2010 (Oct) Canadian Diabetes Association Annual Conference, Aboriginal health Symposium facilitated by BRAID Research, presentation by BRAID Research

1. “Good News” and “Bad News”: Results
of Screening for Diabetes,
Cardiovascular Risk, and Diabetes
Complications in Remote, Rural Alberta.
Kelli Ralph-Campbell, Richard T. Oster, Tracy
Connor, Adrian Jacobs, Agnes Cheng, Suzanne Poirier, MDSi
Field Team
Presented by Ellen L Toth, MD
University of Alberta
Canadian Diabetes Association 2010

2. Outline
 Brief description of outreach
activities
 Good news and bad news results
 Discussion

4. SLICK team

6. SLICK and MDSI:
Eye photographs

9. KNOWNS and
UNKNOWNS
MDSi
80%
30
%
KNOWNS: UNKNOWNS:
- have diabetes screen for risk of
- visits take longer diabetes and
- need foot and eye exams cardiovascular risk

11. SLICK results
December 2OO1 to
June 2OO7

12. SLICK Activity
SLICK NON-SLICK
Year New Prior This New Prior This Total
Clients Year Year Clients Year Year visits
per Clients Clients per Clients Clients
Year seen again seen Year seen seen
again again again
2001 11 0 0 1 0 0 12
2002 804 5 46 180 0 1 1036
2003 396 375 28 231 38 3 1071
2004 354 601 34 292 83 13 1377
2005 202 594 17 323 141 11 1288
2006 202 721 15 286 169 8 1401
2007(to 133 439 1 200 186 0 959
end of
June)
Totals: 2102 2735 141 1513 617 36 7144

13. Statistical Methodology
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.

15. Example

16. SLICK summary

17. Clients with diabetes, MDSi,
2OO3-2OO9
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
-2 -1.5 -1 -0.5 0 0.5 1 1.5 2

18. Children - Youth
a
Estimates of Fixed Effects
Parameter 95% Confidence Interval
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.

19. 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.
BMI
Waist
A1c
Systolic BP
Diastolic BP
MAP
Cholesterol
-1.5 -1 -0.5 0 0.5 1 1.5

20. Children- Youth
Estimates of Fixed Effects a
Parameter 95% Confidence Interval
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.

21. Children-Youth

22. BAD
NEWS:
many way
too high to
MORE
start with
BAD
NEWS: not
decreasing
GOOD
NEWS: not
increasing,
and some
going down
MDSi results to March
2010, DRAFT

23. Outcomes of Slick adults MDSi adults
MDSi adults
BRAID
adults
BRAID
children and
MDSi children
and youth
screened for youth
selected with diabetes with diabetes
(N = 2102 (N = 180)
diabetes (N =
screened for
diabetes (N =
screened for
screened for
diabetes (N =
629) diabetes (N
parameters 91)
= 32)
83)
BMI
BMI centiles NA NA NA NA
Waists NA
trend to inc p =
A1c 0.05
BP syst
BP diast
MAP
TC

25. All Clients
9
8 8.21
7.69 7.61 7.60 7.58
7.54
7 7.16
6
Mean A1c
5
4
3
2
1
0
2001 2002 2003 2004 2005 2006 2007
Year

26. A1c by Year At first
clients at 1st
(N=2091 Slick at 1st visit)
(N=2091 Slick clients visit!????
14
13 Slope = -0.143
p-value=<.0001
12
11
Mean A1c
10
9
8
7
6
5
4
2001 2002 2003 2004 2005 2006 2007
year

29. Total Cholesterol by Year
(N=1704 Slick clients at 1st visit)
11
(N = 1704)
Mean Cholesterol
10 Slope = -0.158
9 p-value <.0001
8
7
6
5
4
3
2
1
2001 2002 2003 2004 2005 2006 2007
year

30. 100
90
80
percentage
70
60
Diet Alone
50 Oral
Insulin
40 Insulin+Oral
30
20
10
0
<7 7-9 9-12 >=12

31. Summary
 Seeing improvements:
 A1c
 Weight/ waists
 Total cholesterol
 Blood pressure
 LIMITATIONS
 No control group

35. MDSi baseline results