..Current Projects
DIABETES PROJECTS
- Sandy Lake Health and Diabetes Project, Phase 2: Diabetes Incidence and Complications Prevalence
- Diabetes, Homocysteine, CRP, and the Lipid Oxiation Hypothesis of Vascular Disease in the Sandy Lake Oji-Cree
- Induction of Pancreatic Beta Cell Insensitivity to Glucose by FF
- Sentinel Surveillance
- A Strategy to Improve the Care and Outcome of Diabetes in Pregnancy in On-Reserve First Nations Women
- CIRCLE: The Canadian First Nations Diabetes Clinical Management Epidemiologic Study
- The Sandy Lake Health Diabetes Program
- WebDR/Diabetes Access Database (DAD)
- Primary Care Diabetes Boot-Camp - A Diabetes Resource for Ontario's Family Health Teams
1 - Title: Sandy Lake Health and Diabetes Project, Phase 2: Diabetes Incidence and Complications Prevalence
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Abstract: Over the past several decades an epidemic of type 2 diabetes has emerged among First Nations communities in Canada. Although important discoveries have been made regarding the burden of this disease and risk factors for its development, there remain 2 major gaps in our understanding of diabetes in Canada's First Nations: (1) Little is known about the number of new cases of diabetes that develop each year (the diabetes "incidence rate"), and (2) there is only limited information available about the frequency (or "prevalence rate") of the complications of diabetes among Native Canadians. This information is important in estimating the upcoming burden of diabetes in First Nations communities, in targeting future health resources to care for diabetic patients, and in understanding which factors increase the risk of developing diabetes and its complications. The objectives of our project are to measure the incidence of diabetes and the prevalence of associated complications in partnership with Sandy Lake First Nations, Ontario, a community with which we have worked for the past decade in addressing the challenges of diabetes (sandylakediabetes.com).
For further information please contact Dr. Stewart Harris
2 - Title: Diabetes, Homocysteine, CRP, and the Lipid Oxiation Hypothesis of Vascular Disease in the Sandy Lake Oji-Cree
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Abstract: Objectives: to understand the association of diabetes and determinants of vascular disease in the Sandy Lake Oji-Cree. Rationale: aboriginal population of Canada has traditionally been at low risk for heart disease. However, the Sandy Lake Oji-Cree now have a prevalence of 26% for diabetes and 11% for impaired glucose tolerance. We hypothesize that plasma homocysteine (tHcys), C-reactive protein (CRP) and other chronic inflammatory proteins, and indices of oxidative stress (isoprostanes, glycated phosphatidylethanolamine (PtdEtn)) and cardiovascular metabolic syndrome (CDS)(small LDL) are elevated in this population. These factors have been chosen because they are candidates for a causal interaction with diabetes and strong risk factors for vascular disease. Proposed Research: determination of plasma concentrations of tHcys, folate, B6 and B12 in 729 samples from the Sandy Lake Oji-Cree survey. Statistical analysis of the concentration of tHcys for the Oji-Cree divided into age </>/equal to 18. Analysis of statistical association of tHcys with folate, B12, B6, creatinine and uric acid concentrations for men/women separately with adjustment for covariate age. Analysis for statistical interaction between diabetes status and plasma tHcys levels. Analysis of statistical interaction between plasma folate and MTHFR genotype as determinants of plasma tHcys. Determination of plasma concentrations of chronic inflammatory proteins CRP, SAA and IL-6 in 729 samples. Statistical analysis of concentration of CRP, SAA and IL-6 for the Oji-Cree divided into age </>equal to 18. Analysis of the statistical association of CRP/SAA/IL-6 with indices of obesity, BMI, percent body fat, and waist-to-hip ratio for men and women separately with adjustment for the covariate age. Analysis of differences in CRP/SAA/IL-6 among subjects classified as normal, impaired glucose tolerance or diabetic. Analysis for statistical association of plasma isoprostanes, glycated PtdEtn, LDL particle size, Lp(a), vitamin E and carotinoids and diabetes status for men/women separately with adjustment for the covariate age.
For further information please contact Dr. Stewart Harris
3 - Title: Induction of Pancreatic Beta Cell Insensitivity to Glucose by FF
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Abstract: Type 2 (adult onset) diabetes results in part from the inability of the pancreas to produce sufficient insulin to control the blood sugar and other aspects of the body's metabolism. Exactly what causes the pancreas to fail in type 2 diabetes is not known, and is the subject of investigation in our studies. An elevation of fats in the blood, called free fatty acids, is frequently seen in individuals who are obese, pre-diabetic. We are testing whether this elevation of plasma free fatty acids is responsible for the impairment of pancreatic function in individuals who are predisposed to developing type 2 diabetes. We propose to administer a solution of fat intravenously for 2 to 5 days to such individuals and then to examine how their pancreas responds to stimulation. We will study healthy lean non-diabetic individuals, obese individuals whose body is resistant to the effects of insulin, in Native Canadians from the Sandy Lake community in Northern Ontario, who have been identified as carrying a defective gene which predisposes them to developing type 2 diabetes. These studies will help us to understand what causes the pancreatic dysfunction which is typical of type 2 diabetes, in order to then design treatments which will counteract this abnormality.
For further information please contact Dr. Stewart Harris
4 - Title: Sentinel Surveillance |
Abstract: First Nations continue to have the highest rates of diabetes in Canada. The care of First Nation individuals with diabetes, unfortunately, is often fractionated resulting in inconsistent application of CDA clinical practice guidelines which contributes to the alarmingly high rate of diabetes-related complications. An information gap exists with little current, systematic, validated Canadian data available on the prevalence, incidence, morbidity and mortality rates due to type 2 diabetes in First Nations.
The First Nations Web-Based Diabetes Sentinel Surveillance System, currently under development, will include community diabetes registries identifying all adult cases of type 2 diabetes accessible through a secure community portal. This portal will enable communities to view their historic clinical indicators and prevalence, enter data, and review and track progress and plan quality improvement initiatives at the touch of a button. Integrated into a national surveillance system, anonymized data from the participating communities will be aggregated to track indicators nationally to inform and evaluate new programs. Similar programs in Aboriginal settings in the United States (IHS program) and Australia (ABCD program) have been associated with sustained improvements in quality of care.
Funded by Health Canada, the Surveillance System is a collaboration of First Nations communities and investigators from the existing CIRCLE network. The investigative team leading this proposal will include: Dr. Stewart Harris as the Principal Investigator and Drs. Bhattacharyya and Hanley from the University of Toronto and Dr. Thind from The University of Western Ontario. Honouring the Ownership, Control, Access and Possession principles and the CIHR Guidelines for Health Research Involving Aboriginal Peoples, communities are involved in all aspects of the process, control and own their data, and will have access to their data at all times.
5 - Title: A Strategy to Improve the Care and Outcome of Diabetes in Pregnancy in On-Reserve First Nations Women |
Abstract: Gestational diabetes mellitus (GDM) rates in First Nations women are amongst the highest reported in the world. GDM puts not only young women at risk for future diabetes, but also increases the risk of diabetes for their offspring. Little information is available for the care and treatment of GDM in this population, including the use of new technologies such as continuous glucose monitoring (CGM). Many First Nations communities are remote, located in isolated centres without road access, thereby limiting access to high quality care. Even in communities situated close to urban centres, dissimilarities in the biologic presentation of disease and in cultural perceptions of health, well-being and illness may be evident. These important differentiations may lead to alternate care-seeking behavior. This study proposes to address these concerns through a three phase research process.
The first phase will perform an epidemiologic assessment including health administrative data from the Institute for Clinical Evaluative Sciences that would document the delivery experiences of First Nations women. This information will provide a comprehensive understanding of the current prevalence and incidence, as well as the clinical management of type 2 diabetes and GDM among pregnant First Nations women in Ontario. As well, a protocol will be developed to pilot the CGM technology with First Nations communities. In the second phase an operational steering committee will be established to further develop the research protocol and initiate the engagement and recruitment of First Nation communities. In the third, and final phase, the evaluation pilot of CGM technology with four First Nations communities in Southern Ontario will be implemented. Funding has been secured from the Juvenile Diabetes Research Fund (JDRF) to carry out this study.
6 - Title: CIRCLE: The Canadian First Nations Diabetes Clinical Management Epidemiologic Study |
Abstract: CIRCLE was a 3-year national research study aimed at documenting the current state of clinical management of type 2 diabetes and rates of diabetes-related complications and comorbidities in First Nation communities. The CIRCLE study demonstrated that major care gaps exist in the management and treatment of diabetes patients in First Nations communities. Study results have been presented to First Nations communities and their leaders, Health Canada Policy Makers. Manuscripts have been accepted for publication in 2011; four additional manuscripts are currently in process.
7 - Title: The Sandy Lake Health Diabetes Program |
Abstract: In 1991, Dr. Stewart Harris led a team of researchers establishing a partnership with the First Nations community of Sandy Lake in Northwestern Ontario. The collaboration has included researchers from the Robarts Research Institute, University of Toronto, and John Hopkins University. This year represents the 20th anniversary of this unique and important collaboration that has resulted in 31 grants and 78 peer-reviewed papers.
8 - Title: WebDR/Diabetes Access Database (DAD) |
Abstract: Created in 2000 at St Joseph’s Health Care Centre, the Diabetes Access Database, DAD, is a stand alone, combination tertiary-primary care electronic health record (EMR) and researchable database with more than 10,000 patient records. It is utilized by several diabetes clinics at St Joseph's Health Care and the Primary Care Diabetes Support Program at St Joseph’s Family Medical Center. Currently a web-based diabetes electronic decision support system (WebDR) including a patient portal is under development. WebDR will integrate patient records from DAD and Humabase, a type 1 paediatric diabetes database, and have the ability to interface with the hospital’s medical records system. WebDR, expanded throughout the St. Joseph’s Health Care, London will be launched in 2011. This unique, innovative researchable patient registry/EMR will not only enhance patient care, but will provide an excellent resource for clinical trial recruitment and to monitor trends in diabetes care and related complications.
9 - Title: Primary Care Diabetes Boot-Camp – A Diabetes Resource For Ontario’s Family Health Teams |
Abstract: Family physicians in family health teams are being offered the support of a multidisciplinary team (nurse practitioners, nurses, social workers, psychologists, pharmacists) as well as information technology and health management systems to better equip them to address the growing challenge of diabetes prevention and management. The Primary Care Diabetes Boot Camp, a two-day workshop, was developed to meet a growing demand for information on integrated diabetes care, including program development, team construction and tools to support optimal diabetes care. The goals of the program are to: build capacity by maximizing the potential of nurses and nurse practitioners; create an effective, accessible mechanism for dissemination of evidence based practice in diabetes prevention and management tailored to the primary care setting. The workshop program is facilitated by a multidisciplinary team of diabetes experts mirroring the family health team; the curriculum includes clinical practice guidelines, physical exam, patient education strategies, glucose monitoring and assessment and starting insulin. To date, 17 Boot Camps / ½-day Boot Camp Refresher courses have been held with over 650 participants, and the evaluations have been overwhelmingly and consistently positive.
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