The UNHCR estimates that 14.6% of Syrian refugees in Lebanon have chronic diseases, such as diabetes, but lack access to appropriate treatment. In response, a novel refugee-led diabetes care program (DCP) was created. We characterized its structure processes and costs.
Diabetes requires patients to engage in self-management to avoid complications. People with lived experience of homelessness (PWLEH) often struggle with self-management and have higher rates of poor glycemic control and adverse outcomes. Our objective was to understand barriers PWLEH face in managing diabetes, and which barriers are perceived as being most and least impactful.
Despite the benefits and cost-effectiveness of insulin pump therapy for type 1 diabetes (T1D), funding for insulin pumps varies by province. This study assessed the impact of government-funded insulin pump programs on insulin pump use.
Glycated hemoglobin (HbA1c) lowering was significantly greater for oral semaglutide 14 mg than empagliflozin 25 mg for patients with type 2 diabetes (T2D) uncontrolled on metformin in the 52-week, randomized, open-label PIONEER 2 trial (NCT02863328). We estimated the cost effectiveness of oral semaglutide vs empagliflozin in Canada from payer and societal perspectives.
While nutrition intervention is the cornerstone of diabetes management, many people with diabetes struggle to attain and/or sustain registered dietitians’ (RDs) recommended dietary changes, resulting in the need for intensified pharmacological treatments. This study aims to identify the barriers and facilitators encountered by people living with diabetes in making and maintaining dietary changes.
A minimum annual incidence of type 2 diabetes (T2D) in Canadian youth (<18 years) of 1.54/100,000 has been reported, with 0.7 per 100,000 in the Atlantic provinces.
The childhood obesity epidemic has contributed to the emergence of pediatric type 2 diabetes mellitus (T2DM); however, the global scale of obesity in children with T2DM is unknown. This systematic review aimed to determine the prevalence of obesity in pediatric T2DM, understand how sex and ethnicity impact the prevalence of obesity, and assess the association between glycemic control, dyslipidemia and obesity.
Childhood cancer survivors (CCS) experience late effects that impact quality of life and life expectancy. Diabetes mellitus and cardiovascular disease are emerging outcome determinants in this population. This systematic review and meta-analysis calculated the prevalence of diabetes mellitus type 1, type 2 (T1DM; T2DM) and undifferentiated diabetes (UDM) in CCS and noncancer controls.
Self-management education is a cornerstone of medical management among adults with diabetes. It is particularly important during pregnancy for women with type 1 (T1D) and type 2 diabetes (T2D), as perinatal outcomes are affected by the degree of glycemic control.
Do-it-yourself artificial pancreas systems (DIY APS) use open-source software to deliver insulin in an automated fashion. While not medically approved, their customizable settings highlight their potential to improve glycemic control and alleviate diabetes burden. Despite considerable effort, few pregnant women with type 1 diabetes achieve the tight glycemic control required in pregnancy. Use of DIY APS is growing, but little is known about their safety and efficacy during pregnancy.
The 2018 Diabetes Canada guidelines contain a Grade D consensus supporting the use of glycated hemoglobin (HbA1c) for early gestational diabetes mellitus (eGDM) screening.
Diabetes Canada guidelines suggest that women with diabetes should receive preconception care from their diabetes health-care team. Studies have revealed that rates of preconception counselling vary from 30-70%. We assessed the rate of preconception counselling in women with diabetes at an academic endocrinology clinic, and designed and implemented a quality improvement initiative to improve preconception counselling rates.
The aim of this study was to systematically review existing evidence on the risk of type 2 diabetes mellitus (T2DM) in women with previous hypertensive disorders in pregnancy (HDP) and to identify appropriate strategies for prevention.
Diabetes mellitus (DM) is a common concern for pregnant and breastfeeding mothers in terms of lack of support and belief about outcomes for health and wellness. The purpose of this study was to collaborate with mothers with DM to understand their pregnancy and breastfeeding support needs to develop appropriate health-care transitions and support interventions.
The purpose of this pilot was to develop and test the clinical utility of a template, constructed around the 13 Health Quality Ontario (HQO) quality standards and indicators, to measure performance and guide quality improvement (QI) of an interprofessional diabetes management team that includes integrated care of diabetic feet and foot ulcers.
Diabetic foot ulcer (DFU), an important complication of diabetes, is associated with increased morbidity and mortality, and generates a significant social and economic burden. However, the dedicated team approach as a model of care has been insufficiently studied for DFU. The aim of this study was to evaluate the quality of DFU care of an interdisciplinary wound care clinic in Canada, based on an extended Donabedian model: structure, process and outcome quality indicators combined with patient characteristics.
Health-care providers face a multitude of challenges in providing care to patients with diabetes who are experiencing homelessness. Considering the unique circumstances faced by this population, mainstream services must be adapted to provide tailored services. The objective of this study was to explore the barriers providers face in offering comprehensive care to these patients, and their suggestions for improvement.
Diabetic ketoacidosis (DKA) is a common medical emergency. We previously found hypokalemia developed in 40% of people admitted with DKA. Canadian guidelines suggest fluids containing 10-40mmol/L potassium be used. We explored how residents balance priorities and risks of fluid and insulin replacement, and whether avoiding iatrogenic complications drove behaviours.
The need for an improved approach to transition from pediatric to adult care for youth with type 1 diabetes is evident. As part of a regional quality improvement initiative, a novel pretransition visit (Pre-T Visit), was developed and implemented in January 2018 for patients aged 15-18. It evaluates self-management skills, introduces transition tools and establishes self-care goals.
Repeating glycated hemoglobin (HbA1c) testing as a surrogate measure of overall glycemic control within 3 months is frequently done, but has limited utility. We conducted a quality improvement (QI) initiative to reduce unnecessary repeat HbA1c testing at Sunnybrook Health Sciences Centre by 75%.
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