“Good News” and “Bad News”: Resultsof Screening for Diabetes,Cardiovascular Risk, and DiabetesComplications in Remote, Rur...
Outline   Brief description of outreach    activities   Good news and bad news results   Discussion
SLICK team
SLICK and MDSI:Eye photographs
KNOWNS and   UNKNOWNS                      MDSi                              80%               30               %KNOWNS:  ...
SLICK resultsDecember 2OO1 toJune 2OO7
SLICK Activity                      SLICK                           NON-SLICKYear       New          Prior      This      ...
Statistical MethodologyFor the longitudinal analysis, univariate general linear mixedeffect models with random client effe...
Example
SLICK summary
Clients with diabetes, MDSi,2OO3-2OO9Health indicators of returning subjects with diabetes (N= 180). Values are estimates ...
Children - Youth                                                                  a                                       ...
Clients without diabetes,MDSi, 2OO3-2OO9 Health indicators of returning subjects without diabetes (N = 629). Values are es...
Children- Youth                                         Estimates of Fixed Effects aParameter                             ...
Children-Youth
BADNEWS:many waytoo high toMOREstart withBADNEWS: notdecreasingGOODNEWS: notincreasing,and somegoing down  MDSi results to...
Outcomes of    Slick adults  MDSi adults                                           MDSi adults                            ...
All Clients           9           8          8.21                             7.69   7.61          7.60   7.58            ...
A1c by Year                   At first                                         clients at 1st                         (N=2...
Total Cholesterol by Year                             (N=1704 Slick clients at 1st visit)                   11            ...
100             90             80percentage             70             60                                            Diet ...
Summary   Seeing improvements:     A1c     Weight/ waists     Total cholesterol     Blood pressure   LIMITATIONS    ...
MDSi baseline results
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, ...
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“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, Rural Alberta.

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2010 (Oct) Canadian Diabetes Association Annual Conference, Aboriginal health Symposium facilitated by BRAID Research, presentation by BRAID Research

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“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, Rural Alberta.

  1. 1. “Good News” and “Bad News”: Resultsof Screening for Diabetes,Cardiovascular Risk, and DiabetesComplications in Remote, Rural Alberta.Kelli Ralph-Campbell, Richard T. Oster, TracyConnor, Adrian Jacobs, Agnes Cheng, Suzanne Poirier, MDSiField TeamPresented by Ellen L Toth, MDUniversity of Alberta Canadian Diabetes Association 2010
  2. 2. Outline Brief description of outreach activities Good news and bad news results Discussion
  3. 3. SLICK team
  4. 4. SLICK and MDSI:Eye photographs
  5. 5. KNOWNS and UNKNOWNS MDSi 80% 30 %KNOWNS: UNKNOWNS:- have diabetes screen for risk of- visits take longer diabetes and- need foot and eye exams cardiovascular risk
  6. 6. SLICK resultsDecember 2OO1 toJune 2OO7
  7. 7. SLICK Activity SLICK NON-SLICKYear New Prior This New Prior This Total Clients Year Year Clients Year Year visits per Clients Clients per Clients Clients Year seen again seen Year seen seen again again again2001 11 0 0 1 0 0 122002 804 5 46 180 0 1 10362003 396 375 28 231 38 3 10712004 354 601 34 292 83 13 13772005 202 594 17 323 141 11 12882006 202 721 15 286 169 8 14012007(to 133 439 1 200 186 0 959end ofJune)Totals: 2102 2735 141 1513 617 36 7144
  8. 8. Statistical MethodologyFor the longitudinal analysis, univariate general linear mixedeffect models with random client effect and fixed time (year)effect were used for continuous outcome variables.Logit general linear mixed effect models (binary ormultinomial) with random client effect and fixed time effectwere used for categorical (binary) outcome variables.Longitudinal analyses for baseline clinical parameters per yearwere adjusted for duration of diabetes.
  9. 9. Example
  10. 10. SLICK summary
  11. 11. Clients with diabetes, MDSi,2OO3-2OO9Health indicators of returning subjects with diabetes (N= 180). Values are estimates for the average change peryear with 95% CI. BMI Waist A1c Systolic BP Diastolic BP MAP Cholesterol -2 -1.5 -1 -0.5 0 0.5 1 1.5 2
  12. 12. Children - Youth a Estimates of Fixed EffectsParameter 95% Confidence Interval Estimate Std. Error df t Sig. Lower Bound Upper BoundIntercept 23.020897 1.363142 30.993 16.888 .000 20.240722 25.801071abs_days .006886 .000918 26.184 7.499 .000 .005000 .008773a. Dependent Variable: New_BMI.
  13. 13. Clients without diabetes,MDSi, 2OO3-2OO9 Health indicators of returning subjects without diabetes (N = 629). Values are estimates for the average change per year with 95% CI. BMI Waist A1c Systolic BP Diastolic BP MAP Cholesterol -1.5 -1 -0.5 0 0.5 1 1.5
  14. 14. Children- Youth Estimates of Fixed Effects aParameter 95% Confidence Interval Estimate Std. Error df t Sig. Lower Bound Upper BoundIntercept 23.020897 1.363142 30.993 16.888 .000 20.240722 25.801071abs_days .006886 .000918 26.184 7.499 .000 .005000 .008773a. Dependent Variable: New_BMI.
  15. 15. Children-Youth
  16. 16. BADNEWS:many waytoo high toMOREstart withBADNEWS: notdecreasingGOODNEWS: notincreasing,and somegoing down MDSi results to March 2010, DRAFT
  17. 17. Outcomes of Slick adults MDSi adults MDSi adults BRAID adults BRAID children and MDSi children and youth screened for youthselected with diabetes with diabetes (N = 2102 (N = 180) diabetes (N = screened for diabetes (N = screened for screened for diabetes (N = 629) diabetes (Nparameters 91) = 32) 83)BMIBMI centiles NA NA NA NAWaists NA trend to inc p =A1c 0.05BP systBP diastMAPTC
  18. 18. All Clients 9 8 8.21 7.69 7.61 7.60 7.58 7.54 7 7.16 6Mean A1c 5 4 3 2 1 0 2001 2002 2003 2004 2005 2006 2007 Year
  19. 19. A1c by Year At first clients at 1st (N=2091 Slick at 1st visit) (N=2091 Slick clients visit!???? 14 13 Slope = -0.143 p-value=<.0001 12 11Mean A1c 10 9 8 7 6 5 4 2001 2002 2003 2004 2005 2006 2007 year
  20. 20. Total Cholesterol by Year (N=1704 Slick clients at 1st visit) 11 (N = 1704)Mean Cholesterol 10 Slope = -0.158 9 p-value <.0001 8 7 6 5 4 3 2 1 2001 2002 2003 2004 2005 2006 2007 year
  21. 21. 100 90 80percentage 70 60 Diet Alone 50 Oral Insulin 40 Insulin+Oral 30 20 10 0 <7 7-9 9-12 >=12
  22. 22. Summary Seeing improvements:  A1c  Weight/ waists  Total cholesterol  Blood pressure LIMITATIONS  No control group
  23. 23. MDSi baseline results

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