Canadian Diabetes Research Articles

451-P: Participants’ Satisfaction with the Support Online Self-Guided Educational Platform for Type 1 Diabetes Management: A Proof-of-Concept Study, Preliminary Results

Introduction: The development of the SUPPORT self-guided online educational platform was guided by the behavioral wheel framework and built by healthcare professionals specialized in type 1 diabetes (T1D) and patient-partners. It has 4 learning paths that are based on the mode of insulin delivering and blood glucose monitoring of the patient. The learning modules are divided into 6 groups (e.g., medication, nutrition) and have 3 levels of complexity. Features (e.g., quiz, glossary) are included. This proof-of-concept study aims to evaluate the satisfaction of adults with T1D using the SUPPORT platform after 6 months. Methods: Adults (≥18 years old) living with T1D for ≥ 1 year, using ≥ 4 insulin injections per day or an insulin pump, and having access to the Internet were recruited from the BETTER registry in Quebec. People with ongoing pregnancy or illness limiting diabetes care were excluded. Usage data were collected with Google Analytics. A face-validated 10-item questionnaire was sent after 6 months of access to SUPPORT to evaluate participants’ satisfaction and feedback (e.g., top 3 preferred features). Results: A total of 61 participants (38% men; age 50.3±13.3 years; T1D duration 24.3±14.6 years; mean viewing time per connected session: 12min56sec) completed the 6-month questionnaire. The mean satisfaction score was 39.6±7.8 (out of 49; higher score for a greater satisfaction). The most preferred features were access to downloadable PDF summaries, quizzes, and blogs on scientific updates. Providing certificates, virtual points, and glossary were the least appreciated. More than half reported being more confident to prevent (53%) and manage (53%) hypoglycemia. Conclusion: The SUPPORT platform received a high level of satisfaction. Although further validation is needed, this platform may be a useful resource for widely and timely diabetes education and for reducing the hypoglycemia burden faced by patients. Disclosure L. Xie: None. C. Leroux: None. A. Roy-fleming: None. R. Rabasa-lhoret: Advisory Panel; Self; Bayer Inc., Covance Inc., Insulet Corporation, Pfizer Inc., Other Relationship; Self; Abbott, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk, Sanofi-Aventis, Research Support; Self; Canadian Institutes of Health Research, Cystic Fibrosis Canada, Diabetes Canada, JDRF, National Institutes of Health, Prometic, Société Francophone du Diabète, Speaker’s Bureau; Self; CMS Canadian Medical&Surgical Knowledge Translation Research Group, CPD Network. A. Brazeau: None. Funding Canadian Institutes of Health Research (JT1-157204); JDRF (4-SRA-2018-651-Q-R)

Effect of Important Food Sources of Fructose-Containing Sugars on Non-alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials

ObjectivesFructose as a source of excess calories increases non-alcoholic fatty liver disease (NAFLD) markers. Whether this effect is mediated by the food matrix is unknown. We thus conducted a systematic review and meta-analysis of controlled feeding trials assessing the effect of important food sources of fructose-containing sugars at different energy control levels on NAFLD markers. MethodsMEDLINE, Embase, and Cochrane Library were searched through January 18, 2021 for controlled trials ≥7-days. Four trial designs were prespecified based on energy control: substitution (energy-matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed by GRADE. ResultsWe included 44 trials (65 trial comparisons, n = 1941) assessing the effect of 8 food sources (sugar-sweetened beverages [SSBs]; sweetened dairy alternative [soy]; fruit juice; fruit; dried fruit; baked goods, desserts and sweets; added nutritive sweetener; and mixed sources) across 4 energy levels. Total fructose-containing sugars increased IHCL in addition trials (standardized mean difference = 1.69 [95% CI, 1.00–2.37], P < 0.001), but no effect in substitution, subtraction and ad libitum trials. There was evidence of interaction by food source in addition trials with SSBs increasing IHCL and ALT, and mixed sources increasing AST. The overall certainty of evidence was high for SSBs on IHCL and ALT in addition trials and high to very low for all other comparisons. ConclusionsEnergy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. High certainty evidence suggests that SSBs providing excess energy increase NAFLD markers, while the evidence is less certain that mixed sources share the same effect and other food sources do not. More high-quality randomized trials of different food sources are needed to improve our estimates (ClinicalTrials.gov identifier, NCT02716870). Funding SourcesPrimary funding: Diabetes Canada.

Relation of Food Sources of Fructose Containing Sugars With Incident Obesity Outcomes: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

ObjectivesSugars have been implicated in the epidemic of obesity. It is unclear whether food sources of fructose-containing sugars other than sugar-sweetened beverages (SSBs) are associated with increased risk of obesity. To assess the evidence of the relation of food sources of fructose-containing sugars with incident overweight or obesity, we undertook a systematic review and meta-analysis of prospective cohort studies. MethodsWe searched MEDLINE, EMBASE and Cochrane Library through Aug 2019. We included prospective cohort studies of ≥1 year. Two reviewers extracted data and assessed the risk of bias. The primary outcome was incident overweight/obesity. Data were pooled using generic-inverse variance method (random effects) and expressed as relative risks (RR) for incident outcomes and ß-coefficients for WC with 95% confidence intervals (CI). GRADE assessed the certainty of evidence ResultsWe included 12 and 8 prospective cohorts involving 181,295 adults and 31,717 children, respectively. Four food sources of fructose-containing sugars were identified: SSBs, 100% fruit juice, fruit and yogurt. There was no data available in children for yogurt or WC. SSBs were associated with increased incident overweight/obesity in children (RR, 1.22 [95% CI, 1.03 to 1.44] but not in adults and increased incident abdominal obesity in both children (3.78 [1.08 to 13.25]) and adults (1.51 [1.11 to 2.06]), but there was no association with change in WC in adults. Fruit juice was associated with increased incident overweight/obesity in children (1.28 [1.07 to 1.53]) but not in adults, and there was no association with incident abdominal obesity in either children or adults or WC in adults. Fruit was associated with decreased incident overweight/obesity (0.87 [0.82 to 0.92]) and decreased WC (ß, –0.23 cm [–0.33 to –0.13]) in adults. Yogurt was associated with decreased incident abdominal obesity (0.65 [0.47 to 0.90]) in adults with no data available on WC. The certainty of the evidence was graded as “very low” to “moderate”. ConclusionsCurrent evidence indicates that the relation between fructose-containing sugars and obesity outcomes differs by food sources. More research of more food sources of sugars is needed to improve our certainty in the evidence. (ClinicalTrials.gov, NCT02558920) Funding SourcesASN, Diabetes Canada, Banting and Best Diabetes Centre.

Effect of Intermittent Fasting Strategies on Cardiometabolic Risk Factors: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

ObjectivesIntermittent fasting (IF) is a popular trending diet, yet there is limited evidence-based support considering its clinical impact on cardiometabolic outcomes. In an effort to inform the European Association for the Study of Diabetes (EASD) clinical practice guidelines for nutrition therapy, we conducted a network meta-analysis of randomized controlled trials (RCTs) comparing IF strategies and continuous energy restriction (CER) on cardiometabolic outcomes using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. MethodsMEDLINE, EMBASE, and Cochrane databases were searched through Nov 2020. We included RCTs assessing the effect of IF strategies (alternate-day fasting (ADF), whole-day periodic fasting (WDF), time-restricted feeding (TRF)), CER, and ad libitum diet. Outcomes included body weight, fasting glucose and LDL-cholesterol. Two independent researchers extracted data and assessed risk of bias. A network meta-analysis was performed and data were expressed as mean differences (MD) with 95% confidence intervals (CI). The certainty of the evidence was assessed using GRADE. ResultsWe identified 19 RCTs (n = 590) including adults of varying health backgrounds. ADF and CER both showed a benefit for body weight reduction compared to ad libitum diet (18 trials, n = 520; MD –3.95 kg [95% CI –6.09, –1.81] and MD –2.85 kg [95% CI –4.99, –0.71], respectively). For fasting glucose (17 trials, n = 590), TRF showed a benefit compared to ad libitum diet (MD –0.39 mmol/L [95% CI –0.59, –0.20]), to CER (MD –0.25 mmol/L [95% CI, –0.45 to –0.06]) and to WDF (MD –0.20 mmol/L [95% CI, –0.45, –0.05]). Furthermore, ADF showed a benefit in reducing LDL-cholesterol (17 trials, n = 590) compared to ad libitum diet (MD –0.21 mmol/L [95% CI –0.40, –0.1]), and to CER (MD –0.15 mmol/L [95% CI –0.31, –0.01]). The certainty of the evidence ranged from high to moderate due to variable downgrades for imprecision. ConclusionsCurrent evidence provides a good indication that IF strategies have similar benefits to CER for weight loss but may have additional benefits for fasting glucose and LDL-cholesterol. Long-term high quality RCTs are needed to clarify the effect of different IF strategies on cardiometabolic outcomes. Funding SourcesDiabetes and Nutrition Study Group of the EASD, Canadian Institutes of Health Research (CIHR), Diabetes Canada.

Important Food Sources of Fructose-Containing Sugars and Postprandial Lipids: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

ObjectivesFructose providing excess calories has been shown to increase postprandial triglycerides (TAG). Whether this effect holds for different food sources of fructose-containing sugars is unclear. We conducted a systematic review and meta-analysis of controlled feeding trials on the effect of different food sources of fructose-containing sugars at different levels of energy control on postprandial blood lipids (NCT02716870). MethodsMEDLINE, EMBASE, and Cochrane Library were searched through June 1st, 2020 for controlled feeding trials ≥7-days assessing the effect of food sources of fructose-containing sugars on postprandial lipids. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients) trials. Independent reviewers extracted data and assessed risk of bias. Outcomes were postprandial TAG and apoB48. Certainty of evidence was assessed using GRADE. ResultsWe included 29 trials (60 trial comparisons, N = 943) assessing 5 food sources (SSBs, fruit, sweets and desserts, added caloric sweetener and mixed sources) across 4 levels of energy control. Total fructose-containing sugars increased postprandial TAG in substitution (MD: 0.17 mmol/L [95% CI: 0.05, 0.30], P = 0.007), addition (0.38 mmol/L [0.13, 0.62], P = 0.003), and ad libitum (0.17 mmol/L [0.02, 0.31], P = 0.024) trials and increased apoB48 in addition trials (0.12 g/L [0.07, 0.18], P < 0.001).There was evidence of interaction by food source with SSBs increasing postprandial TAG and apoB48 in addition trials and mixed sources increasing postprandial TAG in ad libitum trials. The certainty of the evidence was “moderate” for SSBs increasing TAG in addition trials and mixed sources increasing TAG in ad libitum trials and “low” for all other comparisons. ConclusionsFood source more than energy control appears to mediate fructose-containing sugars on postprandial lipids. Good evidence suggests that SSBs and mixed sources increase postprandial lipids while evidence is less certain for the lack of effect of other food sources. More high-quality trials of different food sources are needed. Funding SourcesPrimary: Diabetes Canada.

Effect of Oats and Oat-Fiber on Glycemic Control in Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract Objectives Current approved health claims in Canada, US and Europe recognize the ability of oat ß-glucan to lower blood cholesterol; however, its ability to improve glycemic control is less certain. We undertook a systematic review and meta-analysis of randomized controlled trials to update the evidence of the effect of oats and oat-fiber on markers of glycemic control in people with and without diabetes. Here we present data for the subgroup with diabetes. Methods MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through September 23rd, 2020. We included randomized controlled trials of ≥ 2-weeks of sources of oat ß-glucan and measures of glycemic control in diabetes. Two independent reviewers extracted relevant data and assessed the risk of bias (Cochrane Risk of Bias 2.0 Tool). The outcomes were fasting plasma glucose (FPG), 2h-plasma glucose (2h-PG) from a 75 g-oral glucose tolerance test, HbA1c and fasting plasma insulin (FPI). Data were pooled using the generic inverse variance method. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Pooled estimates were expressed as mean differences with 95% confidence intervals (CI). GRADE assessed the certainty of the evidence. Results Eligibility criteria were met by 5 trial comparisons (N = 359) in type 2 diabetes. No trials were identified in type 1 diabetes. Consumption of oat ß-glucan sources reduced FPG (MD = −0.37 mmol/L [95% CI: −0.70, −0.05 mmol/L], P = 0.03, I2 = 0.00%, PQ = 0.76) and 2h-PG (MD = −1.24 mmol/L [95% CI: −1.97, −0.51 mmol/L], P = 0.00, I2 = 0.00%, PQ = 0.56). There were non-significant reductions in HbA1c (MD = −0.12%, [95% CI: −0.26, 0.01%], P = 0.07, I2 = 0.00%, PQ = 1.00) and FPI (MD = −4.59 pmol/L, [95% CI: −14.71, 5.52 pmol/L], P = 0.37, I2 = 40.84%, PQ = 0.19). The certainty of evidence was high for 2h-PG and moderate for FPG, HbA1c and FPI (single downgrades for imprecision in each case). Conclusions Current evidence provides a good indication that consumption of oat ß-glucan results in small improvements of glycemic control in type 2 diabetes. More high quality randomized trials are required to improve the precision of the pooled estimates. (ClinicalTrials.gov identifier, NCT04631913) Funding Sources Quaker Oats Center of Excellence, Diabetes Canada, Banting &amp; Best Diabetes Centre, Toronto 3D foundation

Important Food Sources of Fructose-Containing Sugars and Adiposity: A Systematic Review and Meta-Analysis of Controlled Feeding Trials

ObjectivesSugar-sweetened beverages (SSBs) have been linked to weight gain. It is unclear if other food sources of fructose-containing sugars behave similarly. We conducted a systematic review and meta-analysis of controlled feeding trials to assess the effect of different food sources of fructose-containing sugars on body weight and markers of adiposity. MethodsMEDLINE, Embase, and the Cochrane Library were searched through January 2020 for controlled feeding trials ≥2 weeks on the effect of fructose-containing sugars. Trial designs were prespecified by energy control: substitution (energy matched replacement of sugars in diets); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in diets). The primary outcome was body weight. Secondary outcomes were body mass index, body fat and waist circumference. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using GRADE. (NCT02558920) ResultsWe identified 119 controlled trials (368 trial comparisons, N = 5263) assessing the effect of 10 food sources (SSBs, sweetened dairy alternative (soy), fruit juice, fruit drink, fruit, dried fruit, sweetened cereal grains/bars, sweets, added sweeteners and mixed sources). Total fructose-containing sugars increased body weight (mean difference, 0.29 kg [95% confidence interval, 0.05 to 0.53 kg], P = 0.017) and body fat in addition trials with no effect in other analyses or outcomes. There was evidence of interaction by food source in substitution trials with fruit reducing and mixed sources increasing some outcomes and in addition trials with 100% fruit juice reducing and SSBs and mixed sources increasing some outcomes. The overall certainty of evidence was moderate for the decreasing effect of fruit and fruit juice and the increasing effect of SSBs and mixed sources and high-to-very low for other comparisons. ConclusionsEnergy control and food source may mediate the effect of fructose-containing sugars on adiposity. The evidence provides good indication that fruit and 100% fruit juice decrease and SSBs and mixed sources increase markers of adiposity. More high-quality randomized trials of different foods are needed to improve our estimates. Funding SourcesAmerican Society for Nutrition, Diabetes Canada, CIHR, Mitacs.

Greater Adherence to the Portfolio Diet Is Associated with Lower Incidence of Type 2 Diabetes in the Women’s Health Initiative

ObjectivesTo assess the association of the plant-based cholesterol-lowering diet, the Portfolio Diet, with incident type 2 diabetes in women. MethodsWe followed 147,732 postmenopausal women initially free of diabetes in the Women’s Health Initiative (WHI) Clinical Trials and Observational Study from 1993 through 2017. Adherence to the Portfolio Diet was assessed using an a priori diet index based on six food categories (high in plant protein [soy & pulses], nuts, viscous fiber, plant sterols and monounsaturated fat, and low in saturated fat) that were previously found to lower cardiovascular risk factors in the Portfolio Diet trials. We used Cox proportional-hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of the association of adherence to a Portfolio Diet score with incident type 2 diabetes, adjusting for potential confounders (demographics, lifestyle behaviors, and medical history). The Portfolio Diet score was cumulatively assessed at baseline and year three using a validated food frequency questionnaire. Type 2 diabetes diagnosis was ascertained by self-reported medication use. ResultsThere were 14,096 cases of incident type 2 diabetes over a mean follow-up of 14.3 years. In the fully adjusted models, adherence to the Portfolio Diet score was associated with a lower risk of incident type 2 diabetes (HR, 0.88, CIs, 0.83, 0.93; P for trend < 0.001), comparing the highest to lowest quartiles of adherence. Results remained similar across subgroup analyses (age, body mass index, family history of diabetes, and ethnicity) and several sensitivity analyses. ConclusionsAmong postmenopausal women, higher adherence to the Portfolio Diet was associated with lower incident type 2 diabetes. These findings are the first to show that the Portfolio Diet may be associated with a lower risk of type 2 diabetes and warrants further investigation. Funding SourcesThe WHI was funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, and the U.S. Department of Health and Human Services. AJG was supported by the Banting & Best Diabetes Centre Tamarack Graduate Award in Diabetes Research, the Peterborough K.M. Hunter Charitable Foundation Graduate Award, and an Ontario Graduate Scholarship. JLS was funded by a Diabetes Canada Clinician Scientist Award.

Diabetes and driving safety: A survey among health care professionals in Saudi Arabia

AimsDiabetes mellitus may impair an individual’s fitness to drive. In this study, we explore health care providers’ (HCPs) knowledge of problems associated with diabetes and driving, and evaluate the consistency of counseling on driving safety for patients with diabetes. MethodsWe conducted a cross-sectional survey-based study among HCPs in Saudi Arabia. We designed a web-based questionnaire to collect demographic data, assess HCPs’ knowledge of driving and diabetes and their compliance with driving safety regulations, and meet Diabetes Canada’s and the British Driver and Vehicle Licensing Agency’s recommendations. Data were analyzed using descriptive statistics and chi-square analysis. ResultsWe received 389 responses to the questionnaire. The majority of the respondents were consultants (38.8%), worked in governmental institutes (72.2%), and managed more than 30 patients weekly (34.4%). Only 5.7% of HCPs correctly answered all the driving safety questions. Diabetes educators and general practitioners had the fewest correct answers (p-value 0.03).About 12.6% of HCPs stated that they always counseled their patients about driving safety strategies. ConclusionHCPs’ education in problems associated with diabetes and driving should be improved to ensure quality counseling for their patients.

An interview with Professor Gregory Steinberg, Co-Director of the Centre for Metabolism, Obesity and Diabetes Research and the Canada Research Chair in Metabolism and Obesity at McMaster University

Gregory Steinberg completed his PhD at the University of Guelph, Canada, where he studied the role of leptin in muscle in the laboratory of Professor David Dyck. From 2002 to 2006, Greg was a postdoctoral fellow with Professor Bruce Kemp at St Vincent’s Institute of Medical Research, Australia, where he studied the role of the AMP-activated protein kinase (AMPK). In 2006, he started his academic career as Lecturer, Senior Research Fellow and Head of Metabolism at St Vincent’s Institute and the University of Melbourne. He returned to Canada in 2009 where his research studies cellular energy sensing mechanisms and looks at how endocrine factors, lipid metabolism and insulin sensitivity are linked and contribute to the development of obesity, type 2 diabetes, cardiovascular disease and cancer. He is the recipient of numerous awards, including the Diabetes Canada-Canadian Institutes of Health Research, Diabetes Young Scientist Award; the Endocrine Society Richard E Weitzman Outstanding Early Career Investigator Award; the Canadian Institutes of Health Research Gold Leaf Prize; and the American Diabetes Association Outstanding Scientific Achievement Award. To help celebrate the 100th anniversary of the discovery of insulin, Greg also recently took part in Diabetes Canada’s fitness fundraiser, ‘Lace Up for Diabetes’, riding 8000 km (the equivalent of crossing Canada) over a period of 80 days and raising almost $15,000 to help fund the next breakthrough discovery in the field. Coinciding with our issue theme of diabetes, which also marks the centenary of this discovery by Canadian scientists, The Biochemist spoke to Greg briefly about his work in this area.

Adequacy Between Canadian Clinical Guidelines and Recommendations Compared With International Guidelines for the Management of Diabetic Foot Ulcers

ObjectivesAlthough quality of care in the prevention and management of diabetic foot ulcer (DFU) has improved with the use of comprehensive evidence-based clinical practice guidelines, disparities between national and international guidelines have been demonstrated in one study conducted in Western Pacific regions. Although there are challenges of systematic implementation of evidence-based care in some clinical settings, their applications have demonstrated positive outcomes on DFU-associated burdens in many countries. The aim of this study was to review and evaluate 3 Canadian clinical practice guidelines and recommendations (CPGRs) in comparison with the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines. MethodsExtraction of all 85 recommendations from the IWGDF guidelines was performed and 3 independent investigators used a rating recommendations adequacy method with descriptive statistics. The Appraisal of Guidelines REsearch & Evaluation (AGREE) II instrument was used for quality appraisal, and reliability scores were noted using intraclass correlation coefficients. ResultsThe Wounds Canada CPGR had the higher adequacy with the IWGDF guidelines. However, its development method was poor to fair. The Registered Nurses’ Association of Ontario CPGR was superior for its development and implementation strategies, but major gaps were found in all chapters. The Diabetes Canada CPGR obtained a good quality appraisal evaluation, but was not dedicated exclusively to DFU and some important recommendations were absent. Reliability scores of AGREE II were good between investigators (p<0.0001). Some disparities were noted between Canadian and international recommendations. ConclusionsSome disparities were noted, future orientations for development should include various health-care professionals involved in the team approach, patient-oriented research, recommendations published along with their level of evidence and strength of recommendations (such as with the Grading of Recommendations, Assessment, Development and Evaluations system) and implementation strategies to enhance evidence-based practice in Canada.

Cardiovascular Harm From Egg Yolk and Meat: More Than Just Cholesterol and Saturated Fat.

Cardiovascular Harm From Egg Yolk and Meat: More Than Just Cholesterol and Saturated Fat.

Trends in National Canadian Guideline Recommendations for the Screening and Diagnosis of Gestational Diabetes Mellitus over the Years: A Scoping Review.

Canada’s largest national obstetric and diabetology organizations have recommended various algorithms for the screening of gestational diabetes mellitus (GDM) over the years. Though uniformity across recommendations from clinical practice guidelines (CPGs) is desirable, historically, national guidelines from Diabetes Canada (DC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have differed. Lack of consensus has led to variation in screening approaches, rendering precise ascertainment of GDM prevalence challenging. To highlight the reason and level of disparity in Canada, we conducted a scoping review of CPGs released by DC and the SOGC over the last thirty years and distributed a survey on screening practices among Canadian physicians. Earlier CPGs were based on expert opinion, leading to different recommendations from these organizations. However, as a result of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, disparities between DC and the SOGC no longer exist and many Canadian physicians have adopted their recent recommendations. Given that Canadian guidelines now recommend two different screening programs (one step vs. two step), lack of consensus on a single diagnostic threshold continues to exist, resulting in differing estimates of GDM prevalence. Our scoping review highlights these disparities and provides a step forward towards reaching a consensus on one unified threshold.

Exploring the lived experience of self-management practices of men, women and 2-spirited individuals living with type 2 diabetes in Canada, USA, Australia and New Zealand: a scoping review

First Nations women are disproportionately affected by Type 2 Diabetes Mellitus (T2DM) compared to First Nations men (20.3% versus 16.0%). Women with T2DM are more likely to develop cardiovascular disease compared to women without T2DM. The purpose of this review was to determine the sex and/or gender influences on the self-management (SM) practices in Indigenous Peoples living with T2DM in Canada, USA, Australia and New Zealand.

Maternal Obesity Before Pregnancy Predicts Offspring Blood Pressure at 18 Years of Age – A Causal Mediation Analysis

Background: Hypertension is the second most common pediatric chronic disease in Westernized countries. Understanding the natural history of hypertension is key to identifying prevention strategies. The present study will examine the relationship between maternal pre-pregnancy body mass index (BMI) and the possible mediating role of growth throughout childhood and adolescence on offspring blood pressure at 18 years. Methods: We performed multivariable regression and causal mediation analyses within 3217 mother - offspring pairs from the Avon Longitudinal Study of Parents and Children (ALSAPC) prospective birth cohort. The main exposure was maternal pre-pregnancy BMI. Latent trajectory analysis (LTA) was used to quantify the mediating variable of offspring BMI Z scores from 7 to 18 years of age. The main outcome was offspring blood pressure at 18 years of age categorized as normal or elevated as per the 2017 American Academy of Pediatrics guidelines. Findings: At 18 years of age, among 3217 offspring, 676 (21%) were overweight or obese, 865 (27%) had elevated blood pressure, and 510 (16%) were hypertensive. LTA identified five distinct offspring BMI trajectories. Multivariable logistic regression revealed that for every 1 unit increase in maternal BMI the risk of elevated blood pressure at 18 years of age increased by 5% (aOR: 1.05, 95% CI: 1.03 – 1.07; p <0.001) and this effect was reduced after adjusting for offspring BMI trajectory (aOR: 1.03, 95% CI: 1.00 – 1.05; p = 0.017). Causal mediation analysis confirmed offspring BMI trajectory as a mediator, accounting for 46% of the total effect of maternal BMI on elevated offspring blood pressure (aOR 1.22; 95% CI: 1.07-1.39). Interpretation: Maternal BMI prior to pregnancy is associated with an increased risk of elevated blood pressure in offspring at 18 years of age and is largely mediated by offspring BMI trajectory throughout childhood and adolescence. Funding Statement: The UK Medical Research Council and Wellcome (Grant ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf). JMM was supported by a Canadian Institute of Health Research (CIHR) Applied Public Health Chair, MBA holds a Tier 2 Canada Research Chair (CRC) in the Developmental Origins of Chronic Disease. JMM holds grants from the CIHR, Diabetes Canada, the Heart and Stroke Foundation (HSF), the Cosmopolitan Foundation, and the Lawson Foundation. AD currently has research funding from CIHR, Research Manitoba and CHRIM. MBA holds grants from the CIHR, The Bill and Melinda Gates Foundation, the Canada Foundation for Innovation, the Garfield G. Weston Foundation, Prolacta Biosciences, Mitacs, the Canadian Institutes for Advanced Research, the Children’s Hospital Foundation of Manitoba, and Research Manitoba; NB and Drs JMM, MBA and AD were also supported by a Research Manitoba grant to the DEVOTION research cluster. Declaration of Interests: None of the authors report potential or actual conflicts of interest. All authors have completed and submitted a Conflict of Interest Statement. Ethics Approval Statement: Ethical approval was obtained from the ALSPAC Law and Ethics Committee and the Biomedical Research Ethics Board at the University of Manitoba. Informed consent for the use of data collected via questionnaires and clinics was obtained from participants following the recommendations of the ALSPAC Ethics and Law Committee at the time.

Providing diabetes education to patients with chronic kidney disease: A survey of diabetes educators in Ontario, Canada.

BackgroundPatients with diabetes and chronic kidney disease (CKD) have complex diabetes care needs. Diabetes educators can play an important role in their clinical care.AimTo understand diabetes educators’ experience providing diabetes support to patients with CKD and elicit their view on the additional care needs of this population.MethodsWe conducted a quantitative online survey of diabetes educators between May 2019 and May 2020. We surveyed English-speaking educators actively practicing in Ontario, Canada for at least 1 year. We recruited them through provincial Diabetes Education Programs and Diabetes Education Section Chairs of Diabetes Canada.ResultsWe made email contact with 219/233 (94%) Diabetes Education Programs and 11/12 (92%) provincial Diabetes Canada Section Chairs. 122 unique diabetes educators submitted complete surveys (survey participation rate ∼79%). Most worked in community education programs (91%). Almost half were registered nurses (48%), and 39% had practiced for more than 15 years. Respondents noted difficulty helping patients balance complex medical conditions (19%), faced socioeconomic barriers (17%), and struggled to provide dietary advice (16%). One-third were uncertain of how to support those receiving dialysis. Eighty-five percent felt they needed more training and education to care for this high-risk group. When asked about the care needs of patients with CKD, almost all (90%) felt that patients needed more diabetes support in general. Improvement in care coordination was most commonly suggested (38%).ConclusionsIn this study of the diabetes educators’ experience treating patients with diabetes and CKD, respondents noted numerous challenges. There may be opportunities to better support both diabetes care professionals, and patients who live with multiple medical comorbidities.

Impact of Clinical Practice Guidelines on Blood Glucose Test Strip Prescription Rates in Manitoba and Saskatchewan (Canada): An Interrupted Time-Series Analysis

ObjectivesOur aim in this study was to assess the impact of the Diabetes Canada Dissemination & Implementation strategy on population-level prescription rates of blood glucose test strips. MethodsWe extracted all diabetes-related drugs and test strip claims in Manitoba and Saskatchewan between January 1, 2000 and September 30, 2015 from the Canadian Institute for Health Information’s National Prescription Drug Utilization Information System. The primary outcome was the proportion of the cohort in each quarter who had been dispensed strips in accordance with the Diabetes Canada 2013 guidelines. We conducted an interrupted time-series analysis examining prescribing trends overall and by drug groups. ResultsThe overall average sample size per quarter was 57,576 (standard deviation [SD]=12,320) and 49,533 (SD=10,206) individuals; the average age was 62.1 (SD=0.3) and 63.8 (SD=0.3) years, and the average proportion of total beneficiaries in the sample was 12.7% (SD=1.9%) and 12.6% (SD=1.7%) for Manitoba and Saskatchewan, respectively. On average preintervention, 27.9% (SD=0.68%, Manitoba) and 31.9% (SD=0.73%, Saskatchewan) of the sampled patients used strips according to the guidelines. On average postintervention, 26.5% (SD=0.29%, Manitoba) and 30.6% (SD=0.53%, Saskatchewan) of the patients used strips according to the guidelines. None of the interrupted time-series models reached statistical significance (p values ranging from 0.44 to 0.98 for Manitoba and 0.13 to 0.81 for Saskatchewan, depending on drug group). ConclusionsThe guideline and its Dissemination & Implementation strategy did not change strip prescribing. Potential reasons include complexity of the recommendations, lack of penetrance to primary care physicians and/or disagreement with recommendations.

Assessing the Quality of Evidence Presented at the Annual Conferences of Diabetes Canada

ObjectivesAnnual general meetings (AGMs) are often seen and promoted as great sources of contemporary information for the modern health-care professional. The quality of research evidence presented at these conferences, however, remains unclear. This paper evaluates the level of evidence (LoE) of research presented at the 2015 to 2019 AGMs of Diabetes Canada (DC). MethodsUsing the framework we first published to evaluate the LoE presented at the Canadian Society of Nephrology (CSN) AGMs, 2 authors independently assigned eligible abstracts a study type and grade. Research assistants separately recorded corresponding author and city affiliations. ResultsOf 832 published abstracts, 68% (N=568) met the inclusion criteria. These abstracts were classified as follows: 12% Level I (highest quality); 30% Level II; 36% Level III; 14% Level IV and 8% Level V (lowest quality). The LoE remained consistent over the 5-year study period, as observed by the Jonckheere–Terpstra test (p=0.754). The LoE of DC AGMs was similar to that of CSN AGMs (p=0.125). The number of authors was positively associated with improved LoE (p<0.001). ConclusionsBased on our novel auditing methodology, the LoE of DC AGMs is on par with other analyzed national AGMs. Adoption of this metric for all AGMs would aid in identifying unfavourable trends and alert planning and abstract selection committees of trends in LoE. Such studies will increase transparency for stakeholders and facilitate quality improvement initiatives.

68 - Flaxseed Lignan Complex Consumption Fails to Reduce Hypertension in Older Type 2 Diabetes Patients

Hypertension in type 2 diabetes patients (T2DP) contributes significantly to myocardial infarction and stroke. Unknown is the impact of flaxseed lignan complex (FLC) on Diabetes Canada’s clinical practice guidelines-defined (DCCPG-D) systolic hypertension (SH) and/or diastolic hypertension (DH) in older T2DP. It was hypothesized that FLC (600 mg secoisolariciresinol diglucoside (SDG)/day) for 3 months would decrease DCCPG-D SH and/or DH in older T2DP. The objective was to test this hypothesis.

46 - Improving Preconception Counselling in Women With Diabetes

Diabetes Canada guidelines suggest that women with diabetes should receive preconception care from their diabetes health-care team. Studies have revealed that rates of preconception counselling vary from 30-70%. We assessed the rate of preconception counselling in women with diabetes at an academic endocrinology clinic, and designed and implemented a quality improvement initiative to improve preconception counselling rates.