363 results on '"Stewart B. Harris"'
Search Results
352. Paraoxonase-2 G148 variant in an aboriginal Canadian girl with non-insulin-dependent diabetes
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Robert A. Hegele, Lap-Chee Tsui, Anthony J. Hanley, Stewart B. Harris, Philip W. Connelly, Stephen W. Scherer, and Bernard Zinman
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chemistry.chemical_classification ,Genetics ,medicine.medical_specialty ,media_common.quotation_subject ,Non insulin dependent diabetes mellitus ,General Medicine ,Biology ,Genome ,Enzyme ,Aryldialkylphosphatase ,Endocrinology ,chemistry ,Internal medicine ,Phosphoric Triester Hydrolases ,Genetic variation ,medicine ,Girl ,Gene ,media_common - Published
- 1997
353. Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review
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Braden Te Hiwi, Stewart B. Harris, Merrick Zwarenstein, Kathleen Rice, D.E. Barre, and Barry Lavallee
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Canada ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Best practice ,Psychological intervention ,review ,Participatory action research ,030209 endocrinology & metabolism ,Context (language use) ,Indigenous ,traitement ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Nursing ,prevention ,Intervention (counseling) ,les meilleures pratiques ,Diabetes Mellitus ,Internal Medicine ,Health Services, Indigenous ,Humans ,Medicine ,best practices ,Indigène ,Obesity ,030212 general & internal medicine ,Social determinants of health ,10. No inequality ,diabetes ,treatment ,business.industry ,1. No poverty ,General Medicine ,revue ,3. Good health ,prévention ,Socioeconomic Factors ,Practice Guidelines as Topic ,Indians, North American ,Physical therapy ,Social exclusion ,business ,diabète - Abstract
Objectives To carry out a systematic review of interventions that have aimed at improving screening, treatment, prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices. Methods A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar. Results We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success. Conclusions Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.
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354. Clinical use of insulin degludec
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Jorge Luiz Gross, Lena Landstedt-Hallin, Ambrish Mithal, Bertrand Cariou, Jiten Vora, Stewart B. Harris, Marc Evans, Martín Rodríguez, and Luigi F. Meneghini
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Blood Glucose ,Insulin degludec ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,Insulin Glargine ,Type 2 diabetes ,Pharmacology ,Clinical practice ,Weight Gain ,Drug Administration Schedule ,Endocrinology ,Diabetes mellitus ,Internal Medicine ,Humans ,Medicine ,Insulin ,Dosing ,education ,education.field_of_study ,business.industry ,Insulin glargine ,Diabetes ,General Medicine ,medicine.disease ,Hypoglycemia ,Insulin, Long-Acting ,Diabetes Mellitus, Type 1 ,Diabetes Mellitus, Type 2 ,Pharmacodynamics ,business ,Hypoglycaemia ,medicine.drug - Abstract
The limitations of current basal insulin preparations include concerns related to their pharmacokinetic and pharmacodynamic properties, hypoglycaemia, weight gain, and perception of management complexity, including rigid dosing schedules. Insulin degludec (IDeg) is a novel basal insulin with improved pharmacokinetic and pharmacodynamic properties compared to insulin glargine (IGlar) including a long half-life of ∼25h and a duration of action >42h at steady state, providing a flat and stable blood glucose-lowering effect when injected once daily. Evidence from phase 3a clinical trials with a treat-to-target design in patients with type 1 and type 2 diabetes has shown that IDeg has similar efficacy to IGlar, with a 9% and 26% reduction in risk of overall and nocturnal hypoglycaemia, respectively (in the pooled population) during the entire treatment period, and a 16% and 32% reduction during the maintenance period, respectively. Given its pharmacodynamic properties, IDeg offers a broad dosing window, allowing for flexible dose administration, if required. Two different formulations of IDeg are available (100units/mL [U100] and 200units/mL), the latter providing the same IDeg dose as the U100 formulation in half the injection volume. The unique pharmacokinetic profile of IDeg facilitates glycaemic control while minimising the risk of nocturnal hypoglycaemia.
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355. A comparison of ultrasound measurements to assess carotid atherosclerosis development in subjects with and without type 2 diabetes
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Andrew A. House, J. David Spence, Aaron Fenster, Rebecca L. Pollex, Anthony J. Hanley, Bernard Zinman, Stewart B. Harris, and Robert A. Hegele
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Carotid Artery Diseases ,Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Type 2 diabetes ,Imaging ,Impaired glucose tolerance ,chemistry.chemical_compound ,High-density lipoprotein ,Computer-Assisted ,Risk Factors ,Single-Blind Method ,Anatomy, Cross-Sectional ,Incidence ,Ultrasound ,General Medicine ,Middle Aged ,Prognosis ,Medical Microbiology ,Echocardiography ,Radiology Nuclear Medicine and imaging ,Cardiology ,Female ,Radiology ,Anatomy ,Cardiology and Cardiovascular Medicine ,Type 2 ,Adult ,medicine.medical_specialty ,Canada ,Waist ,Risk Assessment ,Sensitivity and Specificity ,Imaging, Three-Dimensional ,Internal medicine ,Diabetes mellitus ,Image Interpretation, Computer-Assisted ,medicine ,Diabetes Mellitus ,Humans ,Radiology, Nuclear Medicine and imaging ,Image Interpretation ,Angiology ,Aged ,business.industry ,Research ,Reproducibility of Results ,medicine.disease ,chemistry ,Diabetes Mellitus, Type 2 ,lcsh:RC666-701 ,Three-Dimensional ,Cross-Sectional ,business ,Body mass index - Abstract
Background Subjects with type 2 diabetes are at an increased risk of vascular complications. The use of carotid ultrasound remains an attractive, non-invasive method to monitor atherosclerotic disease progression and/or response to treatment in patients with type 2 diabetes, with intima-media thickness routinely used as the gold standard to detect pathology. However, alternative measurements, such as plaque area or volume, may represent a potentially more powerful approach. Thus, the objective of this study was to compare the traditional intima-media thickness measurement against the novel total plaque volume measurement in analyzing carotid atherosclerosis development in individuals with type 2 diabetes. Methods The case-control study included 49 Oji-Cree adults with diabetes or impaired glucose tolerance, aged 21–69, and 49 sex- and age-matched normoglycemic subjects. At baseline, metabolic variables were measured, including body mass index, waist circumference, total cholesterol:high density lipoprotein ratio, plasma triglycerides, plasma glucose, and serum insulin. Carotid ultrasound measurements, 7 years later, assessed carotid arterial intima-media thickness and total plaque volume. Results At baseline, the two groups were well matched for smoking habits, hypertension, body mass index, and waist circumference. Differences were noted in baseline measurements of total cholesterol:high density lipoprotein (P = 0.0006), plasma triglycerides (P < 0.0001) and fasting glucose (P < 0.0001). After seven years, carotid ultrasound scans revealed that total plaque volume measurements (P = 0.037), but not intima-media thickness measurements, were higher in subjects with diabetes/impaired glucose tolerance compared to the normoglycemic controls. Correlation between intima-media thickness and total plaque volume was moderate. Based on our study findings, to achieve power levels >0.70 when comparing intima-media thickness measurements for diabetics versus non-diabetics, thousands of study subjects are required. For comparing total plaque volume measurements, only hundreds of study subjects are required. Conclusion The development of atherosclerotic plaque is greater in subjects with diabetes/impaired glucose tolerance. Total plaque volume appears to capture the atherosclerotic disease burden more effectively in subjects with type 2 diabetes, and would be an appropriate outcome measure for studies aimed at changing the diabetic milieu.
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356. Prevalence, determinants and co-morbidities of chronic kidney disease among First Nations adults with diabetes: results from the CIRCLE study
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Stewart B. Harris, Mariam Naqshbandi Hayward, and Roland Dyck
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Adult ,Male ,medicine.medical_specialty ,Canada ,Cross-sectional study ,Population ,Type 2 diabetes ,Comorbidity ,lcsh:RC870-923 ,urologic and male genital diseases ,End stage renal disease ,Risk Factors ,Diabetes mellitus ,Internal medicine ,Chronic kidney disease ,medicine ,Prevalence ,Humans ,Risk factors ,Renal Insufficiency, Chronic ,education ,Aboriginal ,First Nations ,education.field_of_study ,business.industry ,Diabetes ,Middle Aged ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,female genital diseases and pregnancy complications ,Cross-Sectional Studies ,Diabetes Mellitus, Type 2 ,Nephrology ,Albuminuria ,Indians, North American ,Female ,medicine.symptom ,Indigenous peoples ,business ,Kidney disease ,Research Article - Abstract
Background Indigenous peoples worldwide are experiencing elevated rates of type 2 diabetes and its complications. To better understand the disproportionate burden of diabetic end stage renal disease (ESRD) among Canadian First Nations people (FN), we examined prevalence, determinants, and co-morbidities of chronic kidney disease (CKD) within this population. Methods The 2007 Canadian FN Diabetes Clinical Management and Epidemiologic (CIRCLE) study conducted a cross-sectional national medical chart audit of 885 FN adults with type 2 diabetes to assess quality of diabetes care. In this sub-study, participants were divided by estimated glomerular filtration rate (eGFR in ml/min/1.73 m2), as well as by albuminuria level in those with eGFRs = > 60. Those with eGFRs = > 60 and negative albuminuria were considered to have normal/near normal kidney function (non-CKD). Using univariate and logistic regression analysis, they were compared with participants having eGFRs = > 60 plus albuminuria (CKD-alb) and with participants having eGFRs Results While 84.5% of total CIRCLE participants had eGFRs = > 60, almost 60% of the latter had CKD-alb. Of the 15.5% of total participants with CKD-eGFR Conclusions High prevalences of CKD-alb and early CKD-eGFR
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357. Association between the FTO rs9939609 polymorphism and the metabolic syndrome in a non-Caucasian multi-ethnic sample
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Salim Yusuf, Philip W. Connelly, Murray W. Huff, Matthew R. Ban, Peter Bjerregaard, Salam A. Al-Attar, Robert A. Hegele, Sonia S. Anand, Anthony J. Hanley, Stewart B. Harris, T. Kue Young, Bernard Zinman, and Rebecca L. Pollex
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Male ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Endocrinology, Diabetes and Metabolism ,FTO gene ,0302 clinical medicine ,Gene Frequency ,Indians ,Risk Factors ,Polymorphism (computer science) ,Odds Ratio ,Body Size ,Original Investigation ,Metabolic Syndrome ,0303 health sciences ,Metabolic Syndrome X ,Single Nucleotide ,Middle Aged ,Cholesterol ,Phenotype ,Inuit ,Medical Microbiology ,Female ,Cardiology and Cardiovascular Medicine ,Medical Genetics ,North American ,Adult ,Asian Continental Ancestry Group ,Canada ,medicine.medical_specialty ,HDL ,Cardiology ,Alpha-Ketoglutarate-Dependent Dioxygenase FTO ,030209 endocrinology & metabolism ,Inuits ,Risk Assessment ,Polymorphism, Single Nucleotide ,03 medical and health sciences ,Sex Factors ,Asian People ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,SNP ,Genetic Predisposition to Disease ,Polymorphism ,Allele frequency ,030304 developmental biology ,business.industry ,Cholesterol, HDL ,Proteins ,nutritional and metabolic diseases ,Odds ratio ,medicine.disease ,Obesity ,Endocrinology ,lcsh:RC666-701 ,Indians, North American ,Metabolic syndrome ,business - Abstract
Background The rs9939609 T>A single-nucleotide polymorphism (SNP) in the FTO gene has previously been found to be associated with obesity in European Caucasian samples. The objective of this study is to examine whether this association extends to metabolic syndrome (MetS) and applies in non-Caucasian samples. Methods The FTO rs9939609 SNP was genotyped in 2121 subjects from four different non-Caucasian geographical ancestries. Subjects were classified for the presence or absence of MetS according to the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III definitions. Results Carriers of ≥ 1 copy of the rs9939609 A allele were significantly more likely to have IDF-defined MetS (35.8%) than non-carriers (31.2%), corresponding to a carrier odds ratio (OR) of 1.23 (95% confidence interval [CI] 1.01 to 1.50), with a similar trend for the NCEP ATP III-defined MetS. Subgroup analysis showed that the association was particularly strong in men. The association was related to a higher proportion of rs9939609 A allele carriers meeting the waist circumference criterion; a higher proportion also met the HDL cholesterol criterion compared with wild-type homozygotes. Conclusion Thus, the FTO rs9939609 SNP was associated with an increased risk for MetS in this multi-ethnic sample, confirming that the association extends to non-Caucasian population samples.
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358. Treatment satisfaction of diabetic patients: what are the contributing factors?
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Aya Biderman, Enav Noff, Stewart B Harris, Nurit Friedman, and Amalia Levy
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DIABETES complications ,HYPOGLYCEMIC agents ,ENDOCRINE diseases ,CHRONIC diseases - Abstract
Background. Treatment satisfaction is an important factor of quality of care, especially in treating chronic diseases such as diabetes mellitus. Identifying factors that independently influence treatment satisfaction may help in improving clinical outcomes. Objective. To find the relationship between treatment satisfaction of diabetic patients and socio-demographic, clinical, adherence, treatment and health perception factors. Methods. Patients were interviewed by telephone about their socio-demographic parameters, health status, clinical data and treatment factors. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was used to measure satisfaction and adherence. This is a cross-sectional study, as part of a larger study of chronic patients in Israel. Subjects were randomly selected diabetes patients. The main outcome measures were DTSQ levels. A multivariate linear regression model was constructed to identify factors independently associated with patientsâ satisfaction. Results. In all, 630 patients were included in the study. Multivariate analysis indicated that demographic parameters (e.g. female gender, P = 0.036), treatment factors (e.g. type of medication, P P P Conclusions. Treatment satisfaction is lower among diabetic patients who have a lower educational level, who are insulin treated or have a diabetic complication and is related to difficulties in taking medications and coming to follow-up visits. Addressing the specific needs of these patients might be effective in improving their satisfaction, thus having a positive influence on other clinical outcomes. [ABSTRACT FROM AUTHOR]
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- 2009
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359. The Educational Impact of Web-Based, Faculty-Led Continuing Medical Education Programs in Type 2 Diabetes: A Survey Study to Analyze Changes in Knowledge, Competence, and Performance of Health Care Professionals
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Stewart B Harris, Shannon Idzik, Adriano Boasso, Sola Quasheba Neunie, Alexander Daniel Noble, Helen Elaine Such, and Joanna Van
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Special aspects of education ,LC8-6691 ,Medicine (General) ,R5-920 - Abstract
BackgroundThe treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited. ObjectiveThis study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence, and performance following short, case-based, multidisciplinary web-based CME activities; and identify the remaining educational gaps. MethodsTwo faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5). ResultsEach activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P
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- 2022
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360. Predicting Real-world Hypoglycemia Risk in American Adults With Type 1 or 2 Diabetes Mellitus Prescribed Insulin and/or Secretagogues: Protocol for a Prospective, 12-Wave Internet-Based Panel Survey With Email Support (the iNPHORM [Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models] Study)
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Alexandria Ratzki-Leewing, Bridget L Ryan, Guangyong Zou, Susan Webster-Bogaert, Jason E Black, Kathryn Stirling, Kristina Timcevska, Nadia Khan, John D Buchenberger, and Stewart B Harris
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Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundHypoglycemia prognostic models contingent on prospective, self-reported survey data offer a powerful avenue for determining real-world event susceptibility and interventional targets. ObjectiveThis protocol describes the design and implementation of the 1-year iNPHORM (Investigating Novel Predictions of Hypoglycemia Occurrence Using Real-world Models) study, which aims to measure real-world self-reported severe and nonsevere hypoglycemia incidence (daytime and nocturnal) in American adults with type 1 or 2 diabetes mellitus prescribed insulin and/or secretagogues, and develop and internally validate prognostic models for severe, nonsevere daytime, and nonsevere nocturnal hypoglycemia. As a secondary objective, iNPHORM aims to quantify the effects of different antihyperglycemics on hypoglycemia rates. MethodsiNPHORM is a prospective, 12-wave internet-based panel survey that was conducted across the United States. Americans (aged 18-90 years) with self-reported type 1 or 2 diabetes mellitus prescribed insulin and/or secretagogues were conveniently sampled via the web from a pre-existing, closed, probability-based internet panel (sample frame). A sample size of 521 baseline responders was calculated for this study. Prospective data on hypoglycemia and potential prognostic factors were self-assessed across 14 closed, fully automated questionnaires (screening, baseline, and 12 monthly follow-ups) that were piloted using semistructured interviews (n=3) before fielding; no face-to-face contact was required as part of the data collection. Participant responses will be analyzed using multivariable count regression and machine learning techniques to develop and internally validate prognostic models for 1-year severe and 30-day nonsevere daytime and nocturnal hypoglycemia. The causal effects of different antihyperglycemics on hypoglycemia rates will also be investigated. ResultsRecruitment and data collection occurred between February 2020 and March 2021 (ethics approval was obtained on December 17, 2019). A total of 1694 participants completed the baseline questionnaire, of whom 1206 (71.19%) were followed up for 12 months. Most follow-up waves (10,470/14,472, 72.35%) were completed, translating to a participation rate of 179% relative to our target sample size. Over 70.98% (856/1206) completed wave 12. Analyses of sample characteristics, quality metrics, and hypoglycemia incidence and prognostication are currently underway with published results anticipated by fall 2022. ConclusionsiNPHORM is the first hypoglycemia prognostic study in the United States to leverage prospective, longitudinal self-reports. The results will contribute to improved real-world hypoglycemia risk estimation and potentially safer, more effective clinical diabetes management. Trial RegistrationClinicalTrials.gov NCT04219514; https://clinicaltrials.gov/ct2/show/NCT04219514 International Registered Report Identifier (IRRID)DERR1-10.2196/33726
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- 2022
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361. COVID-19 hinterland: surveilling the self-reported impacts of the pandemic on diabetes management in the USA (cross-sectional results of the iNPHORM study)
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Stewart B Harris, Bridget L Ryan, Alexandria A Ratzki-Leewing, John D Buchenberger, Joseph W Dickens, and Jason E Black
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Medicine - Abstract
Main objective To determine how and to what extent COVID-19 has affected real-world, self-reported glycaemic management in Americans with type 1 or type 2 diabetes taking insulin and/or secretagogues, with or without infection.Design A cross-sectional substudy using data from the Investigating Novel Predictions of Hypoglycemia Occurrence using Real-world Models panel survey.Setting USA.Participants Americans 18–90 years old with type 1 or 2 diabetes taking insulin and/or secretagogues were conveniently sampled from a probability-based internet panel.Primary outcome measure A structured, COVID-19-specific questionnaire was administered to assess the impact of the pandemic (irrespective of infection) on socioeconomic, behavioural/clinical and psychosocial aspects of glycaemic management.Results Data from 667 respondents (type 1 diabetes: 18%; type 2 diabetes: 82%) were analysed. Almost 25% reported A1c values ≥8.1%. Rates of severe and non-severe hypoglycaemia were 0.68 (95% CI 0.5 to 0.96) and 2.75 (95% CI 2.4 to 3.1) events per person-month, respectively. Ten respondents reported a confirmed or probable COVID-19 diagnosis. Because of the pandemic, 24% of respondents experienced difficulties affording housing; 28% struggled to maintain sufficient food to avoid hypoglycaemia; and 19% and 17% reported challenges accessing diabetes therapies and testing strips, respectively. Over one-quarter reported issues retrieving antihyperglycaemics from the pharmacy and over one-third reported challenges consulting with diabetes providers. The pandemic contributed to therapeutic non-adherence (14%), drug rationing (17%) and reduced monitoring (16%). Many struggled to keep track, and in control, of hypoglycaemia (12%–15%) and lacked social support to help manage their risk (19%). Nearly half reported decreased physical activity. Few statistically significant differences were observed by diabetes type.Conclusions COVID-19 was found to cause substantial self-reported deficiencies in glycaemic management. Study results signal the need for decisive action to restabilise routine diabetes care in the USA.Trial registration number NCT04219514.
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- 2021
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362. National Survey of Indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey
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Jordan W Tompkins, Selam Mequanint, Douglas Edward Barre, Meghan Fournie, Michael E Green, Anthony J Hanley, Mariam Naqshbandi Hayward, Merrick Zwarenstein, Stewart B Harris, and On behalf of the FORGE AHEAD Program Team
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National ,Survey ,Primary healthcare ,Diabetes ,Indigenous ,Chronic disease ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. Methods The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports. Results A total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes. Conclusions The CPS is the first community-based, national-level survey of its kind in Canada. Although the response rate was low, the CPS was distributed and successfully administered across a broad range of First Nations communities, and future considerations would benefit from a governance structure and leadership that strengthens community engagement, and a longitudinal research approach to increase the representativeness of the data. This type of information is important for communities and regions to inform decision making (maintain successes, and identify areas for improvement), strengthen health service delivery and infrastructure, increase accessibility to healthcare personnel, and allocate funding and/or resources to build capacity and foster a proactive chronic disease prevention and management approach for Indigenous communities across Canada. Trial registration Current ClinicalTrial.gov protocol ID NCT02234973. Registered: September 9, 2014.
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- 2018
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363. Does a patient-managed insulin intensification strategy with insulin glargine and insulin glulisine provide similar glycemic control as a physician-managed strategy? Results of the START (Self-Titration With Apidra to Reach Target) Study: a randomized noninferiority trial.
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Harris SB, Yale JF, Berard L, Stewart J, Abbaszadeh B, Webster-Bogaert S, and Gerstein HC
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- Adult, Aged, Algorithms, Blood Glucose drug effects, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 2 blood, Female, Glycated Hemoglobin metabolism, Humans, Hypoglycemia drug therapy, Insulin administration & dosage, Insulin Glargine, Male, Middle Aged, Self Administration, Treatment Outcome, Diabetes Mellitus, Type 2 drug therapy, Hypoglycemic Agents administration & dosage, Insulin analogs & derivatives, Insulin, Long-Acting administration & dosage
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OBJECTIVE Diabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes who are unable to achieve optimal glycemia control with a basal insulin. RESEARCH DESIGN AND METHODS Patients with type 2 diabetes, an HbA1c level >7% (53 mmol/mol), and either nocturnal hypoglycemia episodes or an insufficient basal insulin glargine level (with or without oral agents) to achieve a fasting plasma glucose level ≤6 mmol/L (108 mg/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration or physician titration. The primary outcome was an HbA1c level ≤7% (53 mmol/mol) without severe hypoglycemia. RESULTS After a mean (SD) follow-up of 159.4 days (36.2 days), 28.4% of participants in the self-titration arm vs. 21.2% in the physician titration arm achieved an HbA1c level of ≤7% (53 mmol/mol) without severe hypoglycemia (between-group absolute difference 7.2%; 95% CI -3.2 to 17.7). The lower end of this 95% confidence interval was within the predetermined noninferiority boundary of -5% (P noninferiority = 0.011). CONCLUSIONS In stable patients with type 2 diabetes who are receiving doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-managed titration algorithm is as effective as a physician-managed algorithm.
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- 2014
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