Background:Studies have suggested that the COVID-19 pandemic negatively impacted patient adherence with chronic medications. We explored whether adherence patterns changed in patients chronically treated with cardiovascular drugs after onset of the COVID-19 pandemic. Methods:In this retrospective cohort study we examined drug dispensation data for all adult Albertans who were chronic users of at least 1 cardiovascular drug class between 2017 and 2023. We calculated each patient's proportion of days covered (PDC) for each drug class in the prepandemic phase (March 15, 2018 to March 14, 2020) and the pandemic phase (March 15, 2020 to March 14, 2022), and used generalized estimating equation logistic regression to estimate the effect of time period on achievement of good adherence (PDC >0.8) after adjusting for age, sex, socioeconomic status, and comorbidities. Results:Of 548,601 chronic users of at least 1 cardiovascular drug class between March 15, 2018 and March 14, 2022, 47.2% were women, the mean age was 62.3 years, and 55.4% had Charlson Comorbidity Index (CCI) scores of 0. The most frequently dispensed cardiovascular drugs were angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (67.6%) and statins (53.8%); the most frequent diagnoses were hypertension (77.2%), diabetes mellitus (30.6%), and ischemic heart disease (19.6%). Chronic users of cardiovascular drugs were more likely to have PDC >0.8 during the pandemic than in the prepandemic period: 75.4% vs 72.8%, with adjusted odds ratios ranging from 1.05 (95% confidence interval 1.00-1.11) for mineralocorticoid receptor antagonists to 1.16 (95% confidence interval 1.15-1.17) for statins. Conclusions:Chronic users of cardiovascular drugs exhibited better adherence during the COVID-19 pandemic than before the pandemic.

Background: Some studies have suggested that the COVID-19 pandemic negatively impacted patient adherence with chronic therapies. We designed this study to explore whether cardiovascular drug adherence patterns changed in chronically treated patients during the COVID-19 pandemic. Methods: Retrospective cohort study examining drug dispensation data for all Alberta residents older than 18 years who were chronic users of at least one cardiovascular drug class, defined as receiving at least one prescription per annum for any agent in that drug class from March 15, 2017 to March 14, 2023 and 2 or more prescriptions within 365 days during either the pre-pandemic phase (March 15, 2018 to March 14, 2020) or the pandemic phase (March 15, 2020 to March 14, 2022). We calculated the proportion of days covered (PDC) for each drug class per patient and used generalized estimating equation logistic regression to estimate the effect of time period (pandemic versus pre-pandemic) on achievement of good adherence (PDC>0.8) after adjusting for age, sex, socioeconomic status, and comorbidities. Results: We evaluated 548,601 chronic users of at least one cardiovascular drug class between March 15, 2018 and March 14, 2022. The most frequently dispensed cardiovascular drug classes were ACEi/ARB (67.6%), statins (53.8%), beta-blockers (21.0%), and calcium channel blockers (20.7%); the most frequent diagnoses were hypertension (77.2%), diabetes mellitus (30.6%), and ischemic heart disease (19.6%), although 55.4% of the patients had Charlson Comorbidity Index scores of 0. The mean PDC for cardiovascular drug use in our cohort was 85.7% (median 93%) pre-pandemic and 87.0% (median 94%) during the pandemic. The proportion exhibiting good adherence (PDC>0.8) increased from 72.8% pre-pandemic to 75.4% during the pandemic (p<0.001). During the pandemic, users of cardiovascular drugs were more likely to exhibit good adherence (PDC>0.8) than they were in the pre-pandemic period: aOR ranged from 1.05 (95%CI 1.00-1.11) for mineralocorticoid receptor antagonists to 1.16 (1.15-1.17) for statins. Conclusion: Chronic users of cardiovascular drugs exhibited higher adherence measures during the COVID-19 pandemic than prior to the pandemic. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial not applicable ### Funding Statement No project specific funding but Dr. Kaul holds the CIHR Sex and Gender Science Chair and a Heart&Stroke Foundation of Canada Chair in Cardiovascular Research. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the Health Research Ethics Board of the University of Alberta (Pro00115481) with a waiver of individual signed consent for this study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data underlying this article was provided by the Government of Alberta under the terms of a research agreement and cannot be shared by the investigators under the Alberta Health Information Act. Inquiries regarding access to the data can be made to health.resdata@gov.ab.ca.

Introduction & Objective: Public health measures, especially vaccination, are important for COVID-19 risk reduction. Population level vaccine uptake in people with diabetes is understudied. We assessed COVID-19 vaccine uptake among adults with and without diabetes and the factors associated with vaccination. Methods: This retrospective, population-based cohort study included adults (18+ years) living in Alberta, Canada on December 14, 2020, the date of vaccine availability. Diabetes status was determined using a validated algorithm between April 1, 2002 and December 14, 2020. All individuals were followed until March 31, 2022. The primary outcome was full vaccination as defined by the manufacturer. Descriptive statistics were used to compare vaccination status among people with and without diabetes and multivariate logistic regression assessed the factors associated with full vaccination adjusting for age group, sex, diabetes status, material deprivation, urban/rural residence, and comorbidities (Charlson Comorbidity Index (CCI) score). Results: We identified 3,779,733 adults (49.7% female, mean age 46.8 ± 17.8 years) with 9.8% having diabetes. Overall, 75.5% of the total cohort were fully vaccinated. A higher proportion of people with diabetes, compared to those without, were fully vaccinated (83.9% vs. 74.6%, p<0.001). The presence of diabetes (aOR 1.48; 95% CI 1.46-1.49), female sex (aOR 1.20; 95% CI 1.91-1.21), and CCI score >1 (aOR 1.67; 1.66-1.68) were associated with being fully vaccinated, whereas the age group of ≥ 75 years (aOR 0.84; 95% CI 0.83-0.86), rural residence (aOR 0.60; 95% CI 0.60-0.60) and higher material deprivation (aOR 0.88; 95% CI 0.87-0.89) were associated with lower vaccination. Conclusions: People with diabetes had high COVID-19 vaccination uptake and were more likely than the general population to be fully vaccinated. We also identified several key factors associated with lower uptake highlighting the need for understanding facilitators of vaccination. Disclosure S. Butalia: None. B.R. Shah: None. R.J. Sigal: Research Support; Lexicon Pharmaceuticals, Inc., Bayer Inc., Novo Nordisk. J.L. Benham: None. B. Wicklow: None. C.H. Yu: None. K. Dasgupta: None. S. Amed: None. C. Constantinescu: Research Support; Pfizer Inc. Other Relationship; Sta HealthCare Communications, Canadian Research Network. M. Chu: None. P. Kaul: None. Funding Canadian Institutes of Health Research (CIHR) 483868

Background We examined the association between hemoglobin A1c (HbA1c) and the development of cardiovascular disease (CVD) in men and women, without diabetes or CVD at baseline. Methods and Results This retrospective cohort study included adults aged 40 to <80 years in Alberta, Canada. Men and women were divided into categories based on a random HbA1c during a 3‐year enrollment period. The primary outcome of CVD hospitalization and secondary outcome of combined CVD hospitalization/mortality were examined during a 5‐year follow‐up period until March 31, 2021. A total of 608 474 individuals (55.2% women) were included. Compared with HbA1c 5.0% to 5.4%, men with HbA1c of 5.5% to 5.9% had an increased risk of CVD hospitalization (adjusted hazard ratio [aHR], 1.12 [95% CI, 1.07–1.19]) whereas women did not (aHR, 1.01 [95% CI, 0.95–1.08]). Men and women with HbA1c of 6.0% to 6.4% had a 38% and 17% higher risk and men and women with HbA1c ≥6.5% had a 79% and 51% higher risk of CVD hospitalization, respectively. In addition, HbA1c of 6.0% to 6.4% and HbA1c ≥6.5% were associated with a higher risk (14% and 41%, respectively) of CVD hospitalization/death in men, but HbA1c ≥6.5% was associated with a 24% higher risk only among women. Conclusions In both men and women, HbA1c ≥6.0% was associated with an increased risk of CVD and mortality outcomes. The association between CVD and HbA1c levels of 5.5% to 5.9%, considered to be in the “normal” range, highlights the importance of optimizing cardiovascular risk profiles at all levels of glycemia, especially in men.

OBJECTIVES:Since 2016, clinical guidelines have recommended sodium-glucose cotransporter-2 inhibitors (SGLT2is) for people with type 2 diabetes with heart failure. We examined SGLT2i dispensation, factors associated with dispensation, and heart failure hospitalization and all-cause mortality in people with diabetes and heart failure. METHODS:This retrospective, population-based cohort study identified people with diabetes and heart failure between January 1, 2014, and December 31, 2017, in Alberta, Canada, and followed them for a minimum of 3 years for SGLT2i dispensation and outcomes. Multivariate logistic regression assessed the factors associated with SGTL2i dispensation. Propensity scores were used with regression adjustment to estimate the effect of SGLT2i treatment on heart failure hospitalization. RESULTS:Among 22,025 individuals with diabetes and heart failure (43.4% women, mean age 74.7±11.8 years), only 10.2% were dispensed an SGLT2i. Male sex, age <65 years, a higher baseline glycated hemoglobin, no chronic kidney disease, presence of atherosclerotic cardiovascular disease, and urban residence were associated with SGLT2i dispensation. Lower heart failure hospitalization rates were observed in those with SGLT2i dispensation (548.1 per 100 person-years) vs those without (813.5 per 1,000 person-years; p<0.001) and lower all-cause mortality in those with an SGLT2i than in those without (48.5 per 1,000 person-years vs 206.1 per 1,000 person-years; p<0.001). Regression adjustment found SGLT2i therapy was associated with a 23% reduction in hospitalization. CONCLUSIONS:SGLT2is were dispensed to only 10% of people with diabetes and established heart failure, underscoring a significant care gap. SGLT2i use was associated with a real-world reduction in heart failure hospitalization and all-cause death. This study highlights an important opportunity to optimize SGLT2i use.

Objective: This multi-country study explored trends in causes of death in people with diabetes. Methods: We used cause-specific mortality data in people with diabetes from 9 high-income countries (2000-2020). Data were from registries, health insurance, or other administrative sources. Proportional contributions of causes of death to total deaths across 10 groups (cancer, cardiovascular [CVD], dementia, diabetes, influenza and pneumonia, infection, liver, renal, respiratory disease, and all others) were age-standardized and regressed against time. Results: We included 1,624,100 deaths from 9 jurisdictions. In all jurisdictions, there was a shift in the most common causes of death away from CVD and diabetes. The decline in the proportion of deaths due to CVD ranged from 0.34% to 2.32% per year (all Ptrend < 0.001). Deaths due to diabetes declined in 8/9 jurisdictions with magnitudes from 0.09% to 0.87% per year but rose in Lithuania (0.64% per year). Dementia deaths rose in 8/9 jurisdictions (0.07% to 0.52% per year) as did the proportion of deaths due to ‘other’ causes. Cancer deaths rose in 5/9 jurisdictions. Trends in the remaining cause-of-death categories showed varied patterns. Conclusion: There has been a shift in causes of death among those with diabetes away from CVD and diabetes. The increasing proportion of deaths due to dementia and cancer may require consideration when planning resource allocation. Disclosure D.J. Magliano: None. J.I. Morton: None. L. Chen: None. J.W. Sacre: None. B. Carstensen: Stock/Shareholder; Novo Nordisk. E.W. Gregg: None. M.E. Pavkov: None. M. Arffman: Research Support; Roche Pharmaceuticals. M. Chu: None. K. Eeg-Olofsson: Other Relationship; Abbott, Eli Lilly and Company, Novo Nordisk, Sanofi. K. Fleetwood: None. S. Fosse-Edorh: None. M. Guion: None. R. Gurevicius: None. K. Ha: None. P. Kaul: None. D. Kim: None. T. Laurberg: None. S. Wild: Other Relationship; Novo Nordisk, Novo Nordisk Foundation. J.E. Shaw: Advisory Panel; GlaxoSmithKline plc. Research Support; AstraZeneca. Advisory Panel; AstraZeneca. Speaker's Bureau; AstraZeneca, Roche Diabetes Care, Boehringer-Ingelheim, Zuellig Pharma Holdings Pte. Ltd. Advisory Panel; Novo Nordisk. Speaker's Bureau; Roche Diagnostics. Advisory Panel; Roche Diagnostics, Eli Lilly and Company. Speaker's Bureau; Eli Lilly and Company. Advisory Panel; Abbott, Mylan. Speaker's Bureau; Sanofi. Funding Centers for Disease Control and Prevention, United States

Background The changes in outpatient care delivery during the COVID-19 pandemic represented a natural experiment which allows us to compare outcomes and evaluate the impact of physician-patient continuity after different types of outpatient encounters. Methods Retrospective cohort study using data from 5 linked healthcare databases in Alberta to capture all healthcare encounters (virtual or in-person) for 3.84 million community-dwelling adults between March 1, 2019 and February 28, 2023. Results The proportion of adults having at least one outpatient encounter with a physician per annum was relatively stable between 2019 and 2023 (94.1–93.4%), although approximately half of the encounters were virtual during the pandemic. Patients having outpatient encounters (virtual or in-person) with unfamiliar physicians were younger and healthier (had fewer comorbidities, were less likely to be taking medications, and had less frequent healthcare contacts in the prior year), but outpatient encounters with an unfamiliar physician were associated with more ED visits, hospitalizations, or other outpatient encounters in the subsequent 7 days compared to outpatient encounters with a familiar physician. The increased incidences were similar early and late in the pandemic and whether outpatient encounters were virtual (40%, 77%, and 21% increased hazards in the first 18 months of the pandemic and 28%, 71%, and 20% in the last 18 months) or in-person (40%, 143%, and 26% in the first 18 months of the pandemic and 34%, 131%, and 24% in the last 18 months). Conclusions Outpatient encounters with unfamiliar physicians were associated with higher subsequent healthcare resource use than encounters with familiar physicians both early and late in the pandemic and whether they were virtual or in-person. Continuity of care in the outpatient setting is important even during a pandemic, both during the emergent and the stable phases of the pandemic, and whether encounters are virtual or in-person.

Introduction: Sodium/glucose cotransporter 2 inhibitors (SGLT2i) have an established benefit in people with diabetes mellitus (DM) and chronic heart failure (HF). We aimed to evaluate the uptake and impact of these agents in two cohorts: a community-based cohort of all adults with DM and HF in Alberta who had an echocardiogram and a cohort of people with DM and HF being cared for in a specialized heart failure clinic (HFC). Methods: We identified the community-based cohort using validated ICD code-based case definitions for DM and HF (physician claims, outpatient, hospitalization databases) with an echocardiogram study (available from two major centres) from 2015 (when SGLT2i were available provincially) to March 2022. In addition, we identified the HFC cohort by chart review of patients seen in the Mazankowski Alberta Heart Institute HFCconsented between February 2018 and August 2021 with HF and DM and followed them until August 2022. We examined the association between SGLT2i use and all-cause mortality and/or cardiovascular (CV)-related hospitalizations using Cox proportional hazard models adjusted for clinical covariates and time-varying SGLT2i use. Results: In 12,150 people with DM and HF in the community-based cohort, 2,321 (19.1%) were dispensed an SGLT2i compared to 208 (39.2%) of the 530 patients with DM and HF followed in the HFC. SGLT2i was associated with less CV-related hospitalization and all-cause mortality (the composite outcome) (aHR 0.65 [95%CI 0.58 - 0.73]) in the community but no difference (aHR 0.88 [95% CI 0.64 - 1.21] in the HFC. SGLT2i use was associated with less all-cause mortality (aHR 0.50 [95% CI 0.44 - 0.57]) in the community but no difference (aHR 0.81 [95% CI 0.54 - 1.20]) in the HFC. Conclusion: Despite robust randomized trial evidence of clinical benefit, the uptake of SGLT2i even in people with DM and HF remains low. Although uptake is higher in a specialized HFC overall the rate is below optimal. Multifaceted Strategies (targeted to healthcare professionals, patients, and policymakers) to guide risk identification and raise awareness on the clinical benefits of these agents are warranted.

OBJECTIVES:Although COVID-19 vaccines can reduce the need for intensive care unit admission in COVID-19, their effect on outcomes in critical illness remains unclear. We evaluated outcomes in vaccinated patients admitted to the ICU with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and the association between vaccination and booster status on clinical outcomes. DESIGN:Retrospective cohort. SETTING AND PATIENTS:All patients were admitted to an ICU between January 2021 (after vaccination was available) and July 2022 with a diagnosis of COVID-19 based on a SARS-CoV-2 polymerase chain reaction test in Alberta, Canada. INTERVENTIONS:None. MEASUREMENT:The propensity-matched primary outcome of all-cause in-hospital mortality was compared between vaccinated and unvaccinated patients, and vaccinated patients were stratified by booster dosing. Secondary outcomes were mechanical ventilation (MV) duration ICU length of stay (LOS). MAIN RESULTS:The study included 3,293 patients: 743 (22.6%) were fully vaccinated (54.6% with booster), 166 (5.0%) were partially vaccinated, and 2,384 (72.4%) were unvaccinated. Unvaccinated patients were more likely to require invasive MV (78.4% vs 68.2%), vasopressor use (71.1% vs 66.6%), and extracorporeal membrane oxygenation (2.1% vs 0.5%). In a propensity-matched analysis, in-hospital mortality was similar (31.8% vs 34.0%, adjusted odds ratio [OR], 1.25; 95% CI, 0.97-1.61), but median duration MV (7.6 vs 4.7 d; p < 0.001) and ICU LOS (6.6 vs 5.2 d; p < 0.001) were longer in unvaccinated compared to fully vaccinated patients. Among vaccinated patients, greater than or equal to 1 booster had lower in-hospital mortality (25.5% vs 40.9%; adjusted OR, 0.50; 95% CI, 0.0.36-0.68) and duration of MV (3.8 vs 5.6 d; p = 0.025). CONCLUSIONS:Nearly one in four patients admitted to the ICU with COVID-19 after widespread COVID-19 vaccine availability represented a vaccine-breakthrough case. Mortality risk remains substantial in vaccinated patients and similar between vaccinated and unvaccinated patients after the onset of critical illness. However, COVID-19 vaccination is associated with reduced ICU resource utilization and booster dosing may increase survivability from COVID-19-related critical illness.

Objective The objective of this study was to determine the extent of machine learning (ML) application in asthma research and to identify research gaps while mapping the existing literature.Data Sources We conducted a scoping review. PubMed, ProQuest, and Embase Scopus databases were searched with an end date of September 18, 2020.Study Selection DistillerSR was used for data management. Inclusion criteria were an asthma focus, human participants, ML techniques, and written in English. Exclusion criteria were abstract only, simulation-based, not human based, or were reviews or commentaries. Descriptive statistics were presented.Results A total of 6,317 potential articles were found. After removing duplicates, and reviewing the titles and abstracts, 102 articles were included for the full text analysis. Asthma episode prediction (24.5%), asthma phenotype classification (16.7%), and genetic profiling of asthma (12.7%) were the top three study topics. Cohort (52.9%), cross-sectional (20.6%), and case-control studies (11.8%) were the study designs most frequently used. Regarding the ML techniques, 34.3% of the studies used more than one technique. Neural networks, clustering, and random forests were the most common ML techniques used where they were used in 20.6%, 18.6%, and 17.6% of studies, respectively. Very few studies considered location of residence (i.e. urban or rural status).Conclusions The use of ML in asthma studies has been increasing with most of this focused on the three major topics (>50%). Future research using ML could focus on gaps such as a broader range of study topics and focus on its use in additional populations (e.g. location of residence).Supplemental data for this article is available online at http://dx.doi.org/ .

OBJECTIVES:Insulin resistance (IR) leads to type 2 diabetes mellitus. Multiple IR causes have been identified, including inflammation. This study determines the association between IR and the inflammatory marker C-reactive protein (CRP) in a healthy Canadian population and examines potential differences by sex and age. METHODS:Participants were adults with no self-reported history of diabetes, a glycated hemoglobin (A1C) of <6.5%, and a fasting blood glucose of <7 mmol/L, and who had participated in the Canadian Health Measures Survey, cycles 1 to 4 (2007-2015). IR was calculated using the Homeostasis Model of Insulin Resistance (HOMA-IR) assessment. The crude geometric mean HOMA-IR was calculated using a one-way analysis of variance. The association between CRP levels and HOMA-IR was examined using multivariate linear regression. RESULTS:A total of 4,024 eligible nondiabetic adults (1,994 [49.5%] men and 2,030 [50.4%] women) were identified. Eighty percent of the subjects were Caucasian. Among all subjects, 36% had a CRP of ≥2 mg/L. The crude geometric mean HOMA-IR was 1.33 in men and 1.24 in women. Participants with a CRP of <0.7 mg/L had a crude geometric mean HOMA-IR of 1.15 (1.13 to 1.16), compared with 1.41 (1.39 to 1.43) for those with a CRP of ≥2 mg/L. After adjusting for sex, age, race, high-density lipoprotein cholesterol, triglycerides, body mass index, smoking, and diastolic blood pressure, the HOMA-IR-CRP association remained significant. A positive trend for CRP values in men with increasing values of HOMA-IR was observed. However, this trend was not consistent with the increase in women's CRP levels. CONCLUSIONS:Elevated CPR levels are independently associated with IR in men. Prospective cohort studies can confirm the causal relationship between high CRP levels and IR and identify the underlying mechanisms.

Background: One of the most striking benefits of sodium-glucose cotransporter 2 inhibitors (SGTL2is) in clinical trials has been the reduction in heart failure (HF) hospitalization. Thus, guidelines recommend SGLT2i use in people with diabetes and HF. Objective: We assessed the real-world dispensation of SGTL2is and the factors associated with their dispensation in people with diabetes and HF. Methods: This retrospective, population-based cohort study identified people with diabetes and HF between Jan 1, 2014 to Dec 31, 2017 in Alberta, Canada (population ~ 4.3 million). Individuals were followed until Dec 31, 2020. The index date was the date of physician or hospitalization claim for HF. The primary exposure was SGTL2i dispensation after HF index date. Demographic and clinical characteristics were summarized, and multivariate logistic regression assessed the factors associated with SGTL2i dispensation adjusting for age, sex, baseline HbA1c, diabetes duration, chronic kidney disease (CKD), atherosclerotic cardiovascular disease (ASCVD), comorbidities (Charlson Comorbidity Index (CCI) score), material deprivation, and urban/rural residence. Results: We identified 22,025 people (43.4% female, mean age 74.7 years ± 11.8 years) with diabetes and HF. Only 10.2% (n=2,247) of individuals with diabetes and HF were dispensed an SGTL2i. Male sex (aOR 1.55; 95% CI 1.39-1.72), age < 65 years (aOR 2.28; 95% CI 2.05-2.54), higher HbA1c (aOR 1.35; 95% 1.31-1.40), no CKD (aOR 3.11; 95% CI 2.78-3.49), ASCVD (aOR 1.48; 95% CI 1.33-1.64), and urban residence (aOR 1.17; 95% CI 1.05-1.31) were associated with SGTL2i dispensation while more co-morbidities were associated with less dispensation (CCI score ≥ 5 aOR 0.36; 95% CI 0.30-0.43). Conclusions: Only 1 in 10 people with diabetes and HF were dispensed an SGTL2i. We identified several factors associated with SGTL2i dispensation and importantly this study highlights a significant opportunity to improve management in people with diabetes and HF. Disclosure S.Butalia: None. C.Wen: None. P.A.Senior: Advisory Panel; Novo Nordisk Canada Inc., Consultant; Novo Nordisk Canada Inc., Bayer Inc., Viatris Inc., Vertex Pharmaceuticals Incorporated, ViaCyte, Inc., Insulet Corporation. R.J.Sigal: Research Support; Novo Nordisk. H.Quan: None. M.Chu: None. P.Kaul: None. Funding Diabetes Canada (OG-3-22-5662-SB)

Background:National guidelines recommend that all adults over the age of 40 years undergo screening for diabetes at least once every 3-years. We examined the adherence to these guidelines among males and females after accounting for age, urban/rural residence, and material deprivation. We also examined the incidence of prediabetes and diabetes in adherent and non-adherent individuals. Methods:Our study is based on a retrospective population-level inception cohort of adults aged 40-79 years without pre-existing diabetes or cardiovascular disease on April 1, 2013. Adherence during a 3-year screening period (2013-2016) and prediabetes and diabetes during a 4-year follow-up period were examined. Multivariate logistic regression was used to examine the adjusted association between sex and adherence. Findings:Among 1,380,697 individuals (49·2% male, 50·8% female) adherence rates were 69·9% in males and 79·8% in females. Sex-differences in adherence were largest in younger individuals (58·0% and 72·6% and in males and females aged 40-44 years, respectively) and consistent across rural/urban residence and material deprivation. Females were more adherent (adjusted odds ratio 1·92; 95% confidence interval 1·89 to 1·95) than males. Prediabetes and diabetes rates among individuals who adhered to screening guidelines were 15·7% and 2·6% among males and 13·4% and 1·5% among females. During the follow-up period, an additional 3·2% and 1·9% of adherent males and females had diabetes. Incidence rates of prediabetes and diabetes during the follow-up period among individuals who did not adhere to screening guidelines were 8·8% and 2·1% among males and 7·3% and 1·3% among females. Interpretation:Adherence to diabetes screening guidelines is sub-optimal, especially among young males. Despite lower rates of adherence to screening, males have higher rates of prediabetes and diabetes compared to females. There is a need for education campaigns to improve diabetes screening rates in young adults, especially males. Funding:This study was funded by the Canadian Institutes of Health Research Sex and Gender Science Chair (Recipient: Kaul).

This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program reported new cases of CRPS aged 2 to 18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed, and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment because of pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines.

Pandemic outbreaks such as COVID-19 occur unexpectedly, and need immediate action due to their potential devastating consequences on global health. Point-of-care routine assessments such as electrocardiogram (ECG), can be used to develop prediction models for identifying individuals at risk. However, there is often too little clinically-annotated medical data, especially in early phases of a pandemic, to develop accurate prediction models. In such situations, historical pre-pandemic health records can be utilized to estimate a preliminary model, which can then be fine-tuned based on limited available pandemic data. This study shows this approach -- pre-train deep learning models with pre-pandemic data -- can work effectively, by demonstrating substantial performance improvement over three different COVID-19 related diagnostic and prognostic prediction tasks. Similar transfer learning strategies can be useful for developing timely artificial intelligence solutions in future pandemic outbreaks.

Background The relationship between liver enzymes and Metabolic Syndrome (MetS) in different populations, including Canadians, is not consistent and well understood. We used the Canadian Health Measures Survey data (Cycles 3 and 4) to examine the cross-sectional relationships between select liver biomarkers and MetS in the adult Canadian population. The biomarkers selected were gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), and alkaline phosphatase (ALKP). Methods Fasting blood samples (FBS) were collected from adults above the age of 20 years for Cycle 3 and Cycle 4 ( n = 3003). MetS was diagnosed if the subjects had three or more risk determinants according to the Joint Interim Statement criteria. Primary risk factors included quartile cut-offs for each of the biomarkers ALKP, AST, GGT for males and females separately. A multivariable logistic regression technique based on a maximum likelihood approach was used to evaluate the association between quartiles of ALKP, AST, and GGT, other individual and contextual factors, and the prevalence of MetS. Results MetS was prevalent in 32.3% of subjects. BMI was an effect modifier in the relationship between GGT and MetS prevalence, while sex was an effect modifier in the relationship between ALKP and MetS prevalence; and age was an effect modifier in the relationship between AST and MetS prevalence. Conclusions Since the mechanisms to underpin the associations between the liver enzymes activity and MetS are unknown, further epidemiologic investigations using longitudinal designs are necessary to understand these associations.