Post on 09-Jul-2015
description
Kelli Ralph-Campbell, Richard T. Oster, Tracy Connor, Adrian Jacobs, Agnes Cheng, Suzanne Poirier, MDSi Field Team
Presented by Ellen L Toth, MDUniversity of Alberta
Canadian Diabetes Association 2010
“Good News” and “Bad News”: Results of Screening for Diabetes, Cardiovascular Risk, and Diabetes Complications in Remote, Rural Alberta.
Outline
Brief description of outreach activities
Good news and bad news results
Discussion
SLICK team
SLICK and MDSI: Eye photographs
KNOWNS and UNKNOWNS
MDSi
KNOWNS: - have diabetes - visits take longer - need foot and eye exams
UNKNOWNS: screen for risk of diabetes and cardiovascular risk
30 %
80%
SLICK results December 2OO1 to June 2OO7
SLICK ActivitySLICK NON-SLICK
Year NewClients
per Year
PriorYear
Clients seen again
This Year
Clients seen
again
NewClients
per Year
PriorYear
Clients seen
again
This Year
Clients seen
again
Total visits
2001 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 end of June)
133 439 1 200 186 0 959
Totals: 2102 2735 141 1513 617 36 7144
For the longitudinal analysis, univariate general linear mixed effect models with random client effect and fixed time (year) effect were used for continuous outcome variables.
Logit general linear mixed effect models (binary or multinomial) with random client effect and fixed time effect were used for categorical (binary) outcome variables.
Longitudinal analyses for baseline clinical parameters per year were adjusted for duration of diabetes.
Statistical Methodology
Example
SLICK summary
Clients with diabetes, MDSi, 2OO3-2OO9
-2 -1.5 -1 -0.5 0 0.5 1 1.5 2
Health indicators of returning subjects with diabetes (N = 180). Values are estimates for the average change per year with 95% CI.
BMI
Waist
A1c
Systolic BP
Diastolic BP
MAP
Cholesterol
Children - YouthEstimates of Fixed Effectsa
95% Confidence Interval Parameter
Estimate Std. Error df t Sig. Lower Bound Upper Bound
Intercept 23.020897 1.363142 30.993 16.888 .000 20.240722 25.801071
abs_days .006886 .000918 26.184 7.499 .000 .005000 .008773
a. Dependent Variable: New_BMI.
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.
-1.5 -1 -0.5 0 0.5 1 1.5
BMI
Waist
A1c
Systolic BP
Diastolic BP
MAP
Cholesterol
Children- Youth
Estimates of Fixed Effectsa
95% Confidence Interval Parameter
Estimate Std. Error df t Sig. Lower Bound Upper Bound
Intercept 23.020897 1.363142 30.993 16.888 .000 20.240722 25.801071
abs_days .006886 .000918 26.184 7.499 .000 .005000 .008773
a. Dependent Variable: New_BMI.
Children-Youth
BAD NEWS: many way too high to start withMORE BAD NEWS: not decreasingGOOD NEWS: not increasing, and some going down
MDSi results to March 2010, DRAFT
Outcomes of selected parameters
Slick adults with diabetes (N = 2102
MDSi adults with diabetes (N = 180)
MDSi adults screened for diabetes (N = 629)
BRAID adults screened for diabetes (N = 91)
BRAID children and youth screened for diabetes (N = 32)
MDSi children and youth screened for diabetes (N = 83)
BMI
BMI centiles NA NA NA NA
Waists NA
A1c trend to inc p = 0.05
BP syst
BP diast
MAP
TC
All Clients
7.16
8.21
7.69 7.61 7.54 7.60 7.58
Mean A1c
0
1
2
3
4
5
6
7
8
9
Year
2001 2002 2003 2004 2005 2006 2007
At first visit!????
Slope = -0.143p-value=<.0001
(N=2091 Slick clients at 1stMean A1c
4
5
6
7
8
9
10
11
12
13
14
year
2001 2002 2003 2004 2005 2006 2007
A1c by Year(N=2091 Slick clients at 1st visit)
Slope = -0.158
p-value <.0001
(N = 1704)
Mean Cholesterol
1
2
3
4
5
6
7
89
10
11
year2001 2002 2003 2004 2005 2006 2007
Total Cholesterol by Year(N=1704 Slick clients at 1st visit)
Diet AloneOralInsulinInsulin+Oralp
ercentage
0
10
20
30
40
50
60
70
80
90
100
<7 7-9 9-12 >=12
Summary
Seeing improvements:A1cWeight/ waistsTotal cholesterolBlood pressure
LIMITATIONSNo control group
MDSi baseline results