In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model.
Canadian Journal of Diabetes
Beyond Glycated Hemoglobin: Harnessing Data From Sensor-Based Technology to Improve Glucose Variability, Time in Range and Hypoglycemia in Adult Patients With Type 1 Diabetes
Glycated hemoglobin (A1C) has traditionally been the “gold standard” for monitoring patients with type 1 diabetes (T1D), but it may not be the best indicator of glycemic control for individual patients due to a number of limitations. It is well known that A1C may not accurately reflect glycemic control in patients with conditions, such as hemoglobinopathy and anemia. However, even in the absence of these conditions, a given A1C level can be associated with a wide range of mean glucose concentration due to individual variations in red blood cell lifespan and glycation rates (1).
The objectives of this review were to: 1) examine recent strategies and component interventions used to overcome therapeutic inertia in type 2 diabetes mellitus (T2DM), 2) map strategies to the causes of therapeutic inertia they target and 3) identify causes of therapeutic inertia in T2DM that have not been targeted by recent strategies. A systematic search of the literature published from January 2014 to December 2019 was conducted to identify strategies targeting therapeutic inertia in T2DM, and key strategy characteristics were extracted and summarized.
“It’s a Life Thing, Not a Few Months Thing”: Profiling Patterns of the Physical Activity Change Process and Associated Strategies of Women With Prediabetes Over 1 Year
Engagement in regular physical activity (PA) is a cornerstone prevention strategy for individuals at risk of developing type 2 diabetes. Interventions targeting PA often fail to result in long-term behaviour changes. “Small Steps for Big Changes” is a 3-week diabetes prevention program that promotes PA behaviour changes in individuals with prediabetes through motivational interviewing-informed counselling.
Insulin Pump Therapy Improves Quality of Life of Young Patients With Type 1 Diabetes Enrolled in a Government-Funded Insulin Pump Program: A Qualitative Study
The Nova Scotia Insulin Pump Program (NSIPP) subsidizes the cost of insulin pump therapy for young patients (≤25 years) with type 1 diabetes. The first NSIPP evaluation focused on clinical outcomes rather than quality of life. Existing research on insulin pumps and quality of life is mostly survey based, with limited first-voice experiences. In this qualitative study, we examined patient and parent perspectives on how insulin pumps affect quality of life in the context of a government-funded program.
Association of Glucagon With Obesity, Glycemic Control and Renal Function in Adults With Type 2 Diabetes Mellitus
In this study, we used a double-antibody sandwich enzyme-linked immunosorbent assay to assess the association between blood glucagon levels and indices of obesity, glycemic control and renal function in patients with type 2 diabetes mellitus (T2DM).
Obesity has a significant impact on population health and health care. Administrative databases may be a useful tool to study obesity at a population level. In this work, we aimed to determine the validity of hospital codes for obesity in Ontario, Canada.
Ginger (Zingiber Officinale Roscoe) Extract Protects the Heart Against Inflammation and Fibrosis in Diabetic Rats
Fibrosis and inflammation in the heart of patients with diabetes mellitus alongside increased production of free radicals and collagen are together known as diabetic cardiomyopathy. Ginger rhizome has antidiabetic, antioxidant and anti-inflammatory effects. Thus, we investigated the effect of ginger extract on diabetes-induced cardiomyopathy in streptozotocin-induced diabetic rats.
Conversations and Reactions Around Severe Hypoglycemia Study: Results of Canadian Adults With Insulin Treated Diabetes and Caregivers
The Conversations and Reactions Around Severe Hypoglycemia cross-sectional study was conducted to better understand the severe hypoglycemia experiences in persons with diabetes (PWD) and their caregivers (CGs).
Heterozygous insulin gene (INS) mutations affect proinsulin biosynthesis and are associated with diabetes phenotypes ranging from permanent neonatal diabetes mellitus with complete insulin deficiency to adult onset diabetes, with considerable beta-cell function at diagnosis (1). In this report, we describe the case of a woman with a rare INS R46Q mutation and her response to different therapeutic agents.
Peer Support Added to Diabetes Education Improves Metabolic Control and Quality of Life in Mayan Adults Living With Type 2 Diabetes: A Randomized Controlled Trial
Yucatán, located in the southern region of Mexico, is the state with the country’s highest prevalence of uncontrolled diabetes. Because of its particular cultural and socioeconomic characteristics, the residents of Yucatán face unique health-care challenges. The objective of our study was to evaluate the effect of peer support added to a diabetes education program on glycemic control and diabetes-related quality of life when compared with a conventional diabetes education program in patients with type 2 diabetes in a Mayan community in Mexico.
Prevalence and Clinical Characteristics of Adults Presenting With Sodium-Glucose Cotransporter-2 Inhibitor-Associated Diabetic Ketoacidosis at a Canadian Academic Tertiary Care Hospital
In this study, we examined the prevalence and clinical characteristics of sodium-glucose cotransporter-2 inhibitor (SGLT2i)-associated diabetes ketoacidosis (DKA).
When Low Blood Sugars Cause High Anxiety: Fear of Hypoglycemia Among Parents of Youth With Type 1 Diabetes Mellitus
Hypoglycemia is the most common acute complication of type 1 diabetes (T1D) and the potential short- and long-term sequelae can cause children and parents to develop significant fear of hypoglycemia (FOH). FOH and associated anxiety can be disruptive to activities of daily living and lead to reduced quality of life. We sought to determine the extent of FOH among parents of children with T1D within our clinic and to identify factors associated with greater FOH.
Revision of Alberta’s Provincial Insulin Pump Therapy Criteria for Adults and Children With Type 1 Diabetes: Process, Rationale and Framework for Evaluation
Insulin pump therapy is a valuable, but costly approach, with public funding in Alberta for eligible individuals since 2013. The Provincial Insulin Pump Therapy Program Clinical Advisory Committee has revised and updated the clinical criteria, integrating current literature, best practice and feedback from clinicians. The objective was to develop criteria that would: 1) optimize safety and effectiveness of insulin pump therapy, while 2) carefully stewarding resources available to care for people with type 1 diabetes.
Esophageal Dysphagia and Recurrent Aspiration From Treatment-Induced Neuropathy of Diabetes in a Patient with Type 1 Diabetes
The phenomenon of inducible neuropathic pain and autonomic neuropathy with diabetic treatment has been described since 1933, and recently termed “treatment-induced neuropathy of diabetes” (TIND) by Caravati (1) and Gibbons (2). The hallmark of this condition is the development or worsening of painful or autonomic neuropathy after a rapid improvement of glycemic control, typically after initiating or changing treatment (2,3).
Environmental Scan on Canadian Interactive Knowledge Translation Tools to Prevent Diabetes Complications in Patients with Diabetes
In this study, we identify existing interactive knowledge translation tools that could help patients and health-care professionals to prevent diabetes complications in the Canadian context. We conducted an environmental scan in collaboration with researchers and 4 patient partners across Canada. We conducted searches among the research team members, their networks and Twitter, and through searches in databases and Google. To be included, interactive knowledge translation tools had to meet the following criteria: used to prevent diabetes complications; used in a real-life setting; used any instructional method or material; had relevance in the Canadian context, written in English or French; developed and/or published by experts in diabetes complications or by a recognized organization; created in 2013 or after; and accessibility online or on paper.
Systematic Evaluation of Canadian Diabetes Smartphone Applications for People With Type 1, Type 2 and Gestational Diabetes
Our aims in this study were to: 1) review diabetes apps available in Canada using the Mobile App Rating Scale tool and generate usability scores for each, 2) characterize availability of features across all apps, 3) evaluate the clinical safety of bolus insulin calculators and 4) evaluate the quality of exportable blood glucose reports meant for use by health-care providers.
Association Between Systolic Blood Pressure and Cardiovascular Inpatient Cost Moderated by Peer-Support Intervention Among Adult Patients with Type 2 Diabetes: A 2-Cohort Study
People with type 2 diabetes and increased systolic blood pressure (SBP) are at high risk of cardiovascular disease (CVD). In this study, we aimed to investigate the association between CVD-related hospital payments and SBP and tested whether this association is influenced by diabetes peer support.
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