ObjectiveAdrenal insufficiency is a life-threatening chronic disease with limited patient educational resources. We used human-centered design (HCD) to co-design an adrenal insufficiency patient education toolkit.BackgroundHCD encompasses methodologies centered around the user to co-create tailored solutions to address the problem. In healthcare, HCD has been used to develop shared decision-making tools and interventions. The aim of this study was to develop an educational toolkit for individuals living with adrenal insufficiency. To achieve this, academics and clinicians collaborated with patients and human-centered designers to co-create practical and intuitive patient educational resources and treatment plans.MethodsThe toolkit was developed through a HCD process-discovery, ideation, prototyping, design iterations, usability testing, and implementation. At each step, the human-centered designer worked alongside endocrinologists and patient partners in collaborative co-design sessions.ResultsThe toolkit consisted of two handouts: a patient education resource including causes and symptoms of adrenal insufficiency/crisis, prevention and treatment, circumstances to seek healthcare, web resources, and a personalized treatment plan for stress dosing of adrenal hormone replacement with common scenarios and suggested dosing. Usability testing of the toolkit with 11 patients demonstrated that the toolkit was intuitive and practical, and all participants reported that they would use the toolkit to guide self-management decisions.ConclusionOur toolkit development process illustrates the value of HCD in healthcare. By collaborating with human-centered designers and patient partners, we created an educational resource that was intuitive and practical for those affected by adrenal insufficiency.

OBJECTIVES:Our aim in this study was to assess the effect of a 6-week continuous glucose monitor (CGM) intervention with telemonitoring-enabled virtual diabetes educator visits on patient-reported outcomes (PROs) in adults with type 2 diabetes (T2D) not using insulin. METHODS:Individuals with glycated hemoglobin (A1C) >7.0% (n=105) were computer randomized in an open-label parallel-group design (clinicaltrials.gov NCT05319496) to receive either 6 weeks of upfront CGM (weeks 0 to 6) (n=45) or enhanced usual care (n=41), both with virtual diabetes educator visits. The following outcomes were measured at baseline (week 0), 6 weeks, and 12 weeks using the Problem Areas in Diabetes (PAID), the Diabetes Empowerment Scale---Short Form, the EuroQol-5D Visual Analogue Scale, the International Physical Activity Questionnaire, and the UK Diabetes and Diet Questionnaire. Between-group differences in change scores for each outcome at 6 and 12 weeks were assessed using t tests. RESULTS:Of the 105 participants (mean age 57 years, 51% male, A1C 8.1%) studied, 86 completed the trial. CGM participants exhibited a greater reduction in total PAID scores at 12 weeks vs baseline when compared with those not using CGM (p=0.03), with similar between-group differences observed for PAID subscales of emotional distress (p=0.02) and food-related problems (p=0.004). CGM participants also had larger improvements in diabetes empowerment at 6 weeks (p=0.009). We did not detect any differences in the number of antihyperglycemic medication classes, physical activity, and diet. CONCLUSIONS:In adults with T2D not on insulin, CGM with virtual educator visits produced improvements in emotional and food-related distress and in diabetes-related empowerment at 12 weeks.

INTRODUCTION:User experience design aims to create products and services that are accessible, usable, and enjoyable. The Reshape T1D study aims to apply these principles to understand how individuals living with T1D interact with and experience healthcare to inform T1D clinical quality improvement. METHODS:Using a community-based participatory research design, we involved four patients and four clinicians as co-researchers throughout the research. A questionnaire and virtual semi-structured interview were applied across a purposeful sample of 41 adults living with T1D across Alberta, Canada, between September 2021 and May 2022. Audio recordings were transcribed verbatim and de-identified before coding. Thematic analysis was conducted on coded participant discourse through multiple coders. RESULTS:Participants indicated the need for a centralized hub that provides consistent, reliable, and up-to-date T1D education and resources and an emphasis on access to mental health resources within T1D care settings. Providing greater flexibility for appointment types (ie. in-person, virtual, etc.) and after-hours access contributed to better self-management and prevented emergency room visits. Participants desired a choice as to who comprises their T1D care team and for teams to address patient needs specific to their reality. We identified that medical trauma had long-term impacts on perceptions of healthcare and contributed to a reluctance to seek future care. Women expressed challenges in discussing reproductive health with their clinicians. Diabetes online communities provide an adjunct to clinical care through peer support. Cost and access to the latest technology are ongoing barriers for many participants, especially concerning publicly funded programmes that use advanced insulin pump therapy, continuous glucose monitoring, and automated insulin delivery systems. A quality improvement framework emerged through data analysis, and findings were synthesized into actionable recommendations for ongoing clinical quality improvement. CONCLUSION:Our findings highlight how important health system user suggestions are for more equitable, accessible, and empathetic healthcare for individuals living with T1D. Further work is needed to explore health system user experiences with clinicians and healthcare administrators to effectively carry out T1D clinical quality improvement.

OBJECTIVE:Our aim in this work was to examine postpartum diabetes screening and rates in women diagnosed with gestational diabetes mellitus (GDM) using standard vs modified criteria during the COVID-19 pandemic. METHODS:Women with GDM pregnancies between January 1, 2020, and December 31, 2021, in Alberta, Canada, were stratified by the GDM diagnosis criteria and followed for 18 months postpartum diabetes screening. Proportions of prediabetes and diabetes were compared between the standard vs modified GDM criteria groups at 6 and 18 months. Multivariable logistic regression analysis was used to examine differences in prediabetes and diabetes rates between the 2 GDM criteria groups after adjusting for baseline differences. RESULTS:Among 10,238 individuals with GDM, 780 were diagnosed using the modified criteria and 9,458 were diagnosed using the standard criteria. There was no difference in the proportion of individuals who underwent postpartum screening by 6 months (27.1% vs 28.9%, p=0.29) or by 18 months (43.1% vs 45.3%, p=0.24) among the modified and standard groups, respectively. Diabetes proportions were higher in women diagnosed with GDM using the modified criteria compared with those diagnosed using the standard criteria (27.0% vs 4.2%, p<0.0001; adjusted odds ratio 8.18, 95% confidence interval 5.76 to 11.6). Proportions of prediabetes and diabetes at 18 months were 15.2% and 20.8% (p=0.014) and 29.8% and 6.1% (p<0.0001) for modified and standard groups, respectively. CONCLUSIONS:Regardless of the GDM diagnostic method, postpartum diabetes screening among women with GDM was suboptimal during the COVID-19 pandemic. The modified criteria for GDM identified a group of women who were at higher risk for conversion to diabetes.

OBJECTIVES:Ontario listed sodium-glucose cotransporter-2 inhibitors (SGLT2is) as a regular public drug benefit for adults ≥65 years of age, whereas other Canadian provinces providing benefits for SGLT2is have implemented special authorization restrictions. We hypothesized that special authorization led to lower SGLT2i use among older adults with diabetes and cardiovascular disease (CVD) in other provinces (Alberta, Manitoba, New Brunswick, and Saskatchewan) as compared with Ontario. METHODS:We performed a retrospective cohort study of adults with diabetes and CVD who were ≥65 years of age and discharged from hospital between April 1, 2016, and March 31, 2019, in 5 Canadian provinces. Data were obtained from a national discharge database linked with public pharmacy claims. We followed individuals from discharge until March 31, 2019, for SGLT2i uptake. We also examined SGLT2i discontinuation and sulfonylurea uptake as control outcomes. Fine-Gray hazard models were adjusted for comorbidities and area-level sociodemographics. RESULTS:Of 161,249 individuals (average age 78 years, 42% female, median follow-up 1.8 years), 68% were from Ontario and 32% were from other provinces. Cumulative SGLT2i uptake at 6 months was 2.2% in Ontario as compared with 0.7% in other provinces, with an adjusted hazard ratio (aHR) of 2.72 (95% confidence interval 2.56 to 2.94, p<0.001). Ontario residents had similar SGLT2i discontinuation or sulfonylurea uptake compared with other provinces. Other predictors of SGLT2i uptake were identified. CONCLUSIONS:There was an interprovincial disparity in SGLT2i uptake in older adults with diabetes and CVD, among whom SGLT2is are now indicated for cardiorenal benefit. Special authorization restrictions should be flexibly and rapidly reassessed and revised as new evidence of clinical benefits becomes available.

AIMS:Estimate the effectiveness of continuous glucose monitoring (CGM) with remote telemonitoring-enabled virtual diabetes educator visits for improving glycemic management in adults with type 2 diabetes, not on insulin. METHODS:Participants with type 2 diabetes, not on insulin, and HbA1c > 7.0 % were enrolled in an open-label randomized trial of 6 weeks of CGM with telemonitoring versus enhanced usual care. Both groups received educator visits. HbA1c was assessed at 12 weeks. RESULTS:Of 105 participants (mean age 57.3 years, 49.5 % females, mean baseline HbA1c 8.0 %), 86 remained at follow-up. Change in HbA1c was -0.69 % (CGM) versus -0.33 % (enhanced usual care). Adjusting for baseline HbA1c, CGM was superior (0.65 % greater HbA1c reduction [95 % CI 0.17-1.12 %], p = 0.008). CGM participants were 92 % (RR = 1.92, 1.19-3.06, p = 0.007) more likely to have an HbA1c reduction ≥ 0.5 %, lost more weight (difference in weight reduction 2.17 kg, 0.22-4.11, p = 0.029) and were more satisfied with their treatment. No treatment-related adverse events were observed. CONCLUSIONS:CGM with virtual diabetes educator visits is effective, safe, and acceptable in adults with type 2 diabetes not on insulin and should be considered as an alternative to drug therapy for improving blood glucose.

Introduction & Objective: Gestational diabetes (GDM) can negatively impact the long-term metabolic health of patients and their infants, and mixed experiences with GDM care have been reported. The objective of this study was to identify themes and directives for improving quality of prenatal care from patients with lived experiences of GDM or their partners. Methods: This study is a systematic review of qualitative studies and was registered on PROSPERO (CRD42023394014). A comprehensive search strategy was developed to identify qualitative studies including pregnant or postpartum patients with GDM, or their partners. A thematic synthesis approach, following meta-aggregation was applied to identify patient-directives for GDM care. The Critical Appraisal Skills Programme qualitative checklist was used to assess quality and risk of bias. Results: Our search strategy was executed in six databases and a total of 80 studies were included. Patient-reported directives for improving care included: education on GDM and its management, personalized or tailored care, patient-centered care, digital or online adjuncts to care, and peer support. Additional directives for care arising from interpretation of patient-reported barriers and enablers of GDM management included providing support from healthcare professionals and facilitating support from partners and family, and acknowledging the stigma around GDM and patients’ motivations and concerns. Conclusion: Many patient and environmental factors affect the experience of GDM. Our systematic review findings identify several patient-reported directives for care, and our interpretation of additional directions through barriers and enablers experienced by patients. These findings provide rich direction for improving antenatal GDM care from the patient perspective. Disclosure Y. Feng: None. Z. Deng: None. R.O. Yeung: Research Support; Abbott. Advisory Panel; Dexcom, Inc. T. Nagpal: None.

AimsTo provide real-world evidence on the uptake of and outcomes associated with the modified gestational diabetes mellitus (GDM) screening approach offered during the COVID-19 pandemic compared with the standard screening approach.MethodsAll pregnancies between 01 January 2020 and 31 December 2021, in Alberta, Canada, were included in the study. We examined GDM screening and diagnosis rates, and large-for-gestational-age (LGA) outcomes.ResultsAnnual GDM screening rates were > 95% during the study time period. Overall, 84.7%, and 11.6% of the 92,505 pregnancies underwent standard and modified screening for GDM, respectively. The use of modified screening was the highest among deliveries in August 2020 (49.8%) which corresponded to the early first wave of the pandemic. GDM diagnosis rate was lower in the modified screening (7.4%) than in the standard screening (12.3%, p < 0.001) group. The LGA rates in the modified screening with GDM and the standard screening with GDM groups were 24.8% and 12.6%, respectively (p < 0.001). Women in the modified screening with GDM group were at a higher risk of having an LGA infant (adjusted odds ratio: 3.46; 95% confidence interval: 2.93, 4.08) compared to the standard screening with no GDM group.ConclusionsThe COVID-19 epidemic had no impact on screening for GDM. Women who underwent modified screening, based on HbA1c/random plasma glucose, had lower rates of GDM cases.

Objectives: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) provide heart and kidney benefits in adults with diabetes and cardiovascular disease (CVD). Public drug coverage policies for SGLT2is differ by province in Canada. In this study, we describe the potential effects of prior authorization/step therapy (PA/ST) and relatively high income-based deductibles, compared with regular benefit status with modest copay, on SGLT2i prescriptions in high-risk adults. Methods: This investigation was a cross-sectional study of adults >= 65 years of age with type 2 diabetes and CVD and taking at least 1 antihyperglycemic agent from 2019 to 2020. Using electronic medical record data obtained from primary care practices, we compared SGLT2i use (2019 to 2020) in Alberta (PA/ ST, modest copay) and Manitoba (PA/ST, relatively high income-based deductible) vs Ontario (regular benefit status, modest copay). Poisson regression was used to adjust for confounders, including age, sex, glycated hemoglobin, and other medication use. Other diabetes medications were estimated as control cases. Results: We included 3,191 adults (average age 75 years, 31% women). SGLT2i use was lowest in Manitoba (15.6%), followed by Alberta (25.9%), and highest in Ontario (31.9%). After adjustment, compared with Ontario, SGLT2i prescriptions were lower in Alberta (prevalence ratio [PR] 0.80, 95% confidence interval [CI] 0.71 to 0.91, p<0.001) and Manitoba (PR 0.48, 95% CI 0.39 to 0.59, p<0.001). Conclusions: PA/ST and relatively high deductibles are associated with reduced SGLT2i prescribing-PA/ST by approximately 20% in Alberta and Manitoba, and relatively high deductibles by an additional relative reduction of 40% in Manitoba. PA/ST and cost-sharing policies should be flexible and responsive to changing evidence of clinical benefit.

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.

INTRODUCTION:In numerous qualitative primary studies, women have identified opportunities to improve prenatal gestational diabetes care. The objective of our systematic review and meta-aggregation was to synthesize patient-guided suggestions for improving prenatal gestational diabetes care that are informed by lived experience of women and their support persons. MATERIAL AND METHODS:This study was registered a priori on PROSPERO (CRD42023394014). Our search strategy was executed in five databases (Medline, PsycInfo, CINAHL, Scopus, and Web of Science). Primary studies that were qualitative, had full texts in English, studied women who have or had gestational diabetes or their support persons, and included experiential accounts on prenatal gestational diabetes care were included. No date restrictions were applied. Studies that were not qualitative, were secondary analyses, included data on only postpartum care, or evaluated an intervention that was not standard care were excluded. Two independent authors used Covidence software to facilitate screening. The outcomes of interest were patient-reported suggestions to improve quality of gestational diabetes care that are informed by women's or their support persons' accounts of the lived experience of gestational diabetes. Meta-aggregation followed by a thematic synthesis approach was used to analyze the qualitative data to identify women's perspectives to improve gestational diabetes care. RESULTS:After duplicate removal, a total of 4761 studies underwent screening and a total of 80 studies were ultimately included. Patient- and support persons-reported suggestions to improve care include timely and comprehensive education around gestational diabetes with active engagement of family members, personalized and tailored counseling, patient-centered care, incorporation of digital or online adjuncts to care, and increasing support for women. CONCLUSIONS:Our systematic review and meta-aggregation identifies several actionable and patient-guided suggestions to improve prenatal gestational diabetes care that are important to consider when embarking on clinical quality improvement.

Objectives: To apply a case definition to a Northern Alberta-based primary care practice population and to assess the sex-specific characteristics of young-onset metabolic syndrome (MetS). Design: We carried out a cross-sectional study to identify and estimate the prevalence of MetS using electronic medical record (EMR) data and perform descriptive comparative analyses of demographic and clinical characteristics between males and females. Setting: Northern Alberta Primary Care Research Network (NAPCReN) consists of EMR patient data from 77 physicians among 18 clinics. Participants: Patients with one or more clinic visit between 2015 and 2018, between 18 and 40 years old, residing in Northern Alberta. Main Outcome Measures: Comparison of prevalence in MetS between sexes as well as sex-specific distribution of MetS characteristics [body mass index (BMI), fasting blood glucose, glycated hemoglobin, triglycerides, and high-density lipoprotein cholesterol (HDL-C), presence of hypertension, and presence of diabetes]. Results: Of 15,766 patients, 4.4% (n = 700) had young-onset MetS based on recorded data, prevalence was nearly twice as high in males (6.1%, n = 354) compared with females (3.5%, n = 346). The most prevalent risk factor for MetS consisted of having an elevated BMI for both females (90.9%) and males (91.5%). In the presence of MetS, more females had lower HDL-C [68.2% females (F) vs. 52.5% males (M)], and higher prevalence of diabetes (21.4% F vs. 9.0% M), whereas more males had hypertriglyceridemia (60.4% F vs. 79.7% M) and hypertension (12.4% F vs. 15.8% M). Females also had consistently higher percentages of absent laboratory data compared with males when identified as having MetS and BMI ≥25 kg/m2. Conclusions: Males have nearly twice the prevalence of young-onset MetS compared with females, with notable sex-specific differences in the manifestation of MetS, although we suspect that this is partially due to underreporting where the absence of anthropomorphic and laboratory investigations point to a lack of testing. Sex-specific screening for MetS, especially among young females of childbearing years, is important for downstream prevention.

Previously, we have shown that mothers with gestational diabetes mellitus (GDM) are at high risk for adverse obstetrical and neonatal outcomes. Evidence on the association between pharmacological treatment of GDM and obstetrical interventions and neonatal outcomes is sparse. Our objective was to compare rates of obstetrical interventions (C-section and labor induction) and neonatal outcomes (large for gestational age [LGA] and neonatal intensive care unit [NICU] use) in pregnancies with and without pharmacologically-treated GDM and no GDM.

Background: An update on the degree to which patients with type 2 diabetes in Canada achieve treatment targets is needed to document progress and identify subgroups that need attention. We sought to estimate the frequency with which patients managed in primary care met treatment targets (i.e., HbA1c ≤ 7.0%, blood pressure < 130/80 mm Hg and low-density lipoprotein cholesterol [LDL-C] < 2.00 mmol/L), guideline-based use of statins and of angiotensin-convertingenzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and the effects of patient age and sex. Methods: We conducted a cross-sectional study of 32 503 and 44 930 adults with diabetes in Canada on June 30, 2015, and 2020, respectively, using electronic medical record data from primary care practices across 5 provinces. We grouped achievement of diabetes targets by age and sex, and compared between groups using logistic regression with adjustment for cardiovascular comorbidities. Results: In 2020, target HbA1c levels were achieved for 63.8% of women and 58.9% of men. Blood pressure and LDL-C targets were achieved for 45.6% and 45.8% of women, and for 43.1% and 59.4% of men, respectively. All 3 treatment targets were achieved for 13.3% of women and 16.5% of men. Overall, 45.3% and 54.0% of women and men, respectively, used statins; 46.5% of women used ACE inhibitors or ARBs, compared with 51.9% of men. With the exception of blood pressure and HbA1c levels among women, target achievement was lower among younger patients. Achievement of the LDL-C target, statin use and ACE inhibitor or ARB use were lower among women at any age. From 2015 to 2020, target achievement increased for HbA1c, remained consistent for LDL-C and declined for blood pressure; use of statins and of ACE inhibitors or ARBs also declined. Interpretation: Target achievement for blood pressure and use of statins and of ACE inhibitors and ARBs declined between 2015 and 2020, and was suboptimal in all patient groups. Widespread quality improvement is needed to increase evidence-based therapy for people with diabetes.

BACKGROUND: We assessed the association between maternal glucose levels in pregnancy and subsequent hypertension. METHODS: This population-level, retrospective cohort study examined women aged 12 to 54 years with singleton pregnancies completed at ≥29 weeks of gestation from October 1, 2008 to December 1, 2018 followed until March 31, 2019 in Alberta, Canada. Women were stratified by results in the 50-gram glucose challenge test and by 75-gram oral glucose tolerance test subtypes (normal oral glucose tolerance test, elevated fasting plasma glucose only [elevated fasting], elevated postload glucose only, or both elevated fasting and postload glucose [combined]. Time to development of hypertension was modeled using Cox proportional hazards models. RESULTS: Of 313 361 women, 231 008 (79.1%) underwent a glucose challenge test only while 60 909 (20.9%) underwent either an oral glucose tolerance test only or both. Nine thousand five hundred eighty (3.1%) developed hypertension, and 2824 (0.9%) developed cardiovascular disease over a median follow-up of 5.7 years. Every 1-mmol/L increase in glucose in the glucose challenge test increased the risk of subsequent hypertension by 15% (adjusted hazard ratio and 95% CI, 1.15 [1.14–1.16]). Among those who underwent the oral glucose tolerance test, the combined group conferred the highest risk of subsequent hypertension, followed by elevated fasting, then elevated postload glucose only (reference: glucose challenge test ≤7.1 mmol/L, adjusted hazard ratio [95% CI]: elevated postload glucose only, 1.83 [1.68–2.00]; elevated fasting 2.02 [1.70–2.40]; combined, 2.65 [2.33–3.01]). No significant associations between maternal glucose levels and cardiovascular disease were observed. CONCLUSIONS: Increasing maternal glucose levels in pregnancy were associated with increasing risk of subsequent hypertension. These findings may help identify higher-risk women who should be targeted for earlier postpartum cardiovascular risk reduction.

OBJECTIVE:Our aim in this study was to implement a newly validated algorithm to identify pregnant women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM), and to identify temporal trends in rates over the last decade. We also compared obstetric and neonatal outcomes of pregnancies with and without diabetes mellitus (DM).METHODS:Among women with live births between 2005 and 2018 in Alberta, we calculated yearly rates of T1DM, T2DM, and GDM, overall, and stratified by ethnicity, urban or rural residence, material deprivation score, and maternal age.RESULTS:Between 2005 and 2018, GDM rates increased from 42.3 to 101.8 per 1,000 deliveries (p<0.0001), T2DM rates increased from 2.6 to 6.4 per 1,000 deliveries (p<0.0001), whereas T1DM remained constant at 3.0 per 1,000 deliveries each year (p=0.4301). Higher GDM and T2DM rates were observed among Chinese and South Asian women, respectively, and among women who were materially deprived and living in urban areas. Women with T2DM were older and had the highest rates of pre-existing hypertension (16%). In contrast, women with T1DM were younger and had the highest rates of gestational hypertension (12%), pre-eclampsia (12%), and cesarean section deliveries (62%). Children of women with T1DM had the highest rates of large for gestational age (46%), neonatal hypoglycemia (41.1%), respiratory distress syndrome (7.7%), and jaundice (29.3%).CONCLUSIONS:Diabetes-in-pregnancy rates have more than doubled over the last decade, driven primarily by increases in GDM and T2DM. These trends may have significant implications for the future health of mothers and children in Alberta.