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Latter C.,Dalhousie University | McLean-Veysey P.,Capital Health | Dunbar P.,Diabetes Care Program of Nova Scotia | Sketris I.,Dalhousie University | Putnam W.,Dalhousie University
Canadian Journal of Diabetes | Year: 2011

Objective: The clinical benefit and cost-effectiveness of selfmonitoring of blood glucose (SMBG) in adults with type 2 diabetes not using insulin has been questioned. The objective of this study was to gain insight into healthcare professionals' recommendations, practices and beliefs with respect to SMBG in well-controlled adults (glycated hemoglobin ≤7.0%) with type 2 diabetes not using insulin. Methods: Interviews were conducted with diabetes educators, pharmacists and family physicians in 3 district health authorities in Nova Scotia, Canada. Audiotaped interviews were transcribed and analyzed using a thematic analysis approach. Results: All participants recommended SMBG for persons in this population. Recommendations varied both within and between professional groups and were noted to be highly individual. SMBG results were perceived to be valuable for both patients and healthcare professionals. Participants identified clinical practice guidelines as a trustworthy source of information about SMBG in this population. Conclusion: Guidelines cite a lack of substantial evidence for SMBG in this population. Customized SMBG practices are important, but so are clarity and consistency in guideline recommendations. Reducing the use of SMBG in patient populations where it is unlikely to be beneficial will allow reallocation of resources to interventions with proven benefit.


Baillot A.,Université de Sherbrooke | Pelletier C.,Public Health Agency of Canada | Dunbar P.,Diabetes Care Program of Nova Scotia | Geiss L.,Centers for Disease Control and Prevention | And 3 more authors.
Diabetes Research and Clinical Practice | Year: 2014

Aims: This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs). Methods: We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received. Results: We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control. Conclusion: Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower. © 2013 Elsevier Ireland Ltd.


PubMed | Centers for Disease Control and Prevention, Public Health Agency of Canada, University of Toronto, University of Alberta and 2 more.
Type: Journal Article | Journal: Diabetes research and clinical practice | Year: 2014

This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs).We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received.We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control.Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.


Agborsangaya C.B.,University of Alberta | Gee M.E.,Public Health Agency of Canada | Johnson S.T.,Athabasca University | Dunbar P.,Diabetes Care Program of Nova Scotia | And 4 more authors.
BMC Public Health | Year: 2013

Background: Lifestyle behavior modification is an essential component of self-management of type 2 diabetes. We evaluated the prevalence of engagement in lifestyle behaviors for management of the disease, as well as the impact of healthcare professional support on these behaviors. Methods. Self-reported data were available from 2682 adult respondents, age 20 years or older, to the 2011 Survey on Living with Chronic Diseases in Canada's diabetes component. Associations with never engaging in and not sustaining self-management behaviors (of dietary change, weight control, exercise, and smoking cessation) were evaluated using binomial regression models. Results: The prevalence of reported dietary change, weight control/loss, increased exercise and smoking cessation (among those who smoked since being diagnosed) were 89.7%, 72.1%, 69.5%, and 30.6%, respectively. Those who reported not receiving health professional advice in the previous 12 months were more likely to report never engaging in dietary change (RR = 2.7, 95% CI 1.8 - 4.2), exercise (RR = 1.7, 95% CI 1.3 - 2.1), or weight control/loss (RR = 2.2, 95% CI 1.3 - 3.6), but not smoking cessation (RR = 1.0; 95% CI: 0.7 - 1.5). Also, living with diabetes for more than six years was associated with not sustaining dietary change, weight loss and smoking cessation. Conclusion: Health professional advice for lifestyle behaviors for type 2 diabetes self-management may support individual actions. Patients living with the disease for more than 6 years may require additional support in sustaining recommended behaviors. © 2013 Agborsangaya et al.; licensee BioMed Central Ltd.


Fowles J.R.,Acadia University | Shields C.,Acadia University | d'Entremont L.,Acadia University | McQuaid S.,Acadia University | And 2 more authors.
Canadian Journal of Diabetes | Year: 2014

Objective: The purpose of this study was to determine the effectiveness of enhancing support for physical activity counselling and exercise participation at diabetes centres in Nova Scotia on physical activity and exercise behaviours and clinical outcomes in patients with type 2 diabetes mellitus. Methods: In all, 180 patients at 8 diabetes centres participated in this observational study. A range of enhanced supports for exercise were offered at these centres. A kinesiologist was added to the diabetes care team to primarily provide extra physical activity counselling and exercise classes. Patient physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin (A1C) were evaluated at baseline and 6months. We compared changes in these variables for patients who participated in the enhanced supports versus patients who did not. Results: Participants who attended exercise classes (n=46), increased moderate physical activity by 27% and doubled resistance exercise participation (1.0±1.8 to 2.0±2.1days per week) whereas those who did not attend exercise classes (n=49) reduced moderate physical activity by 26% and did not change resistance exercise participation (interactions, p=0.04 and p=0.07, respectively). Patients who received resistance band instruction (n=15) from a kinesiologist had reductions in A1C (from 7.5±1.4 to 7.1±1.2; p=0.04), whereas other subgroups did not have significant changes in A1C. Conclusions: Offering enhanced support for exercise at diabetes centres produced improvements in physical activity and exercise in type 2 diabetes patients. Resistance band instruction from a kinesiologist combined with participating in a walking and resistance training program improved glycemic control, which underscores the importance of including exercise professionals in diabetes management. © 2014 Canadian Diabetes Association.


Putnam W.,Dalhousie University | Lawson B.,Dalhousie University | Buhariwalla F.,Community based Physician | Goodfellow M.,Community based Physician | And 11 more authors.
BMC Family Practice | Year: 2011

Background: The prevalence of type 2 diabetes is rising, and most of these patients also have hypertension, substantially increasing the risk of cardiovascular morbidity and mortality. The majority of these patients do not reach target blood pressure levels for a wide variety of reasons. When a literature review provided no clear focus for action when patients are not at target, we initiated a study to identify characteristics of patients and providers associated with achieving target BP levels in community-based practice. Methods. We conducted a practice- based, cross-sectional observational and mailed survey study. The setting was the practices of 27 family physicians and nurse practitioners in 3 eastern provinces in Canada. The participants were all patients with type 2 diabetes who could understand English, were able to give consent, and would be available for follow-up for more than one year. Data were collected from each patient's medical record and from each patient and physician/nurse practitioner by mailed survey. Our main outcome measures were overall blood pressure at target (< 130/80), systolic blood pressure at target, and diastolic blood pressure at target. Analysis included initial descriptive statistics, logistic regression models, and multivariate regression using hierarchical nonlinear modeling (HNLM). Results: Fifty-four percent were at target for both systolic and diastolic pressures. Sixty-two percent were at systolic target, and 79% were at diastolic target. Patients who reported eating food low in salt had higher odds of reaching target blood pressure. Similarly, patients reporting low adherence to their medication regimen had lower odds of reaching target blood pressure. Conclusions: When primary care health professionals are dealing with blood pressures above target in a patient with type 2 diabetes, they should pay particular attention to two factors. They should inquire about dietary salt intake, strongly emphasize the importance of reduction, and refer for detailed counseling if necessary. Similarly, they should inquire about adherence to the medication regimen, and employ a variety of patient-oriented strategies to improve adherence. © 2011 Putnam et al; licensee BioMed Central Ltd.


Fowles J.R.,Acadia University | Shields C.,Acadia University | Barron B.,Acadia University | McQuaid S.,Acadia University | Dunbar P.,Diabetes Care Program of Nova Scotia
Canadian Journal of Diabetes | Year: 2014

Objective: The purpose of this study was to determine the effectiveness of toolkit-based physical activity counselling on physical activity and exercise participation of type 2 diabetes patients attending diabetes centres in Atlantic Canada. Methods: Patients with type 2 diabetes (n=198) were recruited to a quasiexperimental study comparing the effectiveness of counselling by persons trained to use a physical activity and exercise resource manual (i.e. toolkit) vs. a standard of care counselling situation. Effectiveness was assessed through questionnaires completed by patients, and clinical data were extracted from patient charts before and 6months after a single appointment with a diabetes educator. Primary outcome measures were patient self-reported physical activity and exercise levels, efficacy perceptions and mean glycated hemoglobin. Results: There were no significant differences in primary outcomes over time. Subanalyses of the toolkit-counselled patients revealed a significant interaction for moderate-to-vigorous physical activity (MVPA [p<0.0001]), whereby patients who were not meeting Canadian Diabetes Association guidelines for physical activity at baseline (i.e. <150 MVPA a week; n=44) increased physical activity (from 20±23 to 120±30 minutes) and patients who were active at baseline (i.e. >150 MVPA a week; n=22) decreased physical activity (from 444±32 to 161±41 minutes) at 6 months. Conclusions: A single counselling appointment using the toolkit did not elicit significant changes in physical activity or clinical outcomes measured 6 months later when compared with standard care condition; however, increased physical activity was observed for patients who were inactive at baseline. Repeated counselling or more intensive strategies may be required to increase patient physical activity levels and produce clinical outcomes. © 2014 Canadian Diabetes Association.


Talbot P.,Diabetes Care Program of Nova Scotia | Dunbar M.J.,Diabetes Care Program of Nova Scotia
Chronic Diseases in Canada | Year: 2011

Introduction: Identifying individuals in the prediabetic state may help delay/prevent disease progression to type 2 diabetes mellitus. We explored the feasibility of a household mailing approach for population-based screening of prediabetes and unidentified type 2 diabetes mellitus, developed standard protocol, and developed and implemented community-based lifestyle programs. Methods: The 16-item Canadian Diabetes Risk Assessment Questionnaire (CANRISK) was mailed to every household in two rural Nova Scotia communities. In total 417 participants aged 40 to 74 years with no prior diagnosis of diabetes self-administered the CANRISK and completed a 2-hour oral glucose tolerance test (OGTT) at a local health care facility. Those with prediabetes were invited to participate in a Prediabetes Lifestyle Program. Results: Glycemic status was identified as normal, prediabetes or diabetes for 84%, 13% and 3% of participants, respectively. Association between glycemic status and overall CANRISK risk score was statistically significant. Six CANRISK items were significantly associated with glycemic status: body mass index, waist circumference, history of hypertension and hyperglycemia, education and perceived health status. Participants and physicians gave positive feedback on the CANRISK screening process. Conclusion: The CANRISK holds promise as a population-based screening tool.


Shields C.A.,Acadia University | Fowles J.R.,Acadia University | Dunbar P.,Diabetes Care Program of Nova Scotia | Barron B.,Acadia University | And 2 more authors.
Canadian Journal of Diabetes | Year: 2013

Objective: The objective of this action research was to examine the effectiveness of a comprehensive intervention (the toolkit) in improving diabetes educators' (DEs') perceptions of their abilities and their patients' abilities related to physical activity as part of regular diabetes self-management. Methods: Two separate studies were conducted. Participants completed measures assessing confidence, attitudes and perceived difficulty. In study 1, a quasi-experimental design was used to examine the impact of the training intervention at 6 months. Cross-sectional sampling at baseline and 12 months then was used to assess the longer-term impact of the intervention. In study 2, a pre-post design was used to test the impact of the intervention at 12-months in a separate sample. Results: The primary finding was a consistent increase in DEs' confidence in their ability to provide physical activity and exercise counselling with increases of up to 20% after the training intervention. Furthermore, DEs reported greater knowledge about physical activity (p<0.03) yet perceived physical activity counselling to be more difficult after receiving the training (p<0.05). In study 2, the DEs reported increases in perceived patient knowledge and confidence in their patients (p<0.03) after the intervention. Secondary analyses showed that frequently referring to the toolkit was associated with higher counselling efficacy and lower perceived difficulty (p<0.03). Conclusions: These findings suggest that the toolkit is an effective resource to improve DEs' confidence in the area of physical activity counselling. As a result of this work, the toolkit has been adopted as standard diabetes care across Nova Scotia and as a foundational resource for DEs across Canada. © 2013 Canadian Diabetes Association.


Dillman C.J.,Acadia University | Shields C.A.,Acadia University | Fowles J.R.,Acadia University | Perry A.,Acadia University | And 2 more authors.
Canadian Journal of Diabetes | Year: 2010

Objective: The purpose of this study was to examine diabetes educators' perceptions of (a) their abilities, attitudes and difficulties/challenges related to physical activity and exercise counselling; and (b) their patients' abilities and attitudes related to performing physical activity and exercise in managing their diabetes. Method: Using a cross-sectional, observational design, diabetes educators (N=119) recruited from 3 provinces completed survey measures of counselling, referral and other efficacies; attitudes; perceived difficulty; barriers; and training practices related to physical activity and exercise. Results: Analyses revealed that diabetes educators lacked confidence in their own ability to counsel patients about, prescribe and make referrals for physical activity and exercise; they also lacked confidence in the ability of their patients to perform physical activity and exercise. While diabetes educators had positive attitudes about physical activity and exercise, they perceived their typical patient's attitudes to be much less positive. Diabetes educators perceived that including more in-depth physical activity and exercise counselling in their practice would be only somewhat difficult, but they indicated that they experienced multiple barriers in this area. Diabetes educators' perceptions were also shown to be associated with their counselling practices related to physical activity and exercise. Conclusion: These findings provide novel insight into diabetes educators' perceptions of their own abilities, as well as those of their patients, and further underscore the need to provide diabetes educators with greater training in physical activity and exercise counselling.

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