3><p>Mean venous A1C was 7.49% and DBS A1C was 7.26%, with an interassay difference of 0.23%. Data showed a strong, positive correlation between A1C collection methods (r=0.86, p<0.001); this was further strengthened at lower A1C values (A1C <7.5%, r=0.87, p<0.0001). A stronger relationship emerged when the data were rescaled to account for the DBS–venous interassay difference (r=0.8935, p<0.0001).</p></div><div><h3>Conclusions</h3><p>Given the potential feasibility, practicality, accessibility, cost-effectiveness, and performance characteristics of the DBS A1C, especially at lower A1C values hovering around the diagnostic threshold for diabetes, this study provides supporting evidence for consideration of the use of DBS A1C testing in pediatric diabetes care.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arin C. Deveci MSc , Muskaan Gurnani MD , Margaret C. Wolfe-Wylie MD , Andrea Regina PhD , Kristina Cordeiro MA , Malini G. Dave MD , Farid H. Mahmud MD , Jill Hamilton MD, FRCPC
{"title":"Looking at Diabetes Through Different Lenses: Focus Groups Conducted With Somali Canadian Families and Their Health-care Providers","authors":"Arin C. Deveci MSc , Muskaan Gurnani MD , Margaret C. Wolfe-Wylie MD , Andrea Regina PhD , Kristina Cordeiro MA , Malini G. Dave MD , Farid H. Mahmud MD , Jill Hamilton MD, FRCPC","doi":"10.1016/j.jcjd.2023.11.004","DOIUrl":"10.1016/j.jcjd.2023.11.004","url":null,"abstract":"<div><h3>Objectives</h3><p><span>In Toronto, many families with Somali backgrounds have children living with type 1 diabetes (T1D). At our clinic, children with African and Caribbean backgrounds have higher </span>glycated hemoglobin than children from European backgrounds. In this study, we explored the experiences and perspectives of Somali Canadian families with children living with T1D, as well as health-care professionals (HCPs) who care for them, to better understand how T1D impacts these families.</p></div><div><h3>Methods</h3><p>We conducted 3 separate focus groups with Somali Canadian parents of children with T1D (n=11), Somali Canadian adolescents with T1D (n=5), and HCPs who treat patients with diabetes (n=9), respectively. A grounded theory approach to data analysis was applied to identify themes.</p></div><div><h3>Results</h3><p>Four key themes emerged: 1) the general impact of living with diabetes, 2) the challenges of self-management, 3) uncertainty on whose job it is to manage the diabetes, and 4) how cultural differences between Canada and Somalia impact diabetes management. There was discordance in the perspectives of families and HCPs for all themes, but especially themes 1 and 3. Parents focussed on the social impact of diabetes and behavioural indicators of management success, whereas HCPs emphasized clinical measures. Families believed children should take charge of their diabetes self-management early on, whereas HCPs believed the children were not developmentally ready for this responsibility.</p></div><div><h3>Conclusions</h3><p>Differing perspectives of patients, families, and HCPs may lead to diverging expectations for treatment and management. Families and practitioners must work together to identify barriers to care and build strategies to promote competency and resilience in the self-management of T1D.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138500517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sebastien O. Lanctôt BSc , Leif Erik Lovblom BSc, MSc, PhD , Evan J.H. Lewis PhD , Michelle Morris DDS , Nancy Cardinez NP , Daniel Scarr MSc , Abdulmohsen Bakhsh MD , Mohammad I. Abuabat , Julie A. Lovshin MD, PhD , Yuliya Lytvyn PhD , Geneviève Boulet MD , Alexandra Bussières MD , Michael H. Brent MD , Narinder Paul MD , Vera Bril MD , David Z.I. Cherney MD, PhD , Bruce A. Perkins MD, MPH
{"title":"Fasted C-Peptide Distribution and Associated Clinical Factors in Adults With Longstanding Type 1 Diabetes: Analysis of the Canadian Study of Longevity in Type 1 Diabetes","authors":"Sebastien O. Lanctôt BSc , Leif Erik Lovblom BSc, MSc, PhD , Evan J.H. Lewis PhD , Michelle Morris DDS , Nancy Cardinez NP , Daniel Scarr MSc , Abdulmohsen Bakhsh MD , Mohammad I. Abuabat , Julie A. Lovshin MD, PhD , Yuliya Lytvyn PhD , Geneviève Boulet MD , Alexandra Bussières MD , Michael H. Brent MD , Narinder Paul MD , Vera Bril MD , David Z.I. Cherney MD, PhD , Bruce A. Perkins MD, MPH","doi":"10.1016/j.jcjd.2023.11.001","DOIUrl":"10.1016/j.jcjd.2023.11.001","url":null,"abstract":"<div><h3>Objective</h3><p>Although insulin production is reportedly retained in many people with longstanding type 1 diabetes (T1D), the magnitude and relevance of connecting peptide (C-peptide) production are uncertain. In this study, we aimed to define fasted C-peptide distributions and associated clinical factors.</p></div><div><h3>Methods</h3><p><span>In a cross-sectional analysis of the Canadian Study of Longevity, fasted serum and urinary C-peptide was measured in 74 patients with longstanding T1D (duration ≥50 years) and 75 age- and sex-matched controls. Extensive phenotyping for complications was performed and patient-reported variables were included. C-peptide distributions were analyzed, and multivariable </span>logistic regression was used to assess the variable association in participants with T1D.</p></div><div><h3>Results</h3><p>The 74 participants with T1D had a mean age of 66±8 years, a disease duration of 54 (interquartile range 52 to 58) years, and a glycated hemoglobin (A1C) of 7.4%±0.8% (56.8±9.15 mmol/mol). The 75 controls had a mean age of 65±8 years and an A1C of 5.7%±0.4% (38.4±4.05 mmol/mol). Participants with T1D had lower fasted serum C-peptide than controls (0.013±0.022 vs 1.595±1.099 nmol/L, p<0.001). Of the participants with T1D, C-peptide was detectable in 30 of 73 (41%) serum samples, 32 of 74 (43%) urine samples, and 48 of 74 (65%) for either serum or urine. The variables independently associated with detectable serum or urinary C-peptide were lower total daily insulin requirement (odds ratio 2.351 [for 1 lower unit/kg], p=0.013) and lower hypoglycemia worry score (odds ratio 1.059 [for 1 point lower on the worry subscore of the Hypoglycemia Fear Survey], p=0.030).</p></div><div><h3>Conclusions</h3><p>Although detectable C-peptide in longstanding diabetes was common, the magnitude of concentration was extremely low when compared with age- and sex-matched controls. Despite minimal detectability, its presence is validated by lower insulin requirements and strongly associated with lower hypoglycemia worry.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72016391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Impact of COVID-19 Lockdown on Occurrence of Acute Complications of Type 1 and Type 2 Diabetes and Overall Glycemic Management","authors":"Richa Parihar MD, FRCPC, Simrit Rana BSc, Zubin Punthakee MD, FRCPC, Hertzel Gerstein MD, FRCPC, Manoela Braga MD, FRCPC, Marie Pigeyre MD, PhD","doi":"10.1016/j.jcjd.2023.12.001","DOIUrl":"10.1016/j.jcjd.2023.12.001","url":null,"abstract":"<div><h3>Objectives</h3><p>The association of diabetes, and COVID-19 infection has been studied extensively; however, the occurrence of diabetic ketoacidosis (DKA) or hyperglycemic/hyperosmolar states (HHS) in adults during the lockdown has not been well characterized. In this study, we aimed to identify the impact of the lockdown on occurrence and severity of DKA/HHS admissions and glycemic management.</p></div><div><h3>Methods</h3><p>A retrospective chart review was conducted of patients admitted to Hamilton Health Sciences with a diagnosis of DKA or HHS from April to September 2019 (pre-lockdown) and from April to September 2020 (lockdown). Adult (≥18 years old) nonpregnant patients with a single admission in the study period were included for study.</p></div><div><h3>Results</h3><p><span>There were 229 admissions related to diabetes, with 171 admissions meeting the inclusion criteria (n=92 pre-lockdown, n=79 lockdown). In the lockdown group, 51.8% of the patients had type 2 diabetes mellitus, with 96.2% of admissions secondary to DKA. When comparing the 2 periods, the lockdown group trended toward higher rates of death (5.4% vs 10.1%, p=0.247) and euglycemic DKA (17.6% vs 24.4%, p=0.403). There were more new diagnoses of type 1 diabetes mellitus in the lockdown group compared with the pre-lockdown group (7.3% vs 16.7%, p=0.230). The average </span>glycated hemoglobin was lower in the lockdown group compared with the pre-lockdown group (11.8% vs 10.4%, p=0.032).</p></div><div><h3>Conclusions</h3><p>Overall, this study is among the first in Canada to assess the impact of the COVID-19 lockdown on admissions due to DKA and HHS. Although no significant differences were noted in severity of admissions, there was a trend toward more new diagnoses of type 1 diabetes mellitus presenting in DKA during the lockdown period.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138573156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Praveen Samuel MBBS , Nabeel Khan BSc , Gerri Klein RN , Sergey Skobkarev MS , Benjamin Mammon BSc, MD , Marc Fournier Dipl , Kate Hawke MBBS, FRACP , Arthur Weissinger PhD , Tom Elliott MBBS
{"title":"Open-source Artificial Pancreas Systems Are Safe and Effective When Supported In-clinic: Outcomes in 248 Consecutive Type 1 Diabetes Clients","authors":"Praveen Samuel MBBS , Nabeel Khan BSc , Gerri Klein RN , Sergey Skobkarev MS , Benjamin Mammon BSc, MD , Marc Fournier Dipl , Kate Hawke MBBS, FRACP , Arthur Weissinger PhD , Tom Elliott MBBS","doi":"10.1016/j.jcjd.2023.09.003","DOIUrl":"10.1016/j.jcjd.2023.09.003","url":null,"abstract":"<div><h3>Objective</h3><p>Our aim in this study was to determine the safety, glycemia, and quality of life<span><span> (QoL) associated with in-clinic installation and management of supported open-source artificial pancreas systems (SOSAPS) in </span>type 1 diabetes (T1D).</span></p></div><div><h3>Methods</h3><p><span><span>This investigation is a retrospective cohort study of consecutive SOSAPS users at a Canadian diabetes centre. SOSAPS were offered to all moderately tech-savvy T1D clients on sensor-augmented multiple daily injection or pump, able to pay for hardware, and willing to sign a consent and waiver document. SOSAPS were installed and maintained by clinic staff at no cost to clients. iPhone users were assigned to either Loop (n=108) or iPhone artificial pancreas systems (iAPS; n=114) and Android users to Android-type APS (n=24). Outcomes included severe hypoglycemia and </span>diabetic ketoacidosis (DKA), time in range (TIR) 4.0 to 10.0 mmol/L, time below range (TBR) <4 mmol/L, glucose management indicator (GMI), mean sensor glucose (MSG), change in </span>glycated hemoglobin (A1C), and QoL.</p></div><div><h3>Results</h3><p>Two hundred forty-eight subjects (131 males, 117 females), with a mean age of 36 years and diabetes duration of 21 years, experienced 3 episodes of severe hypoglycemia and no DKA over a follow-up of 17 months. TIR rose by 16%, from 64% to 80% (p<0.0001); TBR fell by 1.0%, from 3.5% to 2.5% (p=0.001); MSG fell from 9.0 to 8.1 mmol/L (p<0.001); GMI fell from 7.3% to 6.7% (p<0.001); and A1C fell from 7.2% to 6.7% (p<0.0001). QoL scores were healthy before and improved after SOSAPS.</p></div><div><h3>Conclusions</h3><p>Clients with T1D using SOSAPS and supported with no-cost care to the client (software, technology, and physician/physician assistant) safely achieved improved TIR, GMI, A1C, and QoL.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41168776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ademola Joshua Itiola MPH, MSc , Lucy Cheng MSc , Wei Zhang PhD , Tara Gomes PhD , Baiju R. Shah MD, PhD , Michael R. Law PhD
{"title":"The Impact of Blood Glucose Test Strips Reimbursement Limits on Utilization, Costs, and Health-care Utilization in British Columbia","authors":"Ademola Joshua Itiola MPH, MSc , Lucy Cheng MSc , Wei Zhang PhD , Tara Gomes PhD , Baiju R. Shah MD, PhD , Michael R. Law PhD","doi":"10.1016/j.jcjd.2023.08.005","DOIUrl":"10.1016/j.jcjd.2023.08.005","url":null,"abstract":"<div><h3>Objective</h3><p>People living with diabetes and not using insulin may not derive clinically significant benefit from routine glucose self-monitoring. As a result, in 2015, British Columbia (BC) introduced quantity restrictions for blood glucose test strips (BGTS) coverage in public plans. We studied the impact of this policy on utilization, costs, and health-care utilization.</p></div><div><h3>Methods</h3><p>We identified a cohort of adults (≥18 years old) with diabetes between 2013 and 2019. Using BC’s administrative data, we studied utilization and costs among individuals with at least one PharmaCare-eligible BGTS claim. Using interrupted time-series analysis, we studied cost savings and determined the level of policy adherence. In addition, we investigated longitudinal changes in all-cause and diabetes-specific physician visits, all-cause hospitalizations, and health-care spending in the 3 to 5 years after policy implementation.</p></div><div><h3>Results</h3><p>Over the study period, 279.7 million BGTS were eligible for PharmaCare coverage, on which the government spent $124.3 million. After policy implementation, we observed an immediate decline in average utilization and PharmaCare expenditure on BGTS, leading to an estimated $44.6 million in savings between 2015 and 2019 (95% confidence interval $16.9 to $72.3 million). We found no association between the policy’s implementation and health services utilization or overall health-care spending over the long term.</p></div><div><h3>Conclusions</h3><p>Restricting reimbursement for BGTS in BC resulted in significant cost savings without any attendant increase in health services utilization over the subsequent 5 years. This disinvestment freed up resources that could be channeled toward other interventions.</p></div>","PeriodicalId":9565,"journal":{"name":"Canadian Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10559317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}