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Kushner J.A.,Baylor College of Medicine | MacDonald P.E.,University of Alberta | MacDonald P.E.,Alberta Diabetes Institute | Atkinson M.A.,University of Florida
Cell Stem Cell | Year: 2014

Two groups recently reported the in vitro differentiation of human embryonic stem cells into insulin-secreting cells, achieving an elusive goal for regenerative medicine. Herein we provide a perspective regarding these developments, compare phenotypes of the insulin-containing cells to human β cells, and discuss implications for type 1 diabetes research and clinical care. ©2014 Elsevier Inc.

Cawsey S.,University of Alberta | Padwal R.,University of Alberta | Padwal R.,Alberta Diabetes Institute | Sharma A.M.,University of Alberta | And 3 more authors.
Osteoporosis International | Year: 2014

Summary: Among women with obesity, those with the lowest bone density have the highest fracture risk. The types of fractures include any fracture, fragility-type fractures (vertebra, hip, upper arm, forearm, and lower leg), hand and foot fractures, osteoporotic, and other fracture types.Introduction: Recent reports have contradicted the traditional view that obesity is protective against fracture. In this study, we have evaluated the relationship between fracture history and bone mineral density (BMD) in subjects with obesity.Methods: Fracture risk was assessed in 400 obese women in relation to body mass index (BMI), BMD, and clinical and laboratory variables.Results: Subjects (mean age, 43.8 years; SD, 11.1 years) had a mean BMI of 46.0 kg/m2 (SD, 7.4 kg/m2). There were a total of 178 self-reported fractures in 87 individuals (21.8 % of subjects); fragility-type fractures (hip, vertebra, proximal humerus, distal forearm, and ankle/lower leg) were present in 58 (14.5 %). There were higher proportions of women in the lowest femoral neck BMD quintile who had any fracture history (41.3 vs. 17.2 %, p < 0.0001), any fragility-type fractures (26.7 vs. 11.7 %, p = 0.0009), hand and foot fractures (16.0 vs. 5.5 %, p = 0.002), other fracture types (5.3 vs. 1.2 %, p = 0.02), and osteoporotic fractures (8.0 vs. 1.2 %, p < 0.0001) compared to the remaining population. The odds ratio for any fracture was 0.63 (95 % CI, 0.49–0.89; p = 0.0003) per SD increase in BMD and was 4.3 (95 % CI, 1.9–9.4; p = 0.003) in the lowest BMD quintile compared to the highest quintile. No clinical or biochemical predictors of fracture risk were identified apart from BMD.Conclusions: Women with obesity who have the lowest BMD values, despite these being almost normal, have an elevated risk of fracture compared to those with higher BMD. © 2014, International Osteoporosis Foundation and National Osteoporosis Foundation.

Padwal R.S.,University of Alberta | Padwal R.S.,Alberta Diabetes Institute | Bienek A.,Public Health Agency of Canada | McAlister F.A.,University of Alberta | Campbell N.R.C.,Libin Cardiovascular Institute
Canadian Journal of Cardiology | Year: 2016

Background: High blood pressure (BP) is the leading cause of death and disability in the world. The objective of this analysis was to perform a detailed update of the epidemiology of hypertension in Canada. Methods: Five population-based data sources were analyzed. We used the Canadian Health Measures Survey to determine the latest directly measured prevalence, awareness, and control estimates (2012-2013); the National Population Health Survey, and Canadian Community Health Survey to assess crude and age-standardized self-reported prevalence (1994-2013); the Canadian Chronic Disease Surveillance System to assess administrative data-ascertained prevalence and mortality trends (1998-2010); and Intercontinental Medical Statistics Health data to examine antihypertensive drug-prescribing trends and costs (2007-2014). Results: In 2012-2013, the prevalence of hypertension (defined as drug treatment for high BP or BP ≥ 140/90 mm Hg) in Canadian adults was 22.6%, and the proportion of disease controlled was 68.1%. In Canadians with diabetes, the prevalence (defined as drug treatment or BP ≥ 130/80 mm Hg) was 67.1%, and 60.1% of cases were controlled. Self-reported hypertension prevalence has increased by approximately 2-fold over nearly 2 decades. Age-standardized mortality rates are falling in hypertensive Canadians (from 9.4 to 7.9 deaths per 1000 individuals), but to a lesser extent than in nonhypertensive individuals. Total antihypertensive drug prescription volume has increased steadily since 2007 amid falling drug costs. Conclusions: Hypertension prevalence in Canada continues to rise. Increased use of antihypertensive drugs and improvements in control are apparent. Coordinated efforts to further improve the treatment and control of hypertension in Canada are needed. © 2016 Canadian Cardiovascular Society.

Padwal R.S.,University of Alberta | Padwal R.S.,Alberta Diabetes Institute | Ben-Eltriki M.,University of Alberta | Wang X.,University of Alberta | And 5 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2012

Objectives: Azithromycin is used widely for community-acquired infections. The timely administration of azithromycin in adequate doses minimizes treatment failure. Gastric bypass, a procedure that circumvents the upper gut, may compromise azithromycin plasma levels. We hypothesized that azithromycin concentrations would be reduced following gastric bypass. Methods: A single-dose pharmacokinetic study in 14 female post-gastric bypass patients and 14 sex- and body mass index (BMI)-matched controls (mean age 44 years and BMI 36.4 kg/m. 2) was performed. Subjects were administered two 250 mg azithromycin tablets at time 0 and plasma azithromycin levels were sampled at 0.5, 1, 1.5, 2, 3, 5, 7 and 24 h. The AUC of the plasma azithromycin concentrations from time 0 to 24 h (AUC. 0-24) was the primary outcome. Results: Azithromycin concentrations were lower in gastric bypass patients compared with controls throughout the entire duration of sampling. Compared with controls, the AUC0-24 was reduced in gastric bypass subjects by 32% [1.41 (SD 0.51) versus 2.07 (0.75) mg h/L; P = 0.008], and dose-normalized AUC0-24 was reduced by 33% [0.27 (0.12) versus 0.40 (0.13) kg h/L; P = 0.009]. Peak azithromycin concentrations were 0.260 (0.115) in bypass subjects versus 0.363 (0.200) mg/L in controls (P = 0.08), and were reached at 2.14 (0.99) h in gastric bypass subjects and 2.36 (1.17) h in controls (P = 0.75). Conclusions: Azithromycin AUC was reduced by one-third in gastric bypass subjects compared with controls. The potential for early treatment failure exists, and dose modification and/or closer clinical monitoring of gastric bypass patients receiving azithromycin should be considered. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Padwal R.S.,University of Alberta | Padwal R.S.,Alberta Diabetes Institute | Chang H.-J.,University of Alberta | Klarenbach S.,University of Alberta | And 4 more authors.
International Journal for Equity in Health | Year: 2012

Background: Bariatric surgery is the most effective current treatment for severe obesity. Capacity to perform surgery within Canadas public health system is limited and potential candidates face protracted wait times. A better understanding of the gaps between demand for surgery and the capacity to provide it is required. The purpose of this study was to quantify and characterize the bariatric surgery-eligible population in Canada in comparison to surgery-ineligible subjects and surgical recipients. Methods. Data from adult (age>20) respondents of the 2007-09 nationally representative Canadian Health Measures Survey (CHMS) were analyzed to estimate the prevalence and characteristics of the surgery-eligible and ineligible populations. Federally mandated administrative healthcare data (2007-08) were used to characterize surgical recipients. Results: In 2007-09, an estimated 1.5 million obese Canadian adults met eligibility criteria for bariatric surgery. 19.2 million were surgery-ineligible (3.4 million obese and 15.8 million non-obese). Surgery-eligible Canadians had a mean BMI of 40.1kg/m2 (95% CI 39.3 to 40.9kg/m2) and, compared to the surgery-ineligible obese population, were more likely to be female (62 vs. 44%), 40-59years old (55 vs. 48%), less educated (43 vs. 35%), in the lowest socioeconomic tertile (41 vs. 34%), and inactive (73 vs. 59%). Self-rated mental health and quality of life were lower and comorbidity was higher in surgery-eligible respondents compared with the ineligible populations. The annual proportion of Canadians eligible for surgery that actually underwent a publicly funded bariatric surgery between 2007-09 was 0.1%. Surgical recipients (n=847) had a mean age of 43.6years (SD 11.1) and 82% were female. With the exception of type 2 diabetes, obesity-related comorbidity prevalence was much lower in surgical recipients compared to those eligible for surgery. Conclusions: The proportion of bariatric surgery-eligible Canadians that undergo publicly funded bariatric surgery is very low. There are notable differences in sociodemographic profiles and prevalence of comorbidities between surgery-eligible subjects and surgical recipients. © 2012 Padwal et al.; licensee BioMed Central Ltd.

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