Roseanne Yeung - Academia.edu (original) (raw)

Papers by Roseanne Yeung

Research paper thumbnail of Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort

The Lancet Diabetes & Endocrinology, 2014

The prevalence of diabetes is increasing in young adults in Asia, but little is known about metab... more The prevalence of diabetes is increasing in young adults in Asia, but little is known about metabolic control or the burden of associated complications in this population. We assessed the prevalence of young-onset versus late-onset type 2 diabetes, and associated risk factors and complication burdens, in the Joint Asia Diabetes Evaluation (JADE) cohort. JADE is an ongoing prospective cohort study. We enrolled adults with type 2 diabetes from 245 outpatient clinics in nine Asian countries or regions. We classified patients as having young-onset diabetes if they were diagnosed before the age of 40 years, and as having late-onset diabetes if they were diagnosed at 40 years or older. Data for participants' first JADE assessment was extracted for cross-sectional analysis. We compared clinical characteristics, metabolic risk factors, and the prevalence of complications between participants with young-onset diabetes and late-onset diabetes. Between Nov 1, 2007, and Dec 21, 2012, we enrolled 41,029 patients (15,341 from Hong Kong, 9107 from India, 7712 from Philippines, 5646 from China, 1751 from South Korea, 705 from Vietnam, 385 from Singapore, 275 from Thailand, 107 from Taiwan). 7481 patients (18%) had young-onset diabetes, with age at diagnosis of mean 32·9 years [SD 5·7] versus 53·9 years [9·0] with late-onset diabetes (n=33,548). Those with young-onset diabetes had longer disease duration (median 10 years [IQR 3-18]) than those with late-onset diabetes (5 years [2-11]). Fewer patients with young-onset diabetes achieved HbA1c concentrations lower than 7% compared to those with late-onset diabetes (27% vs 42%;…

Research paper thumbnail of Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data

Journal of the Endocrine Society

Context Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong t... more Context Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients. Objective We aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada. Methods This study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records, and visit reasons. Results The period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3 to 4 times as frequent as the average Albertan, and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medicatio...

Research paper thumbnail of Contextualizing Diabetes and Obesity Care for Immigrant and Refugee Populations

Community-based participatory research

Research paper thumbnail of Sex- and Age-based Achievement of Diabetes Clinical and Treatment Targets in Canadian Primary Care (2015–2020): A Multi-provincial Serial Cross-sectional Study

Canadian Journal of Diabetes

Research paper thumbnail of Adrenal Insufficiency: Investigating Prevalence and Health-Care Utilization Using Administrative Data

Canadian Journal of Diabetes

Research paper thumbnail of New Diabetes Guidelines: Impact on Eligibility for Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Canada

Canadian Journal of Diabetes

Research paper thumbnail of Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data (S1)

Supplementary appendix for a quality improvement study investigating adrenal insufficiency in Alb... more Supplementary appendix for a quality improvement study investigating adrenal insufficiency in Alberta, Canada. This appendix provide details on database descriptions and medication/ATC codes used for this study.

Research paper thumbnail of Not quite type 1 or type 2, what now? Review of monogenic, mitochondrial, and syndromic diabetes

Reviews in endocrine & metabolic disorders, Jan 18, 2018

Diabetes mellitus is a heterogeneous group of conditions defined by resultant chronic hyperglycem... more Diabetes mellitus is a heterogeneous group of conditions defined by resultant chronic hyperglycemia. Given the increasing prevalence of diabetes mellitus and the increasing understanding of genetic etiologies, we present a broad review of rare genetic forms of diabetes that have differing diagnostic and/or treatment implications from type 1 and type 2 diabetes. Advances in understanding the genotype-phenotype associations in these rare forms of diabetes offer clinically available examples of evolving precision medicine where defining the correct genetic etiology can radically alter treatment approaches. In this review, we focus on forms of monogenic diabetes, mitochondrial diabetes, and syndromic diabetes.

Research paper thumbnail of Measuring depressive symptoms using the Patient Health Questionnaire-9 in Hong Kong Chinese subjects with type 2 diabetes

Journal of Affective Disorders, 2013

Background: Depression is common in type 2 diabetes although the prevalence in Chinese patients r... more Background: Depression is common in type 2 diabetes although the prevalence in Chinese patients remains unclear. We validated the Patient Health Questionnaire(PHQ-9), a popular depression screening tool, in Chinese with type 2 diabetes, and documented the prevalence, demographic,and clinical characteristics associated with depression. Methods: A consecutive cohort of 586 Hong Kong Chinese outpatients completed the PHQ-9 during comprehensive diabetes complication assessment. Within 2-4 weeks, 40 patients were retested via telephone survey. Ninety-nine randomly selected patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview as a golden standard. Receiver operating characteristic curve was used to assess performance of the PHQ-9. Results: The internal consistency of the PHQ-9 was 0.86 and test-retest reliability was 0.70. The 3 somatic items explained 53.6% of the PHQ-9 score. The optimal cutoff value was 7 with 82.6% sensitivity and 73.7% specificity, giving a depression prevalence of 18.3% (n ¼107). Of these, 18.7% had been previously diagnosed with depression. Depression was more prevalent in women than men. After controlling for confounders, patients with depression had higher HbA1c (7.807 1.86% versus 7.437 1.29%, [61.77 20.4 versus 57.8 7 14.1 mmol/mol], P o0.05), reduced likelihood of achieving HbA1c target of o7.0% (33.6% versus 41.8%, P o 0.05), and were more likely to have self-reported hypoglycemia in the previous 3 months (18.7% versus 6.7%, Po 0.01). Limitation: A small sample was used in the criterion validation and the cross-sectional design precludes causal inference. Conclusions: PHQ-9 is a validated tool for screening for depression, which is common and frequently undiagnosed in Chinese type 2 diabetic patients and is associated with suboptimal glycemic control, hypoglycemia, and somatization.

Research paper thumbnail of Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol

BMJ Open

IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime... more IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating meal replacement products can induce diabetes remission, but do not lead to improved diastolic function, unlike supervised exercise interventions. We are examining the impact of a combined low energy diet and supervised exercise intervention on T2DM remission, with peak early diastolic strain rate, a sensitive MRI-based measure, as a key secondary outcome.Methods and analysisThis prospective, randomised, two-arm, open-label, blinded-endpoint efficacy trial is being conducted in Montreal, Edmonton and Leicester. We are enrolling 100 persons 18–45 years of age within 6 years’ T2DM diagnosis, not on insulin therapy, and with obesity. During the intensive phase (12 weeks), active intervention participants adopt an 800–900 kcal/day low energy diet combining meal replace...

Research paper thumbnail of Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study

BMC Primary Care

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 recepto... more Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). Objective We assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications. Methods We analyzed data from January 2018–June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests. Results Hemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤...

Research paper thumbnail of Measuring depression with CES-D in Chinese patients with type 2 diabetes: the validity and its comparison to PHQ-9

BMC Psychiatry, 2015

Background: The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) sca... more Background: The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) scale for depression screening in Hong Kong Chinese patients with type 2 diabetes remains unknown. We aimed to validate CES-D, compare its psychometric properties with the 9-item Patient Health Questionnaire (PHQ-9), and explore whether one of the two is more suitable for depression screening in Chinese patients with type 2 diabetes. Methods: Between June 2010 and July 2011, 545 consecutive Chinese patients with type 2 diabetes who underwent structured comprehensive assessments completed the CES-D and PHQ-9. Forty patients were retested within 2-4 weeks by telephone interview and 97 patients were randomly selected to undergo the Mini International Neuropsychiatric Interview (MINI) by psychiatrists for clinical diagnosis of depression. Results: The internal consistency (Cronbach's α) of CES-D was 0.85, with a test-retest correlation coefficient of 0.64. The area under the curve for CES-D compared to the clinical diagnosis of major depression was 0.85. A cutoff score of ≥21 for CES-D provided the optimal balance between sensitivity (78.3 %) and specificity (74.3 %) and identified 17.8 % (n = 97) of patients with depression. CES-D and PHQ-9 showed moderate agreement in depression screening (Cohen's Kappa: 0.45). Compared to non-depressed patients, those who screened positive by PHQ-9 had a higher HbA 1c whereas the glycemic differences were not significant when using CES-D. Conclusion: The CES-D is a valid screening tool for depression in Chinese type 2 diabetic patients although the PHQ-9 was more discriminative in identifying those with suboptimal glycemic control.

Research paper thumbnail of Does a 2.5-year self-management education and support intervention change patterns of healthcare use in African-American adults with Type 2 diabetes?

Diabetic Medicine, 2014

Aims To investigate the impact of a 2.5-year diabetes self-management education and support inter... more Aims To investigate the impact of a 2.5-year diabetes self-management education and support intervention on healthcare use and to examine factors associated with patterns of healthcare use. Methods We recruited 60 African-American adults with Type 2 diabetes who completed a 2.5-year empowerment-based diabetes self-management education and support intervention. Primary healthcare use outcomes included acute care visits, non-acute care visits and days lost to disability. Acute care was a composite score calculated from the frequency of urgent care visits, emergency department visits and hospitalizations. Non-acute care measured the frequency of scheduled outpatient visits. To examine change in patterns of healthcare use, we compared the frequency of healthcare visits over the 6-month period preceding the intervention with that in the last 6 months of the intervention. Results No significant changes in patterns of healthcare use were found for acute care, non-acute care or days lost to disability. Multiple regression models found higher levels of depression (P = 0.001) to be associated with a greater number of non-acute healthcare visits, and found longer duration of diabetes (P = 0.019) and lower levels of diastolic blood pressure (P = 0.025) to be associated with fewer days lost to disability. Conclusions Participation in a long-term diabetes self-management education and support intervention had no impact on healthcare use in our sample of African-American subjects.

Research paper thumbnail of Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial

Clinical diabetes and endocrinology, 2018

In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisc... more In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer sup...

Research paper thumbnail of Association between maternal glucose and large for gestational outcomes: Real‐world evidence to support Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study findings

Research paper thumbnail of T1D Boot Camp 360: Combined Experiential and Classroom Learning Improve Diabetes Care Provider Confidence in Physical Activity Counselling

Canadian Journal of Diabetes, 2017

Research paper thumbnail of Human centered design in co-creation of tool-kit for care of patients with adrenal insufficiency- an iterative quality improvement approach

Research paper thumbnail of Feasibility of identifying and describing the burden of early-onset metabolic syndrome in primary care electronic medical record data: a cross-sectional analysis

BACKGROUND The prevalence of metabolic syndrome is growing worldwide, yet remains underinvestigat... more BACKGROUND The prevalence of metabolic syndrome is growing worldwide, yet remains underinvestigated in Canadian young adults. We sought to explore the use of a harmonized case definition specific to early-onset metabolic syndrome and determine its feasibility in assessing the prevalence of metabolic syndrome among electronic medical record (EMR) data of young adults in Northern Alberta. METHODS We conducted a cross-sectional study using a sample of EMR data from young adult patients aged 18-40 years and residing in Northern Alberta, who had an encounter with a participating primary care clinic between June 29, 2015, and June 29, 2018. Physical examination, laboratory investigation and disease diagnosis data were collected. A case definition and algorithm were developed to assess the feasibility of identifying metabolic syndrome, including measures for body mass index (BMI), blood pressure (BP), dysglycemia, hypertriglyceridemia, high-density lipoprotein cholesterol, diabetes and hyp...

Research paper thumbnail of Starting the Process of Quality Improvement in Edmonton’s Tertiary Diabetes Clinics: Getting Our Data Ducks in a Row

Canadian Journal of Diabetes

Research paper thumbnail of OP1 Peer Leaders Accelerated Training Initiative to Unleash Potential of Mentorship (Platinum) Program: A 4-YEAR Observational Study on the Effects of Providing Peer Support in People with Type 2 Diabetes

Research paper thumbnail of Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort

The Lancet Diabetes & Endocrinology, 2014

The prevalence of diabetes is increasing in young adults in Asia, but little is known about metab... more The prevalence of diabetes is increasing in young adults in Asia, but little is known about metabolic control or the burden of associated complications in this population. We assessed the prevalence of young-onset versus late-onset type 2 diabetes, and associated risk factors and complication burdens, in the Joint Asia Diabetes Evaluation (JADE) cohort. JADE is an ongoing prospective cohort study. We enrolled adults with type 2 diabetes from 245 outpatient clinics in nine Asian countries or regions. We classified patients as having young-onset diabetes if they were diagnosed before the age of 40 years, and as having late-onset diabetes if they were diagnosed at 40 years or older. Data for participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; first JADE assessment was extracted for cross-sectional analysis. We compared clinical characteristics, metabolic risk factors, and the prevalence of complications between participants with young-onset diabetes and late-onset diabetes. Between Nov 1, 2007, and Dec 21, 2012, we enrolled 41,029 patients (15,341 from Hong Kong, 9107 from India, 7712 from Philippines, 5646 from China, 1751 from South Korea, 705 from Vietnam, 385 from Singapore, 275 from Thailand, 107 from Taiwan). 7481 patients (18%) had young-onset diabetes, with age at diagnosis of mean 32·9 years [SD 5·7] versus 53·9 years [9·0] with late-onset diabetes (n=33,548). Those with young-onset diabetes had longer disease duration (median 10 years [IQR 3-18]) than those with late-onset diabetes (5 years [2-11]). Fewer patients with young-onset diabetes achieved HbA1c concentrations lower than 7% compared to those with late-onset diabetes (27% vs 42%;…

Research paper thumbnail of Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data

Journal of the Endocrine Society

Context Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong t... more Context Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients. Objective We aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada. Methods This study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records, and visit reasons. Results The period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3 to 4 times as frequent as the average Albertan, and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medicatio...

Research paper thumbnail of Contextualizing Diabetes and Obesity Care for Immigrant and Refugee Populations

Community-based participatory research

Research paper thumbnail of Sex- and Age-based Achievement of Diabetes Clinical and Treatment Targets in Canadian Primary Care (2015–2020): A Multi-provincial Serial Cross-sectional Study

Canadian Journal of Diabetes

Research paper thumbnail of Adrenal Insufficiency: Investigating Prevalence and Health-Care Utilization Using Administrative Data

Canadian Journal of Diabetes

Research paper thumbnail of New Diabetes Guidelines: Impact on Eligibility for Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-like Peptide-1 Receptor Agonists in Canada

Canadian Journal of Diabetes

Research paper thumbnail of Adrenal Insufficiency: Investigating Prevalence and Healthcare Utilization Using Administrative Data (S1)

Supplementary appendix for a quality improvement study investigating adrenal insufficiency in Alb... more Supplementary appendix for a quality improvement study investigating adrenal insufficiency in Alberta, Canada. This appendix provide details on database descriptions and medication/ATC codes used for this study.

Research paper thumbnail of Not quite type 1 or type 2, what now? Review of monogenic, mitochondrial, and syndromic diabetes

Reviews in endocrine & metabolic disorders, Jan 18, 2018

Diabetes mellitus is a heterogeneous group of conditions defined by resultant chronic hyperglycem... more Diabetes mellitus is a heterogeneous group of conditions defined by resultant chronic hyperglycemia. Given the increasing prevalence of diabetes mellitus and the increasing understanding of genetic etiologies, we present a broad review of rare genetic forms of diabetes that have differing diagnostic and/or treatment implications from type 1 and type 2 diabetes. Advances in understanding the genotype-phenotype associations in these rare forms of diabetes offer clinically available examples of evolving precision medicine where defining the correct genetic etiology can radically alter treatment approaches. In this review, we focus on forms of monogenic diabetes, mitochondrial diabetes, and syndromic diabetes.

Research paper thumbnail of Measuring depressive symptoms using the Patient Health Questionnaire-9 in Hong Kong Chinese subjects with type 2 diabetes

Journal of Affective Disorders, 2013

Background: Depression is common in type 2 diabetes although the prevalence in Chinese patients r... more Background: Depression is common in type 2 diabetes although the prevalence in Chinese patients remains unclear. We validated the Patient Health Questionnaire(PHQ-9), a popular depression screening tool, in Chinese with type 2 diabetes, and documented the prevalence, demographic,and clinical characteristics associated with depression. Methods: A consecutive cohort of 586 Hong Kong Chinese outpatients completed the PHQ-9 during comprehensive diabetes complication assessment. Within 2-4 weeks, 40 patients were retested via telephone survey. Ninety-nine randomly selected patients were interviewed by psychiatrists using the Mini International Neuropsychiatric Interview as a golden standard. Receiver operating characteristic curve was used to assess performance of the PHQ-9. Results: The internal consistency of the PHQ-9 was 0.86 and test-retest reliability was 0.70. The 3 somatic items explained 53.6% of the PHQ-9 score. The optimal cutoff value was 7 with 82.6% sensitivity and 73.7% specificity, giving a depression prevalence of 18.3% (n ¼107). Of these, 18.7% had been previously diagnosed with depression. Depression was more prevalent in women than men. After controlling for confounders, patients with depression had higher HbA1c (7.807 1.86% versus 7.437 1.29%, [61.77 20.4 versus 57.8 7 14.1 mmol/mol], P o0.05), reduced likelihood of achieving HbA1c target of o7.0% (33.6% versus 41.8%, P o 0.05), and were more likely to have self-reported hypoglycemia in the previous 3 months (18.7% versus 6.7%, Po 0.01). Limitation: A small sample was used in the criterion validation and the cross-sectional design precludes causal inference. Conclusions: PHQ-9 is a validated tool for screening for depression, which is common and frequently undiagnosed in Chinese type 2 diabetic patients and is associated with suboptimal glycemic control, hypoglycemia, and somatization.

Research paper thumbnail of Remission of type 2 diabetes and improved diastolic function by combining structured exercise with meal replacement and food reintroduction among young adults: the RESET for REMISSION randomised controlled trial protocol

BMJ Open

IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime... more IntroductionType 2 diabetes mellitus (T2DM) onset before 40 years of age has a magnified lifetime risk of cardiovascular disease. Diastolic dysfunction is its earliest cardiac manifestation. Low energy diets incorporating meal replacement products can induce diabetes remission, but do not lead to improved diastolic function, unlike supervised exercise interventions. We are examining the impact of a combined low energy diet and supervised exercise intervention on T2DM remission, with peak early diastolic strain rate, a sensitive MRI-based measure, as a key secondary outcome.Methods and analysisThis prospective, randomised, two-arm, open-label, blinded-endpoint efficacy trial is being conducted in Montreal, Edmonton and Leicester. We are enrolling 100 persons 18–45 years of age within 6 years’ T2DM diagnosis, not on insulin therapy, and with obesity. During the intensive phase (12 weeks), active intervention participants adopt an 800–900 kcal/day low energy diet combining meal replace...

Research paper thumbnail of Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study

BMC Primary Care

Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 recepto... more Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD). Objective We assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications. Methods We analyzed data from January 2018–June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests. Results Hemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤...

Research paper thumbnail of Measuring depression with CES-D in Chinese patients with type 2 diabetes: the validity and its comparison to PHQ-9

BMC Psychiatry, 2015

Background: The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) sca... more Background: The validity of the 20-item Center for Epidemiological Studies Depression (CES-D) scale for depression screening in Hong Kong Chinese patients with type 2 diabetes remains unknown. We aimed to validate CES-D, compare its psychometric properties with the 9-item Patient Health Questionnaire (PHQ-9), and explore whether one of the two is more suitable for depression screening in Chinese patients with type 2 diabetes. Methods: Between June 2010 and July 2011, 545 consecutive Chinese patients with type 2 diabetes who underwent structured comprehensive assessments completed the CES-D and PHQ-9. Forty patients were retested within 2-4 weeks by telephone interview and 97 patients were randomly selected to undergo the Mini International Neuropsychiatric Interview (MINI) by psychiatrists for clinical diagnosis of depression. Results: The internal consistency (Cronbach's α) of CES-D was 0.85, with a test-retest correlation coefficient of 0.64. The area under the curve for CES-D compared to the clinical diagnosis of major depression was 0.85. A cutoff score of ≥21 for CES-D provided the optimal balance between sensitivity (78.3 %) and specificity (74.3 %) and identified 17.8 % (n = 97) of patients with depression. CES-D and PHQ-9 showed moderate agreement in depression screening (Cohen's Kappa: 0.45). Compared to non-depressed patients, those who screened positive by PHQ-9 had a higher HbA 1c whereas the glycemic differences were not significant when using CES-D. Conclusion: The CES-D is a valid screening tool for depression in Chinese type 2 diabetic patients although the PHQ-9 was more discriminative in identifying those with suboptimal glycemic control.

Research paper thumbnail of Does a 2.5-year self-management education and support intervention change patterns of healthcare use in African-American adults with Type 2 diabetes?

Diabetic Medicine, 2014

Aims To investigate the impact of a 2.5-year diabetes self-management education and support inter... more Aims To investigate the impact of a 2.5-year diabetes self-management education and support intervention on healthcare use and to examine factors associated with patterns of healthcare use. Methods We recruited 60 African-American adults with Type 2 diabetes who completed a 2.5-year empowerment-based diabetes self-management education and support intervention. Primary healthcare use outcomes included acute care visits, non-acute care visits and days lost to disability. Acute care was a composite score calculated from the frequency of urgent care visits, emergency department visits and hospitalizations. Non-acute care measured the frequency of scheduled outpatient visits. To examine change in patterns of healthcare use, we compared the frequency of healthcare visits over the 6-month period preceding the intervention with that in the last 6 months of the intervention. Results No significant changes in patterns of healthcare use were found for acute care, non-acute care or days lost to disability. Multiple regression models found higher levels of depression (P = 0.001) to be associated with a greater number of non-acute healthcare visits, and found longer duration of diabetes (P = 0.019) and lower levels of diastolic blood pressure (P = 0.025) to be associated with fewer days lost to disability. Conclusions Participation in a long-term diabetes self-management education and support intervention had no impact on healthcare use in our sample of African-American subjects.

Research paper thumbnail of Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial

Clinical diabetes and endocrinology, 2018

In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisc... more In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer sup...

Research paper thumbnail of Association between maternal glucose and large for gestational outcomes: Real‐world evidence to support Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study findings

Research paper thumbnail of T1D Boot Camp 360: Combined Experiential and Classroom Learning Improve Diabetes Care Provider Confidence in Physical Activity Counselling

Canadian Journal of Diabetes, 2017

Research paper thumbnail of Human centered design in co-creation of tool-kit for care of patients with adrenal insufficiency- an iterative quality improvement approach

Research paper thumbnail of Feasibility of identifying and describing the burden of early-onset metabolic syndrome in primary care electronic medical record data: a cross-sectional analysis

BACKGROUND The prevalence of metabolic syndrome is growing worldwide, yet remains underinvestigat... more BACKGROUND The prevalence of metabolic syndrome is growing worldwide, yet remains underinvestigated in Canadian young adults. We sought to explore the use of a harmonized case definition specific to early-onset metabolic syndrome and determine its feasibility in assessing the prevalence of metabolic syndrome among electronic medical record (EMR) data of young adults in Northern Alberta. METHODS We conducted a cross-sectional study using a sample of EMR data from young adult patients aged 18-40 years and residing in Northern Alberta, who had an encounter with a participating primary care clinic between June 29, 2015, and June 29, 2018. Physical examination, laboratory investigation and disease diagnosis data were collected. A case definition and algorithm were developed to assess the feasibility of identifying metabolic syndrome, including measures for body mass index (BMI), blood pressure (BP), dysglycemia, hypertriglyceridemia, high-density lipoprotein cholesterol, diabetes and hyp...

Research paper thumbnail of Starting the Process of Quality Improvement in Edmonton’s Tertiary Diabetes Clinics: Getting Our Data Ducks in a Row

Canadian Journal of Diabetes

Research paper thumbnail of OP1 Peer Leaders Accelerated Training Initiative to Unleash Potential of Mentorship (Platinum) Program: A 4-YEAR Observational Study on the Effects of Providing Peer Support in People with Type 2 Diabetes