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CONTEXTE : La recherche sur les defis de la prise en charge du diabete chez les personnes itinerantes qui en sont atteintes n'a pas tendance a prendre en consideration le point de vue des personnes touchees. Nous avons utilise une approche de recherche participative avec la communaute pour explorer ces defis. METHODES : Nous avons recrute des cochercheurs ayant une connaissance experientielle de l'itinerance et du diabete. Les chercheurs principaux leur ont offert une formation en recherche et ont prepare le terrain avec eux pour ce projet. Les cochercheurs ont collectivement choisi d'utiliser la methode photovoix pour illustrer la difficulte de bien s'alimenter quand on est en situation d'itinerance et explorer en quoi cet ecueil affecte plus largement la gestion du diabete. Apres une formation en photographie et en ethique, les cochercheurs ont pris des photos en lien avec les objectifs du projet et redige des recits connexes au moyen de techniques de redaction inspiree par des photos. Les chercheurs principaux ont analyse les photos et les recits, et ils en ont degage des themes qui se sont precises lors de discussions de groupe. RESULTATS : Les 8 cochercheurs etaient atteints de diabete de type 2 (diagnostique de 18 mois a 23 ans auparavant) et avaient vecu en situation d'itinerance pendant des periodes allant de 8 mois a 12 ans. Nous avons degage 4 themes a partir de 17 photos et recits produits. L'itinerance affecte grandement la sante emotionnelle et mentale des personnes, ce qui nuit a leur capacite de bien gerer leur diabete. Les aliments servis dans les refuges sont rarement nutritifs ou appetissants. L'obtention d'une forme de logement peut faciliter la prise en charge du diabete en creant un environnement stable qui favorise l'autonomie, mais les couts et le manque de connaissances sont des obstacles a la preparation de repas sains. L'itinerance complique aussi l'acces aux professionnels de la prise en charge du diabete et aux medicaments d'ordonnance. INTERPRETATION : Les images et les recits associes permettent de dresser un tableau frappant, complet et fidele des defis auxquels sont confrontees les personnes en situation d'itinerance qui essaient de gerer leur diabete. Comprendre ces defis est la premiere etape qui permettra aux intervenants et aux decideurs de repondre aux besoins de cette population., Les patients diabetiques en situation d'itinerance ont souvent de la difficulte a gerer les taches d'autogestion en raison des multiples defis medicaux et sociaux auxquels ils sont confrontes (1). Cela [...]

BACKGROUND: Minimal consideration has been given to understanding the challenges of managing diabetes while homeless from the perspective of those with lived or living experience. We used a community-based participatory approach to explore these challenges. METHODS: We recruited coresearchers with experiential knowledge of both homelessness and diabetes. Lead researchers conducted research training and facilitated research development by coresearchers. Coresearchers collectively chose to use photovoice methodology to illustrate the challenges of accessing healthy food while homeless and to explore how homelessness more broadly affects diabetes management. After training in photography technique and ethics, coresearchers took photos to address these objectives and created accompanying narratives using photo elicitation techniques. Lead researchers analyzed photos and narratives, and extracted themes, refined through group discussion. RESULTS: The 8 coresearchers had type 2 diabetes (diagnosed 18 months to 23 years previously) and had experienced homelessness for periods ranging from 8 months to 12 years. We identified 4 themes from the 17 photos and narratives they produced. Homelessness imposed major demands on emotional and mental health, impairing the ability of those affected to focus on diabetes self-management. Foods provided in shelters were often nutritionally poor or unpalatable. Obtaining housing facilitated diabetes management through stability and autonomy, but cost and lack of knowledge posed challenges to healthy food preparation. Homelessness also presented challenges to accessing diabetes care professionals and prescription medications. INTERPRETATION: The images and narratives provide a powerful firsthand, in-depth account of the challenges faced by people trying to manage diabetes while homeless. Understanding these challenges is the first step in enabling providers and policy-makers to meet the needs of this population., Patients with diabetes who experience homelessness often have a difficult time with self-management tasks, given the various health and social challenges they face. (1) These include financial barriers to accessing [...]

BACKGROUND: Cold-induced thermogenesis is known to improve insulin sensitivity, which may become increasingly relevant in the face of global warming. The aim of this study was to examine the relation between outdoor air temperature and the risk of gestational diabetes mellitus. METHODS: We identified all births in the Greater Toronto Area from 2002 to 2014 using administrative health databases. Generalized estimating equations were used to examine the relation between the mean 30-day outdoor air temperature before the time of gestational diabetes mellitus screening and the likelihood of diagnosis of gestational diabetes mellitus based on a validated algorithm using hospital records and physician service claims. RESULTS: Over the 12-year period, there were 555911 births among 396828 women. Prevalence of gestational diabetes mellitus was 4.6% among women exposed to extremely cold mean outdoor air temperatures ([less than or equal to]-10[degrees]C) in the 30-day period before screening and increased to 7.7% among those exposed to hot mean 30-day temperatures ([greater than or equal to] 24[degrees]C). Each 10[degrees]C increase in mean 30-day temperature was associated with a 1.06 (95% confidence interval [CI] 1.04-1.07) times higher odds of gestational diabetes mellitus, after adjusting for maternal age, parity, neighbourhood income quintile, world region and year. A similar effect was seen for each 10[degrees]C rise in outdoor air temperature difference between 2 consecutive pregnancies for the same woman (adjusted odds ratio 1.06, 95% CI 1.03-1.08). INTERPRETATION: In our setting, there was a direct relation between outdoor air temperature and the likelihood of gestational diabetes mellitus. Future climate patterns may substantially affect global variations in the prevalence of diabetes, which also has important implications for the prevention and treatment of gestational diabetes mellitus., The impact of climate variability on health has become increasingly relevant given the global rise in air temperatures over the past century. (1,2) Extreme weather patterns can adversely influence health--directly, [...]