Catherine Pelletier

Determinants of lifestyle behavior in type 2 diabetes: results of the 2011 cross-sectional survey on living with chronic diseases in Canada.

BackgroundLifestyle 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.MethodsSelf-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.ResultsThe 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.ConclusionHealth 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.

Profile of adults with type 2 diabetes and uptake of clinical care best practices: Results from the 2011 Survey on Living with Chronic Diseases in Canada – Diabetes component

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.

Erratum to: Childhood maltreatment as a risk factor for diabetes: findings from a population-based survey of Canadian adults

It is well established that childhood maltreatment (CM) is a risk factor for various mental and substance use disorders. To date, however, little research has focused on the possible long-term physical consequences of CM. Diabetes is a chronic disease, for which an association with CM has been postulated. Based on data from a sample of 21,878 men and women from the 2012 Canadian Community Health Survey - Mental Health (CCHS - MH), this study examines associations between three types of CM (childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV)) and diabetes in adulthood. Multiple logistic regression models were used to examine associations between CM and diabetes controlling for the effects of socio-demographic characteristics and risk factors for type 2 diabetes. When controlling socio-demographic characteristics, diabetes was significantly associated with reports of severe and frequent CPA (OR = 1.8) and severe and frequent CSA (OR = 2.2). A dose–response relationship was observed when co-occurrence of CSA and CPA was considered with the strongest association with diabetes being observed when both severe and frequent CSA and CPA were reported (OR = 2.6). Controlling for type 2 diabetes risk factors attenuated associations particularly for CPA. CEIPV was not significantly associated with having diabetes in adulthood. CPA and CSA are risk factors for diabetes. For the most part, associations between CPA and diabetes are mediated via risk factors for type 2 diabetes. Failure to consider severity and frequency of abuse may limit our understanding of the importance of CM as a risk factor for diabetes.

MONITORING THE BURDEN OF ALZHEIMER’S DISEASE (AD) AND DEMENTIAS IN CANADA: FIRST PREVALENCE, INCIDENCE AND ALL-CAUSE MORTALITY ESTIMATES FROM THE PUBLIC HEALTH AGENCY OF CANADA'S CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM (CCDSS)

Background:To contribute insights into the causes of dementia, prospective population-based studies need to ascertain large numbers of dementia cases without substantial loss to followup. ‘Active follow-up’, requiring participant re-engagement for repeat assessment, is prone to loss to follow-up. ‘Passive follow-up’ through linkage to health-related datasets should avoid such attrition, provided data are available for the entire cohort from a universal coverage healthcare system and that potential cases present for healthcare assessment. Methods: To establish: (1) the yield of dementia cases from national hospital and death data and from cognitive testing in the Whitehall II cohort; and (2) whether risk of dementia diagnosis in linked health-related data was higher among those who did not attend and complete cognitive testing, we analyzed Whitehall II data from waves 7 (2002-2004) and 9 (2007-2009) assessments. We included surviving participants with no prior recorded dementia diagnosis followed for five years. Both waves included the Mini Mental State Examination (MMSE). Linked hospital admissions and death data were available for all participants. For each wave, we assessed numbers of dementia cases identified from linked data, MMSE score <24 or both, and compared the five year risk of dementia in linked data in those without versus with a completed MMSE. Results:In participants with anMMSE, the overlap in detection by both MMSE and linked data was 4 of 61 cases at wave 7 and 14 of 92 cases at wave 9. Participants without versus those with an MMSE score had a higher five year risk of dementia in linked data (wave 7: 0.93%versus 0.56%;wave 9: 2.9%versus 0.96%).Using logistic regression to adjust for confounding the excess riskof dementia for thosewithout aMMSE remained, although only statistically significant at wave 9 (wave 7: OR 1.41, 95%CI 0.85-2.33; wave 9: OR 2.49, 95%CI 1.76-3.53).Conclusions:MMSE and linked health-related data identified largely non-overlapping dementia cases. Participants without MMSE had a higher risk of subsequent hospitalized or fatal dementia. In the UK, linkage to primary care data should identify dementia cases not detected in hospital and death data without requiring active follow-up.

The Canadian Chronic Disease Surveillance System: A model for collaborative surveillance

Chronic diseases have a major impact on populations and healthcare systems worldwide. Administrative health data are an ideal resource for chronic disease surveillance because they are population-based and routinely collected. For multi-jurisdictional surveillance, a distributed model is advantageous because it does not require individual-level data to be shared across jurisdictional boundaries. Our objective is to describe the process, structure, benefits, and challenges of a distributed model for chronic disease surveillance across all Canadian provinces and territories (P/Ts) using linked administrative data. The Public Health Agency of Canada (PHAC) established the Canadian Chronic Disease Surveillance System (CCDSS) in 2009 to facilitate standardized, national estimates of chronic disease prevalence, incidence, and outcomes. The CCDSS primarily relies on linked health insurance registration files, physician billing claims, and hospital discharge abstracts. Standardized case definitions and common analytic protocols are applied to the data for each P/T; aggregate data are shared with PHAC and summarized for reports and open access data initiatives. Advantages of this distributed model include: it uses the rich data resources available in all P/Ts; it supports chronic disease surveillance capacity building in all P/Ts; and changes in surveillance methodology can be easily developed by PHAC and implemented by the P/Ts. However, there are challenges: heterogeneity in administrative databases across jurisdictions and changes in data quality over time threaten the production of standardized disease estimates; a limited set of databases are common to all P/Ts, which hinders potential CCDSS expansion; and there is a need to balance comprehensive reporting with P/T disclosure requirements to protect privacy. The CCDSS distributed model for chronic disease surveillance has been successfully implemented and sustained by PHAC and its P/T partners. Many lessons have been learned about national surveillance involving jurisdictions that are heterogeneous with respect to healthcare databases, expertise and analytical capacity, population characteristics, and priorities.