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Herpes Zoster Infection in People with Diabetes in Canadian Primary Care Practice
Abstracts / Can J Diabetes 40 (2016) S2–S20
Conclusion: Timing of CGM initiation was not associated with change in responsibility for pump/CGM over time. Parental involvement was, as expected, greater in younger age group. 47 Relative and Absolute Availability of Fast Food Restaurants in Relation to the Development of Diabetes: A Population-Based Cohort Study JANE Y. POLSKY*, RAHIM MOINEDDIN, RICHARD H. GLAZIER, JAMES R. DUNN, GILLIAN L. BOOTH Toronto, ON Objectives: To determine whether residents living in areas with a high proportion of fast food restaurants relative to all restaurants are more likely to develop diabetes and whether the risk varies according to volume of fast food restaurants. Methods: The study cohort consisted of adult respondents (20 to 84 years) to the Canadian Community Health Survey (cycles 2005, 2007/08, 2009/10) who resided within walking distance (720 metres) of at least 1 restaurant in Toronto, Brampton, Mississauga or Hamilton, Ontario. The development of diabetes was established by linking participants to the Ontario Diabetes Database. Cox proportional hazards models were used to estimate hazard ratios (HRs) of incident diabetes associated with relative and absolute measures of restaurant availability. Results: During a median follow up of 5 years, 347 of 7079 participants (4.6%) developed diabetes. Among younger adults (20 to 65 years, n=5806), a greater proportion of fast food relative to all restaurants was significantly associated with incident diabetes after adjustment for a range of individual and area-level covariates, but only in areas with high volumes of fast food retailers (3+outlets) (HR=1.79, 95% CI: 1.03 to 3.12, across the interquartile range). Adjusting for body mass index rendered this association non-significant. No significant associations were observed in areas with low volumes of fast food restaurants or among older adults (65 to 84 years, n=1273). Absolute availability (number) of fast food and other restaurants was generally unrelated to incident diabetes. Conclusion: Areas with a high volume of fast food restaurants that is poorly balanced by other types of restaurants may represent an adverse environment for the development of diabetes. 48 Herpes Zoster Infection in People with Diabetes in Canadian Primary Care Practice JOHN A. QUEENAN, PENDAR FARAHANI, SHAHRIAR KHAN, RICHARD BIRTWHISTLE Kingston, ON Background: Patients with diabetes may have an increased risk of developing herpes zoster infection (VZV). The increased risk may be related to decreases in VZV-specific immunity. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) contains de-identified health data from the electronic medical records of 74 679 Canadian patients with diabetes. We present preliminary results of our investigation to determine the burden of VZV in people with diabetes in CPCSSN. Objectives: 1) To determine the prevalence of VZV infection and complications in people with and without diabetes; 2) Assess the association between diabetes and VZV. Methods: This study is cross-sectional. The study population is patients who have a CPCSSN Case Definition of Diabetes and visited their family physician at least once in the past 2 years. Patients were classified as having VZV if there was any occurrence of IDC-9 codes 053-053.XX in their Billing, Health Condition or Encounter Diagnosis fields. We calculated the age and sex standardized prevalence
S17
of VZV. Logistic regression calculated age- and sex-adjusted odds ratios. Results: The prevalence of HZ in the CPCSSN population was 2.23% and increased with age. In people with diabetes, it was 4.03% (male=3.61%, female=4.47%). The adjusted odds ratio of having VZV in people with diabetes was 1.08 (95% C.I. 1.036, 1.125). Conclusions: VZV is increased in people with diabetes and more prevalent in women than men. The adjusted prevalence was higher than other reports from around the world. However, the adjusted OR associated with VZV in people with diabetes was lower than similar reports. 49 Modelling the EMPA-REG-OUTCOME Study into Long-Term Health Outcomes in a Canadian Population SAM METTAM*,†, HARPREET BAJAJ†, ANURAAG KANSAL†, PRASHANTH KANDASWAMY† Burlington, ON A patient level pharmacoeconomic model was built to evaluate the cost-effectiveness and long-term health outcomes of treatment with empagliflozin in a Canadian population with diabetes and high cardiovascular risk. Risk equations were derived from patient level data from the EMPA-REG-OUTCOME trial for cardiovascular and renal events by fitting parametric survival functions. The model was validated using 10 000 randomly sampled patients from the EMP-REGOUTCOME trial over the trial duration. The main analysis analyzed 5000 patients over a lifetime horizon. The results from this analysis were scaled up to the 506 859 patients who we estimated to have type 2 diabetes and established cardiovascular disease. Over a lifetime horizon, empagliflozin in addition to standard of care is predicted to result in 62 445 fewer cardiovascular deaths, 39 636 fewer hospitalizations for heart failure and 10 543 fewer patients requiring dialysis or transplant. Patients treated with empagliflozin are predicted to live for an average of 14.5 years vs. 12.3 years on standard of care alone, an additional 2.18 life years and 1.65 qualityadjusted life years (QALYs) at an additional cost of $10 265 per patient (drug cost $13 880, assuming no other treatments are displaced, minus health system cost offsets from reduced events of $3615). When discounted at 5%, the additional cost per patient reduces to $4447 per patient and the additional QALYs reduce to 0.74, yielding an incremental cost utility ratio (ICUR) of $5977 per QALY, which is very cost-effective at a typical Canadian willingness to pay of $50 000 per QALY. 50 BC Provincial Diabetes Evaluation: A Quantitative and Qualitative Environment Scan of Diabetes Care Management in British Columbia MARSHALL DAHL, WENDY LEONG* Vancouver, BC Introduction: Preliminary reports indicate that restricted diabetes resources in British Columbia (BC) and Canada have contributed to family physicians (GPs) and primary care nurses independently caring for 80% of type 2 diabetes (T2DM) adults from low-risk to very-complex high-user, high-risk, high-morbidity and high-mortality T2DM. Proven global diabetes population-health initiatives to improve outcomes include early access to diabetes resources and experts; coordinated, seamless care systems; and evidence-based guidelines and pathways. Purpose: To identify major gaps and barriers in T2DM care, and to address the question “How should diabetes care be organized in BC?” Results: Phase 1 (2015/2016) was successful (>20 ocus/working groups, >400 interdisciplinary participants for qualitative data
Conclusion: Timing of CGM initiation was not associated with change in responsibility for pump/CGM over time. Parental involvement was, as expected, greater in younger age group. 47 Relative and Absolute Availability of Fast Food Restaurants in Relation to the Development of Diabetes: A Population-Based Cohort Study JANE Y. POLSKY*, RAHIM MOINEDDIN, RICHARD H. GLAZIER, JAMES R. DUNN, GILLIAN L. BOOTH Toronto, ON Objectives: To determine whether residents living in areas with a high proportion of fast food restaurants relative to all restaurants are more likely to develop diabetes and whether the risk varies according to volume of fast food restaurants. Methods: The study cohort consisted of adult respondents (20 to 84 years) to the Canadian Community Health Survey (cycles 2005, 2007/08, 2009/10) who resided within walking distance (720 metres) of at least 1 restaurant in Toronto, Brampton, Mississauga or Hamilton, Ontario. The development of diabetes was established by linking participants to the Ontario Diabetes Database. Cox proportional hazards models were used to estimate hazard ratios (HRs) of incident diabetes associated with relative and absolute measures of restaurant availability. Results: During a median follow up of 5 years, 347 of 7079 participants (4.6%) developed diabetes. Among younger adults (20 to 65 years, n=5806), a greater proportion of fast food relative to all restaurants was significantly associated with incident diabetes after adjustment for a range of individual and area-level covariates, but only in areas with high volumes of fast food retailers (3+outlets) (HR=1.79, 95% CI: 1.03 to 3.12, across the interquartile range). Adjusting for body mass index rendered this association non-significant. No significant associations were observed in areas with low volumes of fast food restaurants or among older adults (65 to 84 years, n=1273). Absolute availability (number) of fast food and other restaurants was generally unrelated to incident diabetes. Conclusion: Areas with a high volume of fast food restaurants that is poorly balanced by other types of restaurants may represent an adverse environment for the development of diabetes. 48 Herpes Zoster Infection in People with Diabetes in Canadian Primary Care Practice JOHN A. QUEENAN, PENDAR FARAHANI, SHAHRIAR KHAN, RICHARD BIRTWHISTLE Kingston, ON Background: Patients with diabetes may have an increased risk of developing herpes zoster infection (VZV). The increased risk may be related to decreases in VZV-specific immunity. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) contains de-identified health data from the electronic medical records of 74 679 Canadian patients with diabetes. We present preliminary results of our investigation to determine the burden of VZV in people with diabetes in CPCSSN. Objectives: 1) To determine the prevalence of VZV infection and complications in people with and without diabetes; 2) Assess the association between diabetes and VZV. Methods: This study is cross-sectional. The study population is patients who have a CPCSSN Case Definition of Diabetes and visited their family physician at least once in the past 2 years. Patients were classified as having VZV if there was any occurrence of IDC-9 codes 053-053.XX in their Billing, Health Condition or Encounter Diagnosis fields. We calculated the age and sex standardized prevalence
S17
of VZV. Logistic regression calculated age- and sex-adjusted odds ratios. Results: The prevalence of HZ in the CPCSSN population was 2.23% and increased with age. In people with diabetes, it was 4.03% (male=3.61%, female=4.47%). The adjusted odds ratio of having VZV in people with diabetes was 1.08 (95% C.I. 1.036, 1.125). Conclusions: VZV is increased in people with diabetes and more prevalent in women than men. The adjusted prevalence was higher than other reports from around the world. However, the adjusted OR associated with VZV in people with diabetes was lower than similar reports. 49 Modelling the EMPA-REG-OUTCOME Study into Long-Term Health Outcomes in a Canadian Population SAM METTAM*,†, HARPREET BAJAJ†, ANURAAG KANSAL†, PRASHANTH KANDASWAMY† Burlington, ON A patient level pharmacoeconomic model was built to evaluate the cost-effectiveness and long-term health outcomes of treatment with empagliflozin in a Canadian population with diabetes and high cardiovascular risk. Risk equations were derived from patient level data from the EMPA-REG-OUTCOME trial for cardiovascular and renal events by fitting parametric survival functions. The model was validated using 10 000 randomly sampled patients from the EMP-REGOUTCOME trial over the trial duration. The main analysis analyzed 5000 patients over a lifetime horizon. The results from this analysis were scaled up to the 506 859 patients who we estimated to have type 2 diabetes and established cardiovascular disease. Over a lifetime horizon, empagliflozin in addition to standard of care is predicted to result in 62 445 fewer cardiovascular deaths, 39 636 fewer hospitalizations for heart failure and 10 543 fewer patients requiring dialysis or transplant. Patients treated with empagliflozin are predicted to live for an average of 14.5 years vs. 12.3 years on standard of care alone, an additional 2.18 life years and 1.65 qualityadjusted life years (QALYs) at an additional cost of $10 265 per patient (drug cost $13 880, assuming no other treatments are displaced, minus health system cost offsets from reduced events of $3615). When discounted at 5%, the additional cost per patient reduces to $4447 per patient and the additional QALYs reduce to 0.74, yielding an incremental cost utility ratio (ICUR) of $5977 per QALY, which is very cost-effective at a typical Canadian willingness to pay of $50 000 per QALY. 50 BC Provincial Diabetes Evaluation: A Quantitative and Qualitative Environment Scan of Diabetes Care Management in British Columbia MARSHALL DAHL, WENDY LEONG* Vancouver, BC Introduction: Preliminary reports indicate that restricted diabetes resources in British Columbia (BC) and Canada have contributed to family physicians (GPs) and primary care nurses independently caring for 80% of type 2 diabetes (T2DM) adults from low-risk to very-complex high-user, high-risk, high-morbidity and high-mortality T2DM. Proven global diabetes population-health initiatives to improve outcomes include early access to diabetes resources and experts; coordinated, seamless care systems; and evidence-based guidelines and pathways. Purpose: To identify major gaps and barriers in T2DM care, and to address the question “How should diabetes care be organized in BC?” Results: Phase 1 (2015/2016) was successful (>20 ocus/working groups, >400 interdisciplinary participants for qualitative data