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Objectives Copy-number variations (CNVs) are large-scale deletions or duplications of DNA that have required specialized detection methods, such as microarray-based genomic hybridization or multiplex ligation probe amplification. However, recent advances in bioinformatics have made it possible to detect CNVs from next-generation DNA sequencing (NGS) data. Maturity-onset diabetes of the young (MODY) 5 is a subtype of autosomal-dominant diabetes that is often caused by heterozygous deletions involving the HNF1B gene on chromosome 17q12. We evaluated the utility of bioinformatic processing of raw NGS data to detect chromosome 17q12 deletions in MODY5 patients. Methods NGS data from 57 patients clinically suspected to have MODY but who were negative for pathogenic mutations using a targeted panel were re-examined using a CNV calling tool (CNV Caller, VarSeq version 1.4.3). Potential CNVs for MODY5 were then confirmed using whole-exome sequencing, cytogenetic analysis and breakpoint analysis when possible. Results Whole-gene deletions in HNF1B, ranging from 1.46 to 1.85 million basepairs in size, were detected in 3 individuals with features of MODY5. These were confirmed by independent methods to be part of a more extensive 17q12 deletion syndrome. Two additional patients carrying a 17q12 deletion were subsequently diagnosed using this method. Conclusions Large-scale deletions are the most common cause of MODY5 and can be detected directly from NGS data, without the need for additional methods.

OBJECTIVES Few studies have examined the effect of specialized care on patients with diabetes who present to the emergency department (ED) visits for acute hyperglycemia. The objective of this study was to characterize ED patients presenting with hyperglycemia and compare the 30-day outcomes of those followed by specialized diabetes clinics with those not followed. We hypothesized that patients followed by specialized clinics would have improved clinical outcomes compared with those who had no specialized follow up. METHODS We conducted this single-centre retrospective cohort study of adults (≥18 years) with an ED visit for hyperglycemia over 1 year (January to December 2014). Data from ED visits were linked to specialized diabetes clinic records, which contained diabetes-specific clinical data not available in ED visit records. Descriptive statistics were summarized and comparisons between groups were performed, when appropriate. RESULTS There were 456 patients (55.0% men; mean age, 47.7 years; 46.3% with type 1 diabetes) with 250 followed by the specialized diabetes clinics. The 206 patients who were not followed by the diabetes clinics (45%) were more likely to have a recurrent hyperglycemia ED visit (32.5% vs 9.6%, p

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

Background: People with diabetes mellitus commonly experience hypoglycemia, but they may not necessarily present to hospital after severe hypoglycemia requiring paramedic assistance. We sought to describe the incidence and characteristics of calls for hypoglycemia requiring paramedic assistance among adults in southwestern Ontario, Canada, and to determine predictors of hospital transport. Methods: This population-based retrospective cohort study used data extracted from ambulance call reports (ACRs) of 8 paramedic services of the Southwest Ontario Regional Base Hospital Program from January 2008 to June 2014. We described calls in which treatment for hypoglycemia was administered, summarized the incidence of hypoglycemia calls and performed logistic regression to determine predictors of hospital transport. Results: Out of 470 467 ACRs during the study period, 9185 paramedic calls occurred in which hypoglycemia treatment was administered to an adult (mean age 60.2 yr, 56.8% male, 81.1% with documented diabetes). Refusal of hospital transport occurred in 2243 (24.4%) of calls. Documented diabetes diagnosis (adjusted odds ratio [OR] 0.82, 95% confidence interval [CI] 0.69–0.96), higher capillary blood glucose (adjusted OR 0.31, 95% CI 0.22–0.44) and overnight calls (adjusted OR 0.80, 95% CI 0.72–0.91) were associated with lower odds of hospital transport. Higher-acuity calls (adjusted OR 2.05, 95% CI 1.58–2.66) were associated with higher odds of transport. The estimated annual incidence rate of hypoglycemia requiring paramedic assistance was 108 per 10 000 people with diabetes per year. Interpretation: Hypoglycemia requiring paramedic assistance in southwestern Ontario is common, and close to 25% of calls do not result in hospital transport. Physicians managing diabetes care may be unaware of patients’ hypoglycemia requiring paramedic care, suggesting a potential gap in follow-up care; we suggest that paramedics play an important role in identifying those at high recurrence risk and communicating with their care providers.

A 21-year-old male with known type 1 diabetes mellitus presented to the emergency department (ED) with two days of vomiting, polyuria, and polydipsia after several days of viral upper respiratory tract infection symptoms. Since his symptom onset, his home capillary blood glucose readings have been higher than usual. On the day of presentation, his glucometer read “high,” and he could not tolerate oral fluids. On examination, his pulse was 110 beats/minute, and his respiratory rate was 24 breaths/minute. He was afebrile, and the remaining vital signs were normal. Other than dry mucous membranes, his cardiopulmonary, abdominal, and neurologic exams were unremarkable. Venous blood gas demonstrated a pH of 7.25 mm Hg, pCO2 of 31 mm Hg, HCO3 of 13 mm Hg, anion gap of 18 mmol/L, and laboratory blood glucose of 40 mmol/L, as well as serum ketones measuring “large.”

OBJECTIVE To determine if a structured transition program for young adults with type 1 diabetes improves clinic attendance, glycemic control, diabetes-related distress, quality of life, and satisfaction with care. RESEARCH DESIGN AND METHODS In this multicenter randomized controlled trial, young adults (17–20 years) with type 1 diabetes were randomly assigned to a transition program with a transition coordinator or to standard care. The intervention lasted 18 months (6 in pediatric and 12 in adult care). The primary outcome was the proportion of participants who failed to attend at least one adult diabetes clinic visit during the 12-month follow-up after completion of the intervention. RESULTS We randomized 205 participants, 104 to the transition program and 101 to standard care. Clinic attendance was improved in the transition program (mean [SD] number of visits 4.1 [1.1] vs. 3.6 [1.2], P = 0.002), and there was greater satisfaction with care (mean [SD] score 29.0 [2.7] vs. 27.9 [3.4], P = 0.032) and less diabetes-related distress (mean [SD] score 1.9 [0.8] vs. 2.1 [0.8], P = 0.049) reported than in standard care. There was a trend toward improvement in mean HbA1c (8.33% [68 mmol/mol] vs. 8.80% [73 mmol/mol], P = 0.057). During the 12-month follow-up, there was no difference in those failing to attend at least one clinic visit (P = 0.846), and the mean change in HbA1c did not differ between the groups (P = 0.073). At completion of follow-up, the groups did not differ with respect to satisfaction with care or diabetes-related distress and quality of life. CONCLUSIONS Transition support during this 18-month intervention was associated with increased clinic attendance, improved satisfaction with care, and decreased diabetes-related distress, but these benefits were not sustained 12 months after completion of the intervention.

AIMS Hypoglycaemia is a common treatment consequence in diabetes mellitus. Prior studies have shown that a large proportion of people with paramedic assist-requiring hypoglycaemia prefer not to be transported to hospital. Thus, these episodes are "invisible" to their usual diabetes care providers. A direct electronic referral programme where paramedics sent referrals focused hypoglycaemia education at the time of paramedic assessment was implemented in our region for 18 months; however, referral programme uptake was low. In this study, we examined patient and paramedic experiences with a direct electronic referral programme for hypoglycaemia education postparamedic assist-requiring hypoglycaemia, including barriers to programme referral and education attendance. METHODS We surveyed paramedics and conducted semistructured telephone interviews of patients with paramedic-assisted hypoglycaemia who consented to the referral programme and were scheduled for an education session in London and Middlesex County, Canada. RESULTS Paramedics and patient participants felt that the direct referral programme was beneficial. A third of paramedics who responded to our survey used the referral programme for each encounter where they treated patients for hypoglycaemia. Patients felt very positive about the referral programme and their paramedic encounter; however, they described embarrassment, guilt and prior negative experience as key barriers to attending education. CONCLUSIONS Paramedics and patients felt that direct referral for focused hypoglycaemia education postparamedic assist-requiring hypoglycaemia was an excellent strategy. Despite this, referral programme participation was low and thus there remain ongoing barriers to implementation and attendance. Future iterations should consider how best to meet patient needs through innovative delivery methods.

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

BackgroundWhile studies have reported factors affecting adherence to diabetic care plans from a chronic disease perspective, no studies have addressed issues with post-discharge adherence facing patients with diabetes after an emergency department (ED) presentation for hyperglycaemia. This study’s objectives were to describe patient perspectives on their experience during and after an ED visit for hyperglycaemia and to identify factors that influence postdischarge adherence.MethodsWe conducted a qualitative description (QD) study of adult patients who had visited a Canadian ED for hyperglycaemia. Consistent with QD, purposive sampling was utilised, seeking diversity across age, gender and diabetes type. Participants took part in semistructured interviews and thematic analysis was used to identify and describe core themes. Frequent team meetings were held to review the analysis and to develop the final list of themes used to recode the data set. Analytic insights were tracked using reflective memos and an audit trail documented all steps and decisions.Results22 patients with type 1 and 2 diabetes were interviewed from June to October 2019. Participants identified several factors that impacted their ability to adhere to discharge plans: communication of instructions, psychosocial factors (financial considerations, shame and guilt, stigma and mental health), access to follow-up care and paediatric to adult care transitions.ConclusionsThis study describes the patient experience with the communication of discharge instructions, as well as factors affecting adherence post-ED discharge for hyperglycaemia. Our findings suggest four strategies that could improve the patient experience, improve adherence to discharge plans and potentially decrease the frequency of recurrent ED visits for hyperglycaemia.

Hypoglycemia requiring paramedic assistance places a large burden on the health care system (HCS), and negatively impacts quality of life and long-term outcomes in patients with diabetes. Prior studies have shown that only a small proportion of patients with paramedic-assist requiring hypoglycemia are subsequently brought to the Emergency Room; thus severe hypoglycemia (SHG) is often “invisible” to the HCS and is not adequately followed up on. We created an innovative, two-step hypoglycemia education program in London, Canada which consists of a direct electronic referral system by paramedics at the time they assess patients with SHG to the local Diabetes Education Center (DEC) for a standardized hypoglycemia education. There were a total of 446 SHG calls to the Middlesex-London Paramedic Service from September 2017- June 2018. Of those, 322 (72%) were eligible for our study, of whom 135 (42%) were referred to the DEC and only 79 patients agreed to attend. Of the 79 patients who were enrolled over 21 months, 49 (62%) were male; the mean age was 61±16 (range 18-88 yrs); and 40 (51%) had type 2, 32 (41%) type 1, and 7 (9%) were unknown diabetes type. Of those 48 (61%) were taking insulin, 8 (10%) oral hypoglycemic agents of which the most common was glyburide (5/8, 63%), and 19 (24%) were on both oral agents and insulin. Three (4%) patients were on an insulin pump. Mean HbA1c was 63±9 mmol/mol (7.9±1.3, range 4.8-10.6%) and the majority did not have an Endocrinologist (49, 62%). Only 50 (63%) completed the education program. There were no statistically significant differences between the characteristics of the patients who attended and did not attend DEC program. Patients experiencing SHG remain ’hidden’ from the HCS. Hence, the impact of SHG is underestimated and understudied. Despite an accessible referral system to a focused intervention, our program was not successful in engaging many patients with SHG requiring paramedic assistance in a program to decrease their risk for SHG. Further study to explore barriers is needed. Disclosure T. Spaic: Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Dexcom, Inc., Sanofi. S.L. Liu: Consultant; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Novo Nordisk Inc., Sanofi. D.R. Carter: None. M. Peddle: None. J. Mahon: None. Funding Academic Medical Organization of Southwestern Ontario

Hypoglycemia requiring paramedic assistance negatively impacts outcomes in people with diabetes. Prior studies have shown only a small proportion of those with paramedic assist-requiring HG are brought to hospital. These episodes are thus “invisible” to the health care system. An innovative direct electronic referral program in which paramedics sent a referral for focused HG education to the Diabetes Education Centre (DEC) at the time of paramedic assessment was implemented for 18 months. Program uptake was lower than expected (133 referrals, 79 scheduled, and 50 attended). This qualitative study examines barriers and facilitators of DEC attendance for HG education after paramedic assist-requiring HG. We conducted semi-structured interviews of patients with paramedic-assisted HG and surveyed paramedics about their experiences. Of 34 paramedics, 30 (88%) attended at least 1 HG call in the study period and 26 (76%) used the referral program. Fourteen patients (18% response rate) participated: 8 men (57%); 13 (93%) age ≥ 50 yrs. Eight patients (57%) recalled the paramedic referral, 6 (43%) did not, and 4 (29%) thought they were referred by their family doctor. One patient thought attendance was mandatory to keep their drivers’ license. Themes identified from patient responses included: positive impact of diabetes education especially if delivered early after diagnosis, importance of spousal support and in-person education. Barriers to attendance were prior DEC attendance especially in those with long diabetes duration and embarrassment (failure to self-manage, memory loss around the HG event). While patients felt that focused HG education is an excellent strategy to reduce recurrent episodes, many had already attended similar sessions and felt further education was not needed. Hence, an important gap in providing HG education to patients with severe HG may be both system-based and disease-related. Disclosure S.L. Liu: Consultant; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Novo Nordisk Inc., Sanofi. A. Rosa: None. S.L. Sibbald: None. J. Mahon: None. D.R. Carter: None. M. Peddle: None. T. Spaic: Research Support; Self; Novo Nordisk Inc. Speaker’s Bureau; Self; Dexcom, Inc., Sanofi. Funding Academic Medical Association of Southwestern Ontario (INN16-004)

Introduction: Patients with poorly-controlled diabetes often visit the emergency department (ED) for treatment of hyperglycemia. While previous qualitative studies have examined the patient experience of diabetes as a chronic illness, there are no studies describing patients’ perceptions of ED care for hyperglycemia. The objective of this study was to explore the patient experience regarding ED hyperglycemia visits, and to characterize perceived barriers to adequate glycemic control post-discharge. Methods: This study was conducted at a tertiary care academic centre in London, Ontario. A qualitative constructivist grounded theory methodology was used to understand the experience of adult patient partners who have had an ED hyperglycemia visit. Patient partners, purposively sampled to capture a breadth of age, sex, disease and presentation frequency were invited to participate in a semi-structured individual interview to probe their experiences. Sampling continued until a theoretical framework representing key experiences and expectations reached sufficiency. Data were collected and analyzed iteratively using a constant comparative approach. Results: 22 patients with type 1 or 2 diabetes were interviewed. Participants sought care in the ED over other options because of their concern of having a potentially life-threatening condition, advice from a healthcare provider or family member, or a perceived lack of convenient alternatives to the ED based on time and location. Participants’ care expectations centred around symptom relief, glycemic control, reassurance and education, and seeking referral to specialist diabetes care post-discharge. Finally, perceived system barriers that challenged participants’ glycemic control included affordability of medical supplies and medications, access to follow-up and, in some cases, the transition from pediatric to adult diabetes care. Conclusion: Patients with diabetes utilize the ED for a variety of urgent and emergent hyperglycemic concerns. In addition to providing excellent medical treatment, ED healthcare providers should consider patients’ expectations when caring for those presenting with hyperglycemia. Future studies will focus on developing strategies to help patients navigate some of the barriers that exist within our current limited healthcare system, enhance follow-up care, and improve short- and long-term health outcomes.

Hypertension is one of the most common problems encountered in the primary care setting. Numerous secondary causes of hypertension exist and are potentially reversible. The ability to screen for such causes and manage them effectively may spare patients from prolonged medical therapy and hypertensive complications. Licorice can cause hypertension and hypokalemia due its effects on cortisol metabolism. We report a case of jelly bean ingestion that highlights the presentation, pathophysiology and management of licorice-induced hypertension.

Insulin is the most effective therapy for achieving optimal glycemic control; however, many patients with type 2 diabetes on an intensified treatment regimen fail to achieve the recommended HbA1c target (1,2) and face the risk of adverse effects such as hypoglycemia and weight gain (3). The addition of sodium–glucose cotransporter 2 (SGLT2) inhibitors to a regimen of insulin therapy in this patient population has the potential to mitigate insulin-related weight gain and risk of hypoglycemia, with the added benefit of insulin dose reduction (4). Randomized controlled trials (RCTs) have shown improved clinical outcomes of SGLT2 inhibitors as monotherapy and as an add-on to oral and insulin therapy, but there is a paucity of real-world (RW) studies evaluating similar outcomes. Data extracted from WebDR (5) was used to evaluate the RW clinical impact of SGLT2 inhibitors (initiation of canagliflozin or dapagliflozin between February 2014 and December 2016) as an add-on to insulin therapy in patients with type 2 diabetes not achieving glycemic targets (those with HbA1c >7% [>53 mmol/mol]). Empagliflozin was excluded because of inadequate sample size. Ethical approval …

Background: Patients with poorly controlled diabetes mellitus (DM) often visit the emergency department (ED) for management of hyperglycemic episodes, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). It has been previously reported that risk factors for readmission to the intensive care unit (ICU) in DKA include older age, female sex and the presence of significant comorbidity including sepsis. However, there are no ED-based studies on this topic, particularly in a Canadian setting, and data on outcomes such as recurrent ED visits, hospital or ICU admission after discharge in these patients is lacking. Objectives: The primary objective of this study is to derive and internally validate a clinical risk tool for prognosis of patients presenting with hyperglycemic emergencies to identify those at higher risk of adverse outcomes within 30 days of initial ED presentation. Methods: This will be a multicentre prospective cohort study of eligible consecutive adult patients with an ED diagnosis of hyperglycemia, DKA or HHS. We will include all visits of adult (≥18 years) ED patients with either a known or unknown history of DM and a diagnosis of hyperglycemia (blood glucose >11.0 mmol/L), DKA or HHS. We will include patients with co-morbid diagnoses in addition to hyperglycemia. We will exclude patients: a) with advanced care directives for resuscitation involving refusal of treatment, and b) who are initially assessed at a peripheral hospital and transferred to our sites for ongoing management. Research assistants will then contact the enrolled participants via telephone for follow-up regarding clinical outcomes, including repeat visits to see a health care provider, changes in diabetic medications, and time taken off of work or school. Participants will be followed to determine if they have further ED visits, admissions or ICU admissions after their ED visit for hyperglycemia. Data on missed patients or those who refused consent will be collected to assess for selection/enrolment bias. Statistical considerations: The primary outcome will be an unplanned return ED visit for hyperglycemia within 30 days of initial presentation. Secondary outcomes will include unplanned admission to hospital or ICU for hyperglycemia, or death within 30 days of the index ED visit. Additionally, we hope to characterize patient-important and health-care system outcomes such as time taken off work or school and follow-up visits to see a healthcare provider. We will conduct descriptive statistics on investigations, treatments, disposition and patient-important outcomes. We will perform an initial univariate logistic regression, followed by a multivariate analysis to identify predictor variables associated with adverse events such as recurrent ED visits, and admission to hospital or ICU for hyperglycemia within 30 days. We will include individual patients who have multiple recurrent visits to the ED during the study period and statistically weight for these using generalized estimating equations (GEE), which are used to develop regression models for correlated data that arise from repeated measures of the same individuals over time. Finally, a clinical risk tool will be derived by rounding the beta co-efficients. Internal validation will be conducted using bootstrapping techniques. Importance: ED visits for hyperglycemia significantly affect both the healthcare system overall and the individual patient. The results of this project will assist clinicians to better identify these patients and enable them to intervene either medically or educationally to prevent subsequent visits to the ED. As a result, patients will have improved care, better blood glucose control, and be identified for closer follow-up with a family physician or diabetes specialist. Furthermore, by aiming to reduce the number of recurrent visits, this project may reduce ED utilization and the associated healthcare costs with frequent visits and admissions for hyperglycemia.

Introduction: Hypoglycemia is a common treatment consequence in diabetes mellitus (DM) and the second most common cause of Emergency Department (ED) visits for adverse drug events. Prior studies have examined the rates of ED visits and inpatient hospitalizations for hypoglycemia. These represent only a small proportion of severe hypoglycemic events, as many do not present to hospital. To date, there have been no Canadian population-based studies examining the rates of EMS assist-requiring hypoglycemia in DM patients in the pre-hospital setting. The objective of this study was to determine the prevalence and describe the EMS assist-requiring hypoglycemia in DM patients in Southwestern Ontario. Methods: A population-based retrospective cohort study was conducted on all EMS calls for diabetic emergency from 2008-2014 in Southwestern Ontario, Canada. Data was extracted from the electronic ambulance call records for 11 EMS services in the region. Results: There were 9,265 EMS calls for a diabetic emergency (mean age 59 ± 20 years, 57% male, 82% DM). For 223 calls (2.4%) patients were younger than 19 years of age. The mean blood glucose level on presentation was 2.49 ± 1.02 mmol/L and 2,116 (24%) call subjects had initial GCS score less than 9. Treatment (intravenous glucose or IM glucagon) was given in 7,126 (77%) calls. There were 3,884 (51 %) hypoglycemia episodes with documented insulin use and 1,436 (19 %) documented oral hypoglycemia agents use. Between 2008 and 2014, rates of calls increased by 7.4% (pConclusion: The rates of EMS assist-requiring hypoglycemia are almost double the rates of hospitalization/ED visits for acute DM complications in our region. Many life threatening episodes of hypoglycemia may go unreported and subsequently not followed by the patient's primary health care provider. Further assessment and proper education following those episodes may help decrease the rate of severe hypoglycemia.

s / Can J Diabetes 37 (2013) S13eS84 S77 15.0%), indicating that approximately 40% of diabetes cases are undiagnosed. Conclusions: A substantial proportion of diabetes cases are missed by surveillance methods that use health administrative databases. This finding is concerning because individuals with undiagnosed diabetes are likely to have a delay in treatment and, thus, a higher risk for diabetes-related complications.

s / Can J Diabetes 37 (2013) S13eS84 S76 Methods: Medline and EMBASE were searched from inception to January2013toidentifycontrolledstudiesexaminingtheassociation betweensulfonylureasandriskofmortalityorcardiovascularevents.A studywasincludedifitreportedtherateofdeath,cardiovasculardeathor myocardialinfarctionforatleast2sulfonylureas.Thisanalysiscompared theriskofall-causemortalityamongstthesulfonylureasusingrandomeffectsmodels. Results: From 1717 citations, 6 cohort studies met all inclusion criteria and reported 2511 (15%) deaths in 16 801 patients. The table below presents the pooled odds ratio (95% CI) for each head-tohead comparison of mortality risk. The sulfonylurea at the top of the column serves as the reference group for each comparison. Conclusions: The risk of mortality varies significantly amongst the sulfonylureas, with glicilazide having the lowest risk and tolbutamide having the highest risk compared to all other sulfonylureas. Table 1 Summary of insulin pump cohort characteristics Insulin Pump Cohort (n1⁄4181) Current Mean (SD) current age (years) 44.6 (12.8) Mean (SD) current duration of T1DM (years) (n1⁄4180) 25.1 (13.2) Gender (% male) 44.8% Current smoking (%) 3.9% Complications (number, %) CVD 0, 0% CAD 6, 3.3% PVD 1, 0.6% Retinopathy 40, 22.1% Nephropathy 26, 14.4% Neuropathy 20, 11.0% Documented ever CGMS use (number, %) 2, 1.1% Baseline Mean (SD) age at baseline (years) 40.4 (12.7) (1 year pre-pump) Mean (SD) duration of T1DM at baseline (years) (n1⁄4180) 20.9 (13.0) Mean (SD) BMI at baseline (kg/m) (n1⁄4162) 26.3 (4.7) Mean (SD) # CBG checks per day (n1⁄4168) 4.0 (0.8) Mean (SD) # injections per day (n1⁄4173) 4.2 (0.5) Mean (SD) total daily dose (units) (n1⁄4166) 51.4 (25.6) Mean (SD) # DKA episodes per year (n1⁄437) 0.03 (0.16) Mean (SD) # severe hypoglycemic episodes per year (n1⁄4129) 0.13 (0.73) Mean (SD) most recent HbA1c prior to pump start (%) (n1⁄4177) 7.89% (1.33%) Mean (SD) mean of all HbA1c values prior to pump start (n1⁄4177) 7.92% (1.37%) Pump Start Year Mean (SD) age at pump start (years) 41.4 (12.7) Mean (SD) duration of T1DM at pump start (years) (n1⁄4180) 21.9 (13.0) Mean (SD) BMI (kg/m) (n1⁄4160) 26.4 (4.7) Mean (SD) # CBG per day (n1⁄4164) 3.9 (0.5) Mean (SD) total basal daily dose (units) (n1⁄4181) 21.9 (11.3) Mean (SD) # DKA episodes per year (n1⁄423) 0.00 (0.00) Mean (SD) # severe hypos per year (n1⁄4128) 0.03 (0.17) Type of Pump (number, %) Medtronic 159, 87.8% Animas 21, 11.6% Missing Type of Pump 1, 0.6% Year of ADP application (number, %) 2008 13, 7.2% 2009 87, 48.1% 2010 40, 22.1% 2011 21, 11.6% Missing Year 20, 11.0% ADP, Assistive Devices Program; BMI, body mass index; CBG, capillary blood glucose; CGMS, continuous glucose monitoring system; DKA, diabetic ketoacidosis; HbA1c, hemoglobin A1c; SD, standard deviation; T1DM, type 1 diabetes. 222 Use of WebDR, a Web-Based Diabetes Electronic Medical Record, as a Researchable Database to Identify and Define a Cohort of Patients with Type 1 Diabetes on Insulin Pump Therapy SELINA L. LIU*, TAMARA SPAIC, SELAM MEQUANINT, AMARDEEP THIND, IRENE HRAMIAK, JEFFREY L. MAHON, STEWART B. HARRIS London, ON WebDR is a unique web-based diabetes electronic medical record (EMR) currently in use in London, Ontario at St. Joseph’s Health Care (SJHC). In addition to its clinical use, WebDR was developed to be a comprehensive researchable databasedit contains clinical information of >15 000 patients with diabetes from physician charts since 2000. Routine clinical use of WebDR began in autumn 2011. Recently, WebDR was used for the first time to identify and characterize a specific patient cohort for a research study. There are currently 2245 adults with type 1 diabetes (T1DM) followed by the diabetes clinics of SJHC. WebDR queries selected those who started insulin pump therapy (IPT) from September 2008 to August 2011. Use of WebDR, cross-referenced to the SJHC Diabetes Education Centre’s list of IPT starts, identified 347 unique patient records. The cohort was further defined to 181 patients, and data extracted from WebDR and summarized (Table 1). A similar process was used to identify a matched control cohort of adults with T1DM who were not on IPT. This was the first use of WebDR as a researchable database to define and characterize a unique cohort of patients with T1DM on IPT and their matched controls from over >15 000 records. To our knowledge, this is one of the largest descriptive cohorts of patients with T1DM on IPT in Canada to date. This demonstrates the feasibility of using an EMR for research, and the broad impact EMR systems may have beyond their use in routine clinical care.

Background: Transition from pediatric to adult diabetes care is a high risk period during which there is an increased rate of disengagement from care. Suboptimal transition has been associated with higher risks for acute and chronic diabetes-related complications. The period of emerging adulthood challenges current systems of healthcare delivery as many young adults with type 1 diabetes (T1D) default from diabetes care and are at risk for diabetes complications which are undetected and therefore untreated. Despite the importance of minimizing loss to follow-up there are no randomized control trials evaluating models of transition from pediatric to adult diabetes care.Methods/Design: This is a multicentre randomized controlled trial. A minimum of 188 subjects with T1D aged between 17 and 20 years will be evaluated. Eligible subjects will be recruited from three pediatric care centres and randomly assigned in a 1:1 ratio to a structured transition program that will span 18 months or to receive standard diabetes care. The structured transition program is a multidisciplinary, complex intervention aiming to provide additional support in the transition period. A Transition Coordinator will provide transition support and will provide the link between pediatric and adult diabetes care. The Transition Coordinator is central to the intervention to facilitate ongoing contact with the medical system as well as education and clinical support where appropriate. Subjects will be seen in the pediatric care setting for 6 months and will then be transferred to the adult care setting where they will be seen for one year. There will then be a one-year follow-up period for outcome assessment. The primary outcome is the proportion of subjects who fail to attend at least one outpatient adult diabetes specialist visit during the second year after transition to adult diabetes care. Secondary outcome measures include A1C frequency measurement and levels, diabetes related emergency room visits and hospital admissions, frequency of complication screening, and subject perception and satisfaction with care.Discussion: This trial will determine if the support of a Transition Coordinator improves health outcomes for this at-risk population of young adults.Trial registration: Trial Registration Number: NCT01351857. © 2013 Spaic et al.; licensee BioMed Central Ltd.