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South Asian Temple-Goers’ Perspective on Diabetes and its Prevention
Abstracts / Can J Diabetes 37 (2013) S13eS84
Results: Approximately 11% of the entire NS population 20 years was present in 1 of the program registries (n¼79 522). Of these individuals, 89% (n¼70 898) were present in a single program registry, 10% (n¼8 250) were present in 2 and <1% (n¼374) were present in all 3. Although the degree of overlap varied by program, the majority of individuals from each program only appeared in their respective program’s registry (DCPNS: 86%, CVHNS: 72%, NSRP 56%). The overlap increased with age, but there was little difference by sex or geography. Conclusions: The small percentage of cases with multiple morbidities underscores the very different subpopulations covered by the provincial program registries. Within the context of chronic disease management, it is important to recognise that these diseases share common risk factors; however, the lack of overlap in the disease populations also demands that special attention be paid to disease-specific programming.
213 South Asian Temple-Goers’ Perspective on Diabetes and its Prevention MALLIKA KAPUR, GINA AGARWAL, MILAN SINGH-CHEEMA Hamilton, ON; Burlington, ON Introduction: South Asians have been shown to have a higher rate of diabetes than the regular Canadian population. Given this, and the overall increase in diabetes that is being faced nationally, it is important to ascertain South Asians perceptions’ of diabetes, its development and what can be done to prevent it. Methods: We conducted 3 focus groups at a Hindu Temple. Participants were recruited following weekly worship sessions and asked completed consent forms prior to inclusion. Focus groups (facilitated by MK / GA) followed a semi-structured guide and lasted 35 to 45 minutes. Discussions were transcribed (by MK and MSC). Transcripts were analyzed independently (MK,GA, MS-C), and themes generated using a comparative analysis technique. A coding frame was agreed upon and independent coding with collaboration to discuss findings ensued. Results: Twenty-three people, of whom 11 were women and 12 were men, of ages ranging from 36 to 69; and mostly retired, participated in the focus groups. Emerging themes were: beliefs about diabetes causes, lifestyle, barriers to healthy lifestyle and diet. Participants named many reasons for diabetes onset (preservatives, relatives, blood, dirty vegetables), often beyond their control. Although participants’ knowledge of control and prevention was comprehensive, cultural factors such as diet, lack of exercise and family commitments prevented lifestyle changes. Lack of awareness/provision of culturally specific diet was mentioned specifically as a hindrance. Conclusion: Although culturally specific diabetes information may be available, South Asians are not receiving it. More culturally specific healthcare provision is required and physicians should become more aware of South Asian cultural norms.
214 Exploring Differences in Canadian Adult Men and Women with Diabetes: Results from the Canadian Community Health Survey MARGARET DE MELO*, ERIC DE SA, ENZA GUCCIARDI Toronto, ON The literature shows that apparent differences exist in diabetes complications and diabetes management between men and
S73
women. The purpose of this study was to explore sex differences in Canadians with diabetes using a nationally representative sample. Data collected from the Canadian Community Health Survey was used in these analyses. A bootstrap variance estimation method and bootstrap weights provided by Statistics Canada were used to calculate 95% confidence intervals. A fully adjusted multinomial and logistic regression analyses revealed that compared to men with diabetes, women with diabetes were more likely to be in the lowest income quintiles (OR: 1.8, 95% CI: 1.3 to 2.6) and were more likely not to have a job in the previous week (OR: 1.8, 95% CI: 1.4 to 2.4). Women were more likely to avoid foods with fats or high calories (OR: 2.1, 95% CI: 1.4 to 3.0 and OR: 2.2, 95% CI: 1.6 to 3.0, respectively), to be concerned about heart disease (OR: 1.6, 95% CI: 1.1 to 2.2), and to be non-smokers (OR: 2.2, 95% CI: 1.6 to 3.0). However, women checked their blood glucose less frequently on a daily basis than men (mwomen¼ 1.7, 95% CI: 1.7 to 1.8; mmen¼ 3.1, 95% CI: 2.9 to 3.2). Women were more likely to have an anxiety disorder (OR: 2.3, 95% CI: 1.7 to 3.2) and a mood disorder (OR: 2.4, 95% CI: 1.8 to 3.1) and more likely to be physically inactive (OR: 1.5, 95% CI: 1.2 to 1.8). This study identifies sex differences in socioeconomic, health and lifestyle characteristics and highlights the need to eliminate disparities between the sexes in order to optimize health outcomes among Canadians with diabetes.
215 Burden of Young Onset Type 2 DiabetesdInsights from the Joint Asia Diabetes Evaluation (JADE) Program ROSEANNE O. YEUNG*, YUYING ZHANG, JULIANA C.N. CHAN Hong Kong, China The JADE program is a web-based quality improvement (QI) program incorporating care protocols, validated risk engines and feedback reports to facilitate diabetes screening and management. Between 2007 and 2012, over 200 sites from 9 regions enrolled 41 030 patients into JADE (Hong Kong: 15 341, India: 9108, Philippines: 7712, China: 5646, Korea: 1751, Vietnam: 705, Singapore: 385, Thailand: 275; Taiwan: 107). Cross-sectional analysis showed 18.2% (n¼7481) had young onset diabetes (YOD, diagnosed <40 years), with mean age of diagnosis of 32.95.7 vs. 53.99.0 years in the late onset group (LOD, diagnosed 40 years). YOD had longer disease duration (median: 10.0 vs. 5.0 years) and higher A1C (8.32.0 vs. 7.71.8%) than LOD (P<0.001). At enrollment, 57.1% of YOD had metabolic syndrome and fewer achieved A1C target of <7.0% (27.4 vs. 42.0%), with higher rates of macroalbuminuria (16.4 vs. 13.6%), retinopathy (19.8 vs. 17.7%) and end stage renal disease (dialysis/estimated glomerular filtration rate (eGFR)15 to 60 mL/ min/1.73 m2; 1.2 vs. 0.9%). YOD had less chronic kidney disease (non-dialysis with eGFR 15 to 60 mL/min/1.73 m2) (10.0 vs. 16.2%), cerebrovascular (2.3 vs. 5.0%) and cardiac events (5.7 vs. 12.8%) compared to LOD (all P<0.001). Respective usage of insulin, RAS inhibitors and statins in the YOD and LOD groups were 24.4%, 25.8% and 31.4% vs.15.4%, 28.8% and 37.1%. In this multiethnic QI program, 1 in 5 Asian patients had YOD with suboptimal metabolic control, high rates of renal dysfunction and under-usage of life-saving medication. These data herald a looming epidemic of young-onset cardiovascular renal disease in Asia and call for urgent preventive actions.
Results: Approximately 11% of the entire NS population 20 years was present in 1 of the program registries (n¼79 522). Of these individuals, 89% (n¼70 898) were present in a single program registry, 10% (n¼8 250) were present in 2 and <1% (n¼374) were present in all 3. Although the degree of overlap varied by program, the majority of individuals from each program only appeared in their respective program’s registry (DCPNS: 86%, CVHNS: 72%, NSRP 56%). The overlap increased with age, but there was little difference by sex or geography. Conclusions: The small percentage of cases with multiple morbidities underscores the very different subpopulations covered by the provincial program registries. Within the context of chronic disease management, it is important to recognise that these diseases share common risk factors; however, the lack of overlap in the disease populations also demands that special attention be paid to disease-specific programming.
213 South Asian Temple-Goers’ Perspective on Diabetes and its Prevention MALLIKA KAPUR, GINA AGARWAL, MILAN SINGH-CHEEMA Hamilton, ON; Burlington, ON Introduction: South Asians have been shown to have a higher rate of diabetes than the regular Canadian population. Given this, and the overall increase in diabetes that is being faced nationally, it is important to ascertain South Asians perceptions’ of diabetes, its development and what can be done to prevent it. Methods: We conducted 3 focus groups at a Hindu Temple. Participants were recruited following weekly worship sessions and asked completed consent forms prior to inclusion. Focus groups (facilitated by MK / GA) followed a semi-structured guide and lasted 35 to 45 minutes. Discussions were transcribed (by MK and MSC). Transcripts were analyzed independently (MK,GA, MS-C), and themes generated using a comparative analysis technique. A coding frame was agreed upon and independent coding with collaboration to discuss findings ensued. Results: Twenty-three people, of whom 11 were women and 12 were men, of ages ranging from 36 to 69; and mostly retired, participated in the focus groups. Emerging themes were: beliefs about diabetes causes, lifestyle, barriers to healthy lifestyle and diet. Participants named many reasons for diabetes onset (preservatives, relatives, blood, dirty vegetables), often beyond their control. Although participants’ knowledge of control and prevention was comprehensive, cultural factors such as diet, lack of exercise and family commitments prevented lifestyle changes. Lack of awareness/provision of culturally specific diet was mentioned specifically as a hindrance. Conclusion: Although culturally specific diabetes information may be available, South Asians are not receiving it. More culturally specific healthcare provision is required and physicians should become more aware of South Asian cultural norms.
214 Exploring Differences in Canadian Adult Men and Women with Diabetes: Results from the Canadian Community Health Survey MARGARET DE MELO*, ERIC DE SA, ENZA GUCCIARDI Toronto, ON The literature shows that apparent differences exist in diabetes complications and diabetes management between men and
S73
women. The purpose of this study was to explore sex differences in Canadians with diabetes using a nationally representative sample. Data collected from the Canadian Community Health Survey was used in these analyses. A bootstrap variance estimation method and bootstrap weights provided by Statistics Canada were used to calculate 95% confidence intervals. A fully adjusted multinomial and logistic regression analyses revealed that compared to men with diabetes, women with diabetes were more likely to be in the lowest income quintiles (OR: 1.8, 95% CI: 1.3 to 2.6) and were more likely not to have a job in the previous week (OR: 1.8, 95% CI: 1.4 to 2.4). Women were more likely to avoid foods with fats or high calories (OR: 2.1, 95% CI: 1.4 to 3.0 and OR: 2.2, 95% CI: 1.6 to 3.0, respectively), to be concerned about heart disease (OR: 1.6, 95% CI: 1.1 to 2.2), and to be non-smokers (OR: 2.2, 95% CI: 1.6 to 3.0). However, women checked their blood glucose less frequently on a daily basis than men (mwomen¼ 1.7, 95% CI: 1.7 to 1.8; mmen¼ 3.1, 95% CI: 2.9 to 3.2). Women were more likely to have an anxiety disorder (OR: 2.3, 95% CI: 1.7 to 3.2) and a mood disorder (OR: 2.4, 95% CI: 1.8 to 3.1) and more likely to be physically inactive (OR: 1.5, 95% CI: 1.2 to 1.8). This study identifies sex differences in socioeconomic, health and lifestyle characteristics and highlights the need to eliminate disparities between the sexes in order to optimize health outcomes among Canadians with diabetes.
215 Burden of Young Onset Type 2 DiabetesdInsights from the Joint Asia Diabetes Evaluation (JADE) Program ROSEANNE O. YEUNG*, YUYING ZHANG, JULIANA C.N. CHAN Hong Kong, China The JADE program is a web-based quality improvement (QI) program incorporating care protocols, validated risk engines and feedback reports to facilitate diabetes screening and management. Between 2007 and 2012, over 200 sites from 9 regions enrolled 41 030 patients into JADE (Hong Kong: 15 341, India: 9108, Philippines: 7712, China: 5646, Korea: 1751, Vietnam: 705, Singapore: 385, Thailand: 275; Taiwan: 107). Cross-sectional analysis showed 18.2% (n¼7481) had young onset diabetes (YOD, diagnosed <40 years), with mean age of diagnosis of 32.95.7 vs. 53.99.0 years in the late onset group (LOD, diagnosed 40 years). YOD had longer disease duration (median: 10.0 vs. 5.0 years) and higher A1C (8.32.0 vs. 7.71.8%) than LOD (P<0.001). At enrollment, 57.1% of YOD had metabolic syndrome and fewer achieved A1C target of <7.0% (27.4 vs. 42.0%), with higher rates of macroalbuminuria (16.4 vs. 13.6%), retinopathy (19.8 vs. 17.7%) and end stage renal disease (dialysis/estimated glomerular filtration rate (eGFR)15 to 60 mL/ min/1.73 m2; 1.2 vs. 0.9%). YOD had less chronic kidney disease (non-dialysis with eGFR 15 to 60 mL/min/1.73 m2) (10.0 vs. 16.2%), cerebrovascular (2.3 vs. 5.0%) and cardiac events (5.7 vs. 12.8%) compared to LOD (all P<0.001). Respective usage of insulin, RAS inhibitors and statins in the YOD and LOD groups were 24.4%, 25.8% and 31.4% vs.15.4%, 28.8% and 37.1%. In this multiethnic QI program, 1 in 5 Asian patients had YOD with suboptimal metabolic control, high rates of renal dysfunction and under-usage of life-saving medication. These data herald a looming epidemic of young-onset cardiovascular renal disease in Asia and call for urgent preventive actions.