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Despite emerging evidence that individuals with intellectual and developmental disabilities (IDD) have a high prevalence of diabetes, Canada does not have a strategy to address diabetes in this population. The aim of this review was to review effective health policies and practices to improve diabetes prevention and management developed by other jurisdictions in response to the high prevalence of diabetes among individuals with IDD. To do so, a narrative literature review was conducted based on 18 studies, in addition to 3 examples of resources, 2 systematic reviews, the Canadian diabetes guidelines, the UK diabetes guidelines and Kachika's "NHS RightCare Pathway" report. Consistent with the "Diabetes 360°: A Framework for a Diabetes Strategy for Canada" report, findings were summarized under 3 themes: 1) diabetes prevention and health promotion, 2) diabetes screening and 3) diabetes self-management. We also identified 2 additional areas that cut across all 3 of the themes: 1) diabetes health literacy and 2) role of carers in prevention, screening and treatment efforts. Our review identifies strategies to meet the unique needs of people with IDD who have diabetes, in order to encourage Canadian initiatives to address these needs.

Objectives The Canadian Task Force on Preventive Health Care (CTFPHC) produces guidelines for Canadian physicians regarding screening and prevention. To better appreciate the barriers to and facilitators of guideline adherence, we sought to explore physicians' views of guidelines in general and their understanding of this CTFPHC diabetes screening guideline in particular because they pertain to screening and positive treatment. Methods We included Canadian physicians (N=10) who agreed to be interviewed regarding their use of guidelines as part of practice, focusing on the CTFPHC 2012 diabetes screening guideline. Individual semistructured interviews explored primary care physicians' experiences and perspectives on the use, relevance and feasibility of guidelines as part of practice, approaches to screening for diabetes, and suggestions for improving guidelines. Results Overall, physicians recognized the need for guidelines and the benefits of using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods in the guideline development process. Physicians also noted several barriers to guideline adherence, including the lack of opportunity for physicians to provide input during guideline formulation, insufficient guidance on interpreting GRADE's weak or conditional recommendations, and feasibility issues concerning using risk calculators. The predominant challenge raised by physicians was the unclear guidance for pharmacologic interventions; all respondents were unclear about the guidelines' implicit assumption that screen-positive patients would be treated with statins and aspirin (ASA). Conclusions These interviews suggest the need for greater clarity in guideline recommendations, including clarification of the quality of evidence ratings and the strength of recommendation grading. Our low participation rate raises the issue of representativeness; replication in samples with greater willingness to participate would be desirable.

Objective This article describes the Community Health Awareness Diabetes (CHAD) program and its feasibility. Developing and testing the feasibility of strategies to detect diabetes in the community is an important primary care issue. The CHAD program was designed to be a feasible and reproducible, low-cost community program to identify high-risk individuals for subsequent diabetes screening by their family doctors. Methods Participants from Grimsby, Ontario, older than age 40, were invited to self-risk-assess for diabetes using a validated questionnaire and 2 near-patient blood tests (capillary blood glucose and glycosylated hemoglobin). Some participants were self-selected, having seen advertising for the program, others were invited by a letter from their family doctor. None of the participants had pre-existing diabetes. Numbers and characteristics of participants, numbers found at risk and satisfaction of participants were examined. Results There were 588 participants in CHAD. Of these, the majority had received invitation letters, the majority of participants were seniors and were females, 526 did not have pre-existing diabetes and 16% of participants (n=84 of 526) were identified as being at high risk for diabetes. Participants at high risk of diabetes had significantly more modifiable risk factors, including higher fat, fast food and salt intake, and higher systolic blood pressure. Satisfaction with the program was high. Conclusions The CHAD program was feasible and participants were satisfied with it. Participants had a large number of modifiable risk factors. This program could be repeated in other communities and modified to suit the infrastructure of the area.

To determine to what extent participants in the Quebec Health Survey who had 2 or more risk factors for diabetes were screened by their physician and what type of advice they received when diagnosed with prediabetes. Of the participants in the Quebec Health Survey, 4555 were identified from the databank as having 2 or more risk factors for diabetes. These individuals were contacted; 541 (12%) completed a telephone interview and 258 (48%) of their treating physicians provided information from their chart and medical practice profile.

s / Can J Diabetes 37 (2013) S13eS84 S75 The greatest variations in healthy eating and smoking were observed among Aboriginal populations. Those having less than a secondary diploma showed lower rates of healthy eating and physical activity. Except for physical activity, men were at higher risk than women for all behavioural factors. The disaggregation of the latest national data on chronic disease found in the framework can help users understand the distribution of diabetes and vascular disease risk factors and support equity-based prevention initiatives.