Margaret Dunbar

Frailty and Diabetes: Taking the Attention Off Tight Targets

Session ratings were positive: overall rating, 4.7/5; contributed to new knowledge, 4.6/5; likely to use the learning in practice, 4.5/5. Post-chart audits showed improved documentation of appropriate blood glucose (BG) targets; medication reduction/modification when A1C < 8%; appropriate documentation of hypoglycaemia; and efforts to contact physicians when BG inappropriate (too high or too low). Postprovider surveys showed increased recognition of acceptable A1C (8-10%), 52% to 74%; acceptable frequency of A1C testing (1-2 x /year), 26% to 57%; and appropriate frequency of bedside monitoring, from 62% to 91%. Diabetes management confidence increased from 84% to 96%.

Change is Afoot: Lower Extremity Amputation in Nova Scotia, 1996/97 to 2012/13

Results: Nearly 3,500 individuals had ≥1 LEA admissions over the period. On average, there were 281 LEA admissions annually (DM=194, no DM=87). Over time, the annual number of LEA admissions among those with DM was relatively stable despite increasing DM prevalence (3% in 1996/97 to 11% in 2012/13). The LEA admission rate among those with DM decreased > 55% from 47/10,000 to 21/10,000. Those with DM (vs those without) were far more likely to have an LEA admission: 51x, 16x, 10x, and 5x for individuals 20-59yr, 60-69yr, 70-79yr, and ≥80yr respectively. LEAs among those with DM were more likely to be at a lower level (41% at level of toe/foot/ankle vs 26% among those without DM). Length of LEA-related hospitalisation was similar for those with and without DM.

Diabetes Centre Impact on Newly Diagnosed Referrals in Nova Scotia

The purpose of this current work is to describe key measures in a subset of the ND type 1 & 2 adult (≥ age 19) population during the first 3 mos (Pre) and again 8-15 mos later (Post). Using the DCPNS Registry, a total of 3270 ND cases were selected in calendar year 2009. Using additional selection, criteria, 960 cases were chosen. Analysis in the Pre period used the earliest value for A1C, BP, & LDL-C. Post analysis used the last value. Cases with a missing Pre value were excluded from the Post analysis.

Improving diabetes care in Nova Scotia through a Provincial Program Model

| 311 limited economic resources in Mexico. Patients and methods: A prospective study was conducted in diabetes patients treated at outpatient diabetes clinics established in 2001-2007 as the state diabetes program in Hidalgo Mexico, one of the poorest states in the country, with a mostly rural population. Baseline and follow-up consultation was provided by multidisciplinary teams including general physicians and nurses as a minimum. Goals of treatment were clearly explained and negotiated with each patient. Organizational arrangements were made to reduce waiting times, avoid rotation of doctors and nurses, and provide adequate time for baseline and follow-up visits. Each follow-up visit included measuring process and outcomes indicators of quality of diabetes care, including: 1) body mass index; 2) blood pressure; 3) fasting or casual blood glucose 4) lipoprotein measurement; 5) hemoglobin A1c (HbA1c); and 6) foot examination. results: Analysis of 4,393 patients who attended five visits showed the following increases in the percent of recorded process indicators of quality of diabetes care from baseline: 1) body mass index, 85.0 vs. 95.9%; 2) blood pressure measurement, 73.29 vs. 95.6%; 3) HbA1c 12.5 vs. 17.7%; 4) total cholesterol, 18.2 vs. 55.9%; 5); 6) foot examination, 19.0 vs. 95.0%. Outcome measures that showed non-statistically significant differences were body mass index (27.79±4.9 vs. 27.82±4.76), systolic blood pressure (124.7±21.36 vs. 123.54±19.27 mmHg), total cholesterol (193.50±47.94 vs. 208.41±54.02 mg/dl) and triglycerides (258.2±231.5 vs. 244.7±181.6 mg/dl). Significant improvements in glycemic control were documented by a decrease in fasting blood glucose (185.75±79.01 vs. 162.89±72.53 mg/dl, P <0.001), and a 3.6 percentage point decrease in HbA1c (12.05%±4.47 vs. 8.45±1.89, P 0.001). conclusions: The results confirm that it is possible to improve the quality of diabetes care at the primary care level without additional economic resources, through the implementation of a program that integrates changes in the structure and in the process of care, customized clinical guidelines, and a standardized system of information that enables measuring clinical results in settings with limited resources. Models of care delivery No conflict of interest

Using administrative data to define diabetes cases in children and youth

Community Health Survey using the National Diabetes Surveillance System as the gold standard were determined. results: Among people aged 25 years and older, overall agreement between the Canadian Community Health Survey and the National Diabetes Surveillance System was substantial (Kappa = 0.71). Selfreporting of diabetes in the Canadian Community Health Survey was 72% sensitive and showed 98% specificity. Positive predictive value was 77% and negative predictive value was 97%. Discussion/conclusion: This study highlights the importance of having correct estimate of diabetes prevalence for surveillance, research and planning purposes. These findings can support public health decision-making related to diabetes prevention and management.