“RESULTS OF DIABETES OUTREACHand COMPLICATIONS SCREENINGPROGRAMS IN ALBERTA”Sandra Shade, BScNDirector of Home Care, Blood...
Outline Brief description of SLICK SLICK results Discussion MDSi results Other programs
SLICK: Screening for Limbs, I-eyes,Cardiovascular and Kidneys Launched December2001 2 vans 44 eligible communitiesAlberta
SLICK team
SLICK and MDSI:Eye photographs
CollaborativeEndeavour Alberta First Nations University of Alberta First Nations and Inuit Health Branch ADI and Nursi...
Program Objectives Reduce the complications of diabetes Increase access to appropriate diabetescare Increase capacity t...
SLICK: Screening for Limbs, I-eyes,Cardiovascular and KidneysDr David Strong, MOHHeather Young, Director of NursingJudy Ha...
SLICK: Screening for Limbs, I-eyes,Cardiovascular and KidneysDr David Strong, MOHHeather Young, Director of NursingJudy Ha...
Analyses in SLICK SLICK Survey: Care providers and activities Satisfaction with services Diabetes knowledge Clinical ...
SLICK ActivitySLICK NON-SLICKYear NewClientsperYearPriorYearClientsseen againThisYearClientsseenagainNewClientsperYearPrio...
New clients seen per year(N = 2102 Slick and 1513 Non-Slick)020040060080010002001 2002 2003 2004 2005 2006 2007YearNumberN...
Total visits per year(N = 4978 Slick, 2166 Non Slick)0200400600800100012002001 2002 2003 2004 2005 2006 2007YearNumberNon ...
Gender distribution (unique clients)0200400600800100012001400Non-SLICK SlickNumberFemalesMales
Age distribution of SLICK clients at 1st visit (N=2102)0501001502002503003504000-9 10-1920-2930-3940-4950-5960-6970-7980-8...
Age distribution of Non Slick clients at 1st visit (N = 1512)0501001502002503000-9 10-19 20-29 30-39 40-49 50-59 60-69 70-...
Number of visits per person (2001- June 2007)0200400600800100012001 2 3 4 5 6 7 8 9Number of visitsNumberNon SlickSlick
Longitudinal SLICKresults December 2OO1to June 2OO7
SLICK ActivityUNIQUE Clients seen SLICK Non-SLICKOnce only 905 1096X 2 458 256X 3 310 108X 4 199 36X 5 126 12X 6 85 5> 7 4...
Baseline Results for SLICKclients at first visit (seculartrend?)
All Clients7.168.217.69 7.61 7.54 7.60 7.58MeanA1c0123456789Year2001 2002 2003 2004 2005 2006 2007
At firstvisit!????Slope = -0.143p-value=<.0001(N=2091 Slick clients at 1stMeanA1c4567891011121314year2001 2002 2003 2004 2...
Slope = -0.158p-value <.0001(N = 1704)MeanCholesterol1234567891011year2001 2002 2003 2004 2005 2006 2007Total Cholesterol ...
Longitudinal results forRETURNING SLICKclients over time(averageimprovement ofindividuals)
For the longitudinal analysis, univariate general linear mixedeffect models with random client effect and fixed time (year...
SLICK summary
Summary Seeing improvements:A1c (secular and longitudinal)WeightTotal cholesterol (secular andlongitudinal)Blood pres...
Thank YouSandra Shade BscNsshade@onehealth.caDr Ellen Toth: 780 - 407-3636ellen.toth@ualberta.cawww.braiddm.caACADRE
Discussion Seeing improvements:Unable to attribute to SLICK SLICK update ADI funding insecure, but recentlyconfirmed a...
The CIRCLE StudyThe Canadian First Nations Diabetes Clinical ManagementEpidemiologic StudyPrincipal Investigator:Dr. Stewa...
Complications of Diabetes - Screening atRecommended Intervals39%22%26%16%46%28%72%14%27%18%22% 22%85%44%74%86%0%10%20%30%4...
Diet AloneOralInsulinInsulin+Oralpercentage0102030405060708090100<7 7-9 9-12 >=12
Treatment of Diabetes - Insulin andOral Anti-Diabetes Medications0%5%10%15%20%25%30%35%%ofparticipantsNational A B CNo ins...
ABC comparisonsCIRCLE ALBERTACIRCLECommunitiesCanadianchart audit,Harris,2005DOVEstudySLICKbaselineMean A1c ? 8.2 -8.3 8.2...
ADSS 2009Authors: Oster, Hemmelgarn, Toth, King, Crowshoe, Campbell
Other Aboriginal diabetesprograms“TOP”SLICK: federally funded, 9000 visits since 2001(~947/yr)ADIMDSi: provincially fu...
Mobile Diabetes ScreeningInitiative:“… provide resources for screening fordiabetes and its complications inAboriginal off-...
KNOWNS andUNKNOWNSMDSiKNOWNS:- have diabetes- visits take longer- need foot and eye examsUNKNOWNS:screen for risk ofdiabet...
MDSi baseline results
Returning subjects withdiabetes, N = 18OBMIWaistA1cSystolic BPDiastolic BPMAPCholesterol-2 -1.5 -1 -0.5 0 0.5 1 1.5 2BMIWa...
-1.5 -1 -0.5 0 0.5 1 1.5Returning “unknowns”, subjects atdiabetes risk, N = 629BMIWaistA1cSystolic BPDiastolic BPMAPCholes...
Thank YouSandra Shade BscNsshade@onehealth.caDr Ellen Toth: 780 - 407-3636ellen.toth@ualberta.cawww.braiddm.caACADRE
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
Results of Diabetes Outreach Complications Screening Programs in Alberta
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Results of Diabetes Outreach Complications Screening Programs in Alberta

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

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Results of Diabetes Outreach Complications Screening Programs in Alberta

  1. 1. “RESULTS OF DIABETES OUTREACHand COMPLICATIONS SCREENINGPROGRAMS IN ALBERTA”Sandra Shade, BScNDirector of Home Care, Blood Tribe Health DepartmentEllen L Toth, MDUniversity of AlbertaCanadian Diabetes Association Meeting,Edmonton 2010
  2. 2. Outline Brief description of SLICK SLICK results Discussion MDSi results Other programs
  3. 3. SLICK: Screening for Limbs, I-eyes,Cardiovascular and Kidneys Launched December2001 2 vans 44 eligible communitiesAlberta
  4. 4. SLICK team
  5. 5. SLICK and MDSI:Eye photographs
  6. 6. CollaborativeEndeavour Alberta First Nations University of Alberta First Nations and Inuit Health Branch ADI and Nursing, significant partnership andoperational funding from ADI Canadian Health InfrastructurePartnership Program (CHIPP) initialfunding Royal Alexandra Hospital Ophthalmology and Aboriginal DiabetesWellness Program Capital Health Authority Alberta Health and Wellness
  7. 7. Program Objectives Reduce the complications of diabetes Increase access to appropriate diabetescare Increase capacity to meet the CanadianDiabetes Practice Guidelines Foster integration and collaboration ofhealth services across the continuum ofcare Provide cost-effective care Share lessons learned with others
  8. 8. SLICK: Screening for Limbs, I-eyes,Cardiovascular and KidneysDr David Strong, MOHHeather Young, Director of NursingJudy Halladay, RD, promotion andpreventionFirst Nations leadershipDr. Ellen Toth, Medical AdvisorDr Hakique Virani, Medical AdvisorDr. Matt Tennant, OphthalmologistSandra Shade, ADI coordinatorAudrey Inouye, ADI CoordinatorIris Weibel, RN, CDELorraine Trojan, RNKathleen Gibson, RD and R.photographer
  9. 9. SLICK: Screening for Limbs, I-eyes,Cardiovascular and KidneysDr David Strong, MOHHeather Young, Director of NursingJudy Halladay, RD, promotion andpreventionFirst Nations leadershipDr. Ellen Toth, Medical AdvisorDr Hakique Virani, Medical AdvisorDr. Matt Tennant, OphthalmologistSandra Shade, ADI coordinatorAudrey Inouye, ADI CoordinatorIris Weibel, RN, CDELorraine Trojan, RNKathleen Gibson, RD and R.photographer
  10. 10. Analyses in SLICK SLICK Survey: Care providers and activities Satisfaction with services Diabetes knowledge Clinical status Complications screening activities Quality of Life SLICK activity Clinical characteristics: Weight/waist, A1c, Cholesterol, BP, feet, eyes at baseline over time
  11. 11. SLICK ActivitySLICK NON-SLICKYear NewClientsperYearPriorYearClientsseen againThisYearClientsseenagainNewClientsperYearPriorYearClientsseenagainThisYearClientsseenagainTotalvisits2001 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(toend ofJune)133 439 1 200 186 0 959Totals: 2102 2735 141 1513 617 36 7144
  12. 12. New clients seen per year(N = 2102 Slick and 1513 Non-Slick)020040060080010002001 2002 2003 2004 2005 2006 2007YearNumberNon-SlickSlick
  13. 13. Total visits per year(N = 4978 Slick, 2166 Non Slick)0200400600800100012002001 2002 2003 2004 2005 2006 2007YearNumberNon SlickSlick
  14. 14. Gender distribution (unique clients)0200400600800100012001400Non-SLICK SlickNumberFemalesMales
  15. 15. Age distribution of SLICK clients at 1st visit (N=2102)0501001502002503003504000-9 10-1920-2930-3940-4950-5960-6970-7980-8990-100Age groupNumberFemalesMales
  16. 16. Age distribution of Non Slick clients at 1st visit (N = 1512)0501001502002503000-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100Age groupsNumberFemalesMales
  17. 17. Number of visits per person (2001- June 2007)0200400600800100012001 2 3 4 5 6 7 8 9Number of visitsNumberNon SlickSlick
  18. 18. Longitudinal SLICKresults December 2OO1to June 2OO7
  19. 19. SLICK ActivityUNIQUE Clients seen SLICK Non-SLICKOnce only 905 1096X 2 458 256X 3 310 108X 4 199 36X 5 126 12X 6 85 5> 7 40 0Total UNIQUE clients 2102 1513Total VISITS 4978 2166Seen at least TWICE: 1218 41712182102
  20. 20. Baseline Results for SLICKclients at first visit (seculartrend?)
  21. 21. All Clients7.168.217.69 7.61 7.54 7.60 7.58MeanA1c0123456789Year2001 2002 2003 2004 2005 2006 2007
  22. 22. At firstvisit!????Slope = -0.143p-value=<.0001(N=2091 Slick clients at 1stMeanA1c4567891011121314year2001 2002 2003 2004 2005 2006 2007A1c by Year(N=2091 Slick clients at 1st visit)
  23. 23. Slope = -0.158p-value <.0001(N = 1704)MeanCholesterol1234567891011year2001 2002 2003 2004 2005 2006 2007Total Cholesterol by Year(N=1704 Slick clients at 1st visit)
  24. 24. Longitudinal results forRETURNING SLICKclients over time(averageimprovement ofindividuals)
  25. 25. For 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.Statistical Methodology
  26. 26. SLICK summary
  27. 27. Summary Seeing improvements:A1c (secular and longitudinal)WeightTotal cholesterol (secular andlongitudinal)Blood pressure LIMITATIONSNo control group
  28. 28. Thank YouSandra Shade BscNsshade@onehealth.caDr Ellen Toth: 780 - 407-3636ellen.toth@ualberta.cawww.braiddm.caACADRE
  29. 29. Discussion Seeing improvements:Unable to attribute to SLICK SLICK update ADI funding insecure, but recentlyconfirmed and increased SLICK screeners in Communities Comparison to Circle results Provincial surveillance
  30. 30. The CIRCLE StudyThe Canadian First Nations Diabetes Clinical ManagementEpidemiologic StudyPrincipal Investigator:Dr. Stewart HarrisCoordinating Centre:Mariam Naqshbandi, Program CoordinatorJim Esler, Research AssistantMarnie Orcutt, Administrative Assistant
  31. 31. Complications of Diabetes - Screening atRecommended Intervals39%22%26%16%46%28%72%14%27%18%22% 22%85%44%74%86%0%10%20%30%40%50%60%70%80%90%%ofparticipantsFoot exam(annual, 2007) Eye (retinopathy) - (every1-2 years, 2006-2007)Nerve (neuropathy) -(annual, 2007)Kidney (nephropathy) -(annual, 2007)NationalABC
  32. 32. Diet AloneOralInsulinInsulin+Oralpercentage0102030405060708090100<7 7-9 9-12 >=12
  33. 33. Treatment of Diabetes - Insulin andOral Anti-Diabetes Medications0%5%10%15%20%25%30%35%%ofparticipantsNational A B CNo insulin or OADsInsulin alone1 OAD2 OADs3 or more OADsInsulin + 1 OADInsulin + 2 OADsInsulin + 3 or more OADs
  34. 34. ABC comparisonsCIRCLE ALBERTACIRCLECommunitiesCanadianchart audit,Harris,2005DOVEstudySLICKbaselineMean A1c ? 8.2 -8.3 8.2-8.3 7.3 7.4 8.2A1c < 7.0 37% 32-42% 49% 50% 30 or 43%Bloodpressure toohigh53% 44-60% 63% 55% 61%Cholesteroltoo high40% 37-61% 59% 60% 39%Microvascularcomplications(eyes,kidneys,nerves)40% 2-54% 39% 31-39%Heart diseaseand stroke20% 6-16% 28% ?30%
  35. 35. ADSS 2009Authors: Oster, Hemmelgarn, Toth, King, Crowshoe, Campbell
  36. 36. Other Aboriginal diabetesprograms“TOP”SLICK: federally funded, 9000 visits since 2001(~947/yr)ADIMDSi: provincially funded, 5000 visits since 2003(~769/yr)ADWP: ?~ 700 visits per year for last 10 yrs?
  37. 37. Mobile Diabetes ScreeningInitiative:“… provide resources for screening fordiabetes and its complications inAboriginal off-reserve and remoteAlberta communities”(part of the 10 year Alberta Diabetes Strategy,2003-2013)
  38. 38. KNOWNS andUNKNOWNSMDSiKNOWNS:- have diabetes- visits take longer- need foot and eye examsUNKNOWNS:screen for risk ofdiabetes andcardiovascular risk30%80%
  39. 39. MDSi baseline results
  40. 40. Returning subjects withdiabetes, N = 18OBMIWaistA1cSystolic BPDiastolic BPMAPCholesterol-2 -1.5 -1 -0.5 0 0.5 1 1.5 2BMIWaistA1cSystolic BPDiastolic BPMAPCholesterol
  41. 41. -1.5 -1 -0.5 0 0.5 1 1.5Returning “unknowns”, subjects atdiabetes risk, N = 629BMIWaistA1cSystolic BPDiastolic BPMAPCholesterol
  42. 42. Thank YouSandra Shade BscNsshade@onehealth.caDr Ellen Toth: 780 - 407-3636ellen.toth@ualberta.cawww.braiddm.caACADRE
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