Achieving HbA1c and blood pressure targets is an important strategy for preventing chronic vascular complications in diabetes. The aim of this paper was to determine the proportion of type 2 diabetes patients who meet the recommended HbA1c and arterial blood pressure targets and the determinants of failure to do so.
Canadian Journal of Diabetes
An Evaluation of Reach and Effectiveness of a Diabetes Prevention Behaviour Change Program Situated in a Community Site
More than 350 million people are living with prediabetes. Preventing type 2 diabetes (T2D) progression can reduce morbidity, mortality, and healthcare costs. Interventions can support people with diet and physical activity behaviour changes; however, many interventions are university-based, posing barriers (e.g., accessibility, limited reach, maintenance), which highligh the need for community intervention. Limited research has comprehensively evaluated programs in community contexts. The purpose of this study was to pragmatically examine the reach and effectiveness of a diabetes prevention behaviour change program in the community using the RE-AIM framework.
Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): An Emerging Complication of Pre-Gestational Diabetes Mellitus Among First Nations and Non-First Nations People in Saskatchewan Results from the DIP: ORRIIGENSS Project
Because congenital anomalies of the kidneys and urinary tract (CAKUT) are a frequent cause of end stage renal disease (ESRD) in the young, we explored the epidemiology of CAKUT and the role of diabetes in pregnancy.
Blind Spots: Gaps in Disease Knowledge and the Role of Patient Education for Canadians With Diabetic Macular Edema
Over a decade ago, anti vascular endothelial growth factor (anti-VEGF) injections emerged as a viable treatment for diabetic macular edema (DME), the leading cause of new blindness among working-age adults in North America (1). By targeting VEGF, the signal protein that stimulates abnormal blood vessel growth in DME, the injections offered a new approach to managing vision loss resulting from DME, largely replacing vitrectomy and laser surgery as frontline therapy (2,3). Time-release implants have been used in some cases as well, and show promise (4).
Determinants of high dose insulin requirement and upper extremity muscle strength in type 2 diabetic patients
We aimed to determine the association between upper extremity muscle strength and insulin dose in type 2 diabetic patients.
Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study
Diabetic foot ulcer (DFU), a serious complication of diabetes, is associated with increased morbidity and mortality and presents a substantial socioeconomic burden. However, DFU quality of care has been insufficiently studied. Therefore, the aim of this study was to evaluate the quality of DFU care at an interdisciplinary wound care clinic in Canada, based on an extended Donabedian model: structure, process and outcome quality indicators combined with patient characteristics.
1 - The Effect of Diabetes Health Coaching on Glycemic Control and Quality of Life in Adults Living With Type 2 Diabetes: A Community-Based Randomized Controlled Trial
Health coaching for type 2 diabetes (T2DM) holds promise in improving clinical health outcomes and quality of life. The purpose of this study was to evaluate the effect of a 12-month telephone diabetes health coaching (DHC) intervention on glycemic control in persons living with T2DM.
2 - Outcomes With Intermittently Scanned Continuous Glucose Monitoring Used Prior to First Appointment with an Endocrinologist, Compared to Fingerstick Monitoring: SPOT-FIRST study
To investigate if having intermittently scanned continuous glucose monitoring (isCGM) data at the time of first consultation is more effective than fingerstick monitoring (FSBGM).
3 - Patient and Paramedic Experiences With a Direct Electronic Referral Program for Hypoglycemia Education Following Paramedic Service Assist-Requiring Hypoglycemia: A Qualitative Study
Hypoglycemia (HG) requiring paramedic assistance negatively impacts outcomes in people with diabetes. Prior studies have shown only a small proportion of those with paramedic assist-requiring HG are brought to hospital. An innovative direct electronic referral program in which paramedics sent referrals for focused HG education at the time of paramedic assessment was implemented for 18 months. Program uptake was lower than expected (133 referrals, 79 scheduled, 50 attended). This qualitative study examined barriers/facilitators of HG education attendance after paramedic assist-requiring HG.
4 - Benefits of Flash Glucose Sensors on Type 2 Diabetes Management and Exercise Behaviour in Insulin and Noninsulin-Treated Patients: The STAND Study
Behaviour change theory describes present bias; a bias in which people exhibit a tendency towards preferring immediate over delayed feedback (e.g. reducing their CVD risk). It is not well understood if flash glucose sensing (FGS) technology, which provides immediate blood glucose feedback after exercise, has a role in exercise self-efficacy and diabetes self-management.
Guidelines suggest that people with type 1 diabetes (T1D) start exercise with moderately high blood glucose (8-10 mmol/L) (BG) to reduce the risk of hypoglycemia; however, those fearing hypoglycemia often start higher. This study aimed to determine the impact of afternoon aerobic exercise with a higher BG on postexercise glycemia, as measured by continuous glucose monitoring (CGM). Eleven active T1D participants (8F/3M, 30 years, A1C 7.7[0.8]%, VO2peak 38.4[7.7] ml/kg/min) completed 2 exercise sessions in random order: 1) with BG between 8.0-10.0 mmol/L (MOD) and 2) with BG between 12.0-14.0 mmol/L (HI).
6 - Variation in Patient-Described Barriers and Facilitators to Diabetes Self-Management by Glycemic Control and Individual-Level Characteristics
The types of barriers to diabetes management faced by patients have been well documented. However, the impact of individual characteristics on these barriers is not well known. We sought to analyze patient-described barriers and facilitators to self-management, focusing on how these differ across individual characteristics.
7 - Evaluation of a Novel Approach to Health-Care Delivery: The Inclusion of an Indigenous Knowledge Keeper and Art Therapy in a Youth Onset Type 2 Diabetes Clinic
Youth living with type 2 diabetes face a multitude of social and societal barriers that impede their physical and mental health. Western health-care delivery is one of these barriers. Power differentials between health-care providers and patients can impact a patient’s perceived safety and, thus, engagement. To address this, we transformed a combined diabetes/nephrology subspecialty clinic with the inclusion of an Indigenous Knowledge Keeper and art therapist in the care team. Each clinic starts with a sharing circle led by the Knowledge Keeper, followed by a facilitated art therapy session.
Guidelines recommend regular screening, support and anticipatory guidance for psychosocial issues as essential to pediatric diabetes care. We explored diabetes teams’ practices, perceived needs, barriers and facilitators to provision of this care.
Glycemic control in patients with type 2 diabetes (T2D) can be achieved through potentiation of the incretin hormones glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). Signalling through the incretin receptors corrects islet hormone release in T2D by potentiating glucose-stimulated insulin secretion and decreasing glucagon secretion. However, the bioactivity of GLP-1 and GIP is controlled by N-terminal cleavage by the serine protease dipeptidyl peptidase 4 (DPP4).
10 - Novel Fully Automated Fiasp-Plus-Pramlintide Artificial Pancreas for Type 1 Diabetes: Randomized Controlled Trial
We aimed to assess a novel fully automated fiasp-plus-pramlintide artificial pancreas. We conducted a randomized crossover noninferiority trial comparing (i) a fully automated fiasp-and-pramlintide artificial pancreas and (ii) fiasp-alone artificial pancreas with carbohydrate counting, in 23 adults with type 1 diabetes (age 35±15 years, HbA1c 8.1±1.4 per cent [%]). Fiasp and pramlintide were delivered using a novel dosing algorithm at a fixed ratio (10 micrograms per unit [μg/u]) with a meal detection to trigger boluses.
11 - A Meal Detection Algorithm for the Artificial Pancreas: A Randomized Controlled Clinical Trial in Adolescents With Type 1 Diabetes
Adolescents with type 1 diabetes frequently forget to bolus at mealtime. We developed a meal detection algorithm for the artificial pancreas that detects unannounced meals and delivers an insulin bolus.
12 - Investigating the Contribution of the HNF-1αG319S Gene Variant to Early-Onset Type 2 Diabetes Using MIN6 β-Cells and Mice
Forty per cent of Manitoban Indigenous youth with type 2 diabetes (T2D) harbour the HNF-1αG319S variant. Among carriers, clinical evidence implicates pancreatic β-cell dysfunction compounded by modern dietary stress. We hypothesize that the G319S variant alters β-cell metabolism and insulin secretion in a macronutrient-dependent manner.
Beta-cell mass and function are under the control of metabolic, hormonal and neural signals, many of which act via G protein-coupled receptors (GPCRs). Regulator of G protein signalling 9 (RGS9) couples with Galphai and is expected to reduce and terminate signals from inhibitory GPCRs. In this study, we test the hypothesis that RGS9 reduces the inhibitory GPCR signal for beta-cell proliferation and insulin secretion.
14 - Investigating the Molecular and Metabolic Regulators of Rhythmic Insulin Secretion Over 24 Hours
Circadian disruption increases type 2 diabetes (T2D) risk. Healthy pancreatic β-cells secrete insulin in a rhythmic and diurnal manner, which is required for glucose homeostasis; however, the molecular and metabolic factors that regulate rhythmic insulin secretion remain elusive. We hypothesize that the β-cell circadian clock machinery autonomously regulates temporal activation of metabolic pathways which, in turn, control glucose-stimulated insulin secretion (GSIS) capacity.
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