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