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A Community Health Awareness Program in Subsidized Seniors Homes: Using CANRISK as a Risk Assessment and Health Promotion Tool
Abstracts / Can J Diabetes 37 (2013) S13eS84
The greatest variations in healthy eating and smoking were observed among Aboriginal populations. Those having less than a secondary diploma showed lower rates of healthy eating and physical activity. Except for physical activity, men were at higher risk than women for all behavioural factors. The disaggregation of the latest national data on chronic disease found in the framework can help users understand the distribution of diabetes and vascular disease risk factors and support equity-based prevention initiatives.
219 A Community Health Awareness Program in Subsidized Seniors Homes: Using CANRISK as a Risk Assessment and Health Promotion Tool GINA AGARWAL*, BEATRICE MCDONOUGH, BRENT MCLEOD, LISA DOLOVICH, RIC ANGELES, FRANCINE MARZANEK Hamilton, ON Context: Older adults are at risk of developing diabetes (DM) and its complications, leading to emergency medical service (EMS) calls and emergency room visits. Community-based risk-assessment/ lifestyle modification programs linking with primary care for older adults, may reduce EMS calls. Objective: To evaluate uptake and feasibility of the Community Health Awareness Program through EMS (CHAP-EMS) for subsidized seniors housing. Design: Pilot study. Participants and setting: Residents in Hamilton subsidized apartment (n¼280), comprised of low income, seniors, from multicultural backgrounds and frequently calling EMS. Intervention: Two trained paramedics provided weekly drop-in sessions, assessed diabetes risk using the CANRISK questionnaire, discussed lifestyle change. Participants returned for fasting capillary glucose test (CBG) if their CANRISK score was “high.” Blood pressure (BP), lifestyle risk status was collected. Descriptive analyses: number of participants attending sessions, CANRISK and CBG test status, modifiable risk factor status, BP and EMS calls. Results: After 5 months, 45 residents attended; 37 had multiple visits; 72% were female; 85% were 65 years; 10 were previously diagnosed with DM, 9 had concomitant HTN; CANRISK for nondiabetics showed 52% were at high risk of developing DM, 14% had moderate risk. From CBG, 1 had diabetes, 1 prediabetes. Modifiable risk factor status included smoking 33.3%, high salt intake 30.9%, low fruit/vegetable intake 33.3%, low physical activity 45.2%, high BMI 61.9%, elevated BP 66.7%. EMS calls reduced by 32%. Conclusion: CHAP-EMS is feasible intervention for programming in seniors housing in urban areas, detecting at-risk population for diabetes, providing a vehicle for discussing lifestyle change.
Sulfonylurea Deaths (%) of Total Users Gliclazide 708 (9%) of 7800 Glimepiride 5058 (12%) of 40 207 Glipizide 1281 (16%) of 8127 Tolbutamide 1089 (17%) of 6261 Glyburide 2511 (15%) of 16 801
S75
220 Mailed-in Fasting Blood Glucose Sampling Reveals Classic Risk Factors for Undiagnosed Diabetes: An Evaluation of an Innovative Diabetes Screening Strategy AARON LEONG*, KABERI DASGUPTA, JEAN-LOUIS CHIASSON, ELHAM RAHME Montreal, QC Background: Current diabetes screening practices require in-person glucose testing. This presents barriers to individuals with time constraints or competing responsibilities, and those lacking healthcare access. We evaluated a novel population-level screening approach using mailed-in blood glucose samples and determined predictors for undiagnosed diabetes. Methods: A stratified random sample of the Quebec population (n¼6 247) was surveyed by telephone and asked to mail-in fasting blood samples on filter paper to a central laboratory. Multivariate logistic regression estimated the association between socio-demographic characteristics, social habits and activity level, with undiagnosed diabetes (fasting blood glucose 7.0 mmol/L in a previously undiagnosed individual). We performed multiple imputation using health administrative data of the entire study sample to account for non-participation. Results: A total of 1598 (25.6%) participants provided an analyzable blood sample, of which 165 had previously diagnosed diabetes and 93 had undiagnosed diabetes (5.8% [95% CI 4.3, 6.2]; 7.3% [95% CI 6.1, 8.4]). Previous hyperglycemia (odds ratio 1.49 [95% CI 1.12, 1.99]), younger age (1.19 [95% CI 1.14, 1.25] by decade), men (1.18 [95% CI 1.04, 1.35]), non-Caucasian ancestry (1.19 [95% CI 1.03, 1.38]), higher BMI (1.18 [95% CI 1.07, 1.30] by 5 kg/m2), sedentary lifestyle (1.08 [95% CI 1.01, 1.17]) and social factors, including rural residence (1.36 [95% CI 1.14, 1.62]), lower education (1.20 [95% CI 1.02, 1.42]) and lower socioeconomic status (1.05 [95% CI 1.00, 1.10]) were associated with undiagnosed diabetes. Conclusion: This population-based novel screening strategy effectively identified classic biological, demographic and social risk factors for undiagnosed diabetes. Nationwide mailed-in blood collection for glucose testing can be directed toward at-risk individuals. 221 The Risk of Mortality Varies Amongst Sulfonylureas: A Metaanalysis of Controlled Studies JAYSON LEE, AHMED S. ABDELMONEIM, TRAVIS FEATHERSTONE, SCOT H. SIMPSON* Edmonton, AB Objective: Several controlled studies have shown that sulfonylureas are associated with an increased risk of death and cardiovascular events compared to other antidiabetic drugs. However, since sulfonyulreas are the most commonly used second-line agents in type 2 diabetes management, we wanted to know if this increased risk was similar amongst all sulfonylureas.
Glimepiride
Glipizide
Tolbutamide
Glyburide
0.63 (0.57e0.69)
0.51 (0.46e0.57)
0.46 (0.38e0.54)
0.63 (0.47e0.83)
0.81 (0.76e0.87)
0.68 (0.55e0.85)
0.84 (0.80e0.89)
0.90 (0.79e1.02)
1.09 (1.01e1.18) 1.22 (1.12e1.32)
The greatest variations in healthy eating and smoking were observed among Aboriginal populations. Those having less than a secondary diploma showed lower rates of healthy eating and physical activity. Except for physical activity, men were at higher risk than women for all behavioural factors. The disaggregation of the latest national data on chronic disease found in the framework can help users understand the distribution of diabetes and vascular disease risk factors and support equity-based prevention initiatives.
219 A Community Health Awareness Program in Subsidized Seniors Homes: Using CANRISK as a Risk Assessment and Health Promotion Tool GINA AGARWAL*, BEATRICE MCDONOUGH, BRENT MCLEOD, LISA DOLOVICH, RIC ANGELES, FRANCINE MARZANEK Hamilton, ON Context: Older adults are at risk of developing diabetes (DM) and its complications, leading to emergency medical service (EMS) calls and emergency room visits. Community-based risk-assessment/ lifestyle modification programs linking with primary care for older adults, may reduce EMS calls. Objective: To evaluate uptake and feasibility of the Community Health Awareness Program through EMS (CHAP-EMS) for subsidized seniors housing. Design: Pilot study. Participants and setting: Residents in Hamilton subsidized apartment (n¼280), comprised of low income, seniors, from multicultural backgrounds and frequently calling EMS. Intervention: Two trained paramedics provided weekly drop-in sessions, assessed diabetes risk using the CANRISK questionnaire, discussed lifestyle change. Participants returned for fasting capillary glucose test (CBG) if their CANRISK score was “high.” Blood pressure (BP), lifestyle risk status was collected. Descriptive analyses: number of participants attending sessions, CANRISK and CBG test status, modifiable risk factor status, BP and EMS calls. Results: After 5 months, 45 residents attended; 37 had multiple visits; 72% were female; 85% were 65 years; 10 were previously diagnosed with DM, 9 had concomitant HTN; CANRISK for nondiabetics showed 52% were at high risk of developing DM, 14% had moderate risk. From CBG, 1 had diabetes, 1 prediabetes. Modifiable risk factor status included smoking 33.3%, high salt intake 30.9%, low fruit/vegetable intake 33.3%, low physical activity 45.2%, high BMI 61.9%, elevated BP 66.7%. EMS calls reduced by 32%. Conclusion: CHAP-EMS is feasible intervention for programming in seniors housing in urban areas, detecting at-risk population for diabetes, providing a vehicle for discussing lifestyle change.
Sulfonylurea Deaths (%) of Total Users Gliclazide 708 (9%) of 7800 Glimepiride 5058 (12%) of 40 207 Glipizide 1281 (16%) of 8127 Tolbutamide 1089 (17%) of 6261 Glyburide 2511 (15%) of 16 801
S75
220 Mailed-in Fasting Blood Glucose Sampling Reveals Classic Risk Factors for Undiagnosed Diabetes: An Evaluation of an Innovative Diabetes Screening Strategy AARON LEONG*, KABERI DASGUPTA, JEAN-LOUIS CHIASSON, ELHAM RAHME Montreal, QC Background: Current diabetes screening practices require in-person glucose testing. This presents barriers to individuals with time constraints or competing responsibilities, and those lacking healthcare access. We evaluated a novel population-level screening approach using mailed-in blood glucose samples and determined predictors for undiagnosed diabetes. Methods: A stratified random sample of the Quebec population (n¼6 247) was surveyed by telephone and asked to mail-in fasting blood samples on filter paper to a central laboratory. Multivariate logistic regression estimated the association between socio-demographic characteristics, social habits and activity level, with undiagnosed diabetes (fasting blood glucose 7.0 mmol/L in a previously undiagnosed individual). We performed multiple imputation using health administrative data of the entire study sample to account for non-participation. Results: A total of 1598 (25.6%) participants provided an analyzable blood sample, of which 165 had previously diagnosed diabetes and 93 had undiagnosed diabetes (5.8% [95% CI 4.3, 6.2]; 7.3% [95% CI 6.1, 8.4]). Previous hyperglycemia (odds ratio 1.49 [95% CI 1.12, 1.99]), younger age (1.19 [95% CI 1.14, 1.25] by decade), men (1.18 [95% CI 1.04, 1.35]), non-Caucasian ancestry (1.19 [95% CI 1.03, 1.38]), higher BMI (1.18 [95% CI 1.07, 1.30] by 5 kg/m2), sedentary lifestyle (1.08 [95% CI 1.01, 1.17]) and social factors, including rural residence (1.36 [95% CI 1.14, 1.62]), lower education (1.20 [95% CI 1.02, 1.42]) and lower socioeconomic status (1.05 [95% CI 1.00, 1.10]) were associated with undiagnosed diabetes. Conclusion: This population-based novel screening strategy effectively identified classic biological, demographic and social risk factors for undiagnosed diabetes. Nationwide mailed-in blood collection for glucose testing can be directed toward at-risk individuals. 221 The Risk of Mortality Varies Amongst Sulfonylureas: A Metaanalysis of Controlled Studies JAYSON LEE, AHMED S. ABDELMONEIM, TRAVIS FEATHERSTONE, SCOT H. SIMPSON* Edmonton, AB Objective: Several controlled studies have shown that sulfonylureas are associated with an increased risk of death and cardiovascular events compared to other antidiabetic drugs. However, since sulfonyulreas are the most commonly used second-line agents in type 2 diabetes management, we wanted to know if this increased risk was similar amongst all sulfonylureas.
Glimepiride
Glipizide
Tolbutamide
Glyburide
0.63 (0.57e0.69)
0.51 (0.46e0.57)
0.46 (0.38e0.54)
0.63 (0.47e0.83)
0.81 (0.76e0.87)
0.68 (0.55e0.85)
0.84 (0.80e0.89)
0.90 (0.79e1.02)
1.09 (1.01e1.18) 1.22 (1.12e1.32)