Adverse cardiovascular events during treatment with pioglitazone and rosiglitazone: population based cohort study

Objective To compare the risk of acute myocardial infarction, heart failure, and death in patients with type 2 diabetes treated with rosiglitazone and pioglitazone

The effectiveness and efficiency of diabetes screening in Ontario, Canada: a population-based cohort study

<p>Abstract</p> <p>Background</p> <p>Little is known about the efficiency and effectiveness of the current level of diabetes screening activity in Ontario where there is universal access to health services. Our study aims were to: (i) determine how often Ontarians are screened for diabetes; (ii) estimate screening efficiency based on the number needed to screen (NNS) to diagnosis one diabetes case; (iii) examine the population effectiveness of screening as estimated by the number of undiagnosed diabetes cases.</p> <p>Methods</p> <p>Ontario respondents of the Canadian Community Health Survey who agreed to have their responses linked to health care data (n = 37,400) provided the cohort. The five-year probabilities of glucose testing and diabetes diagnoses were estimated using a Cox Proportional Hazards Model. We defined NNS as the ratio of diabetes tests to number of diabetes diagnoses over the study period. We estimated the number of undiagnosed diabetes by dividing the number not tested at the end of study period by the NNS.</p> <p>Results</p> <p>80% of women and 66% of men had a blood glucose test within 5 years. The efficiency of screening was estimated by a NNS of 14 among men and 22 among women. 127,100 cases of undiagnosed diabetes were estimated, representing 1.4% of the Ontario adult population. Increasing age, hypertension, immigrant and non-white ethnicity, and number of general practitioner visits were associated with an increased likelihood of having a glucose test (LR χ2 p < 0.001). Low income men were less likely to be tested.</p> <p>Conclusions</p> <p>Diabetes screening was high in this population-based cohort of Ontarians. Screening efficiency varied considerably in the population. Undiagnosed diabetes continues to be prevalent and remains concentrated in the highest risk groups for diabetes, especially among men.</p

Trends in laboratory testing for diabetes in Ontario, Canada 1995–2005: A population-based study

Abstract Background There are concerns that testing for type 2 diabetes is low and many people with diabetes are not diagnosed. We sought to describe the rates of diabetes-related lab testing in Ontario from 1995–2005, among adults without diabetes, and to explore the extent to which the Canadian clinical practice guidelines for screening are being followed. Methods Descriptive counts of outpatient diabetes laboratory tests performed within Ontario's publicly funded, provincial health insurance program were recorded. The study population was Ontario residents, 20 years and older from 1995 to 2005 (9.3 million people in 2005). The Ontario Diabetes Database, a cumulative registry derived from administrative health records, was used to exclude people who had physician-diagnosed diabetes (n = 839,127 in 2005) from the primary analyses. Diabetes tests included serum blood glucose (SBG), hemoglobin A1c (HbA1c), and oral glucose tolerance tests (OGTT). Results In 2005, 37% of Ontario adults without pre-existing diabetes were tested with an SBG test, a 28% increase from 1995. The age-adjusted proportion of adults without diabetes undergoing a HbA1c test increased from 1.7% in 1995 to 6.0% in 2005. In 2005, a similar number of HbA1c tests were performed for individuals with diabetes (483,746) and without diabetes (496,616) despite large differences in the two groups' denominators. Less than 1% of Ontarians underwent OGTT testing in any year between 1995–2005. Nearly two-thirds of adults age 40 years and over had an SBG test over a 3-year period (April 1, 2002–March 31, 2005), in accordance with the Canadian Diabetes Association recommendations. Conclusion Diabetes testing is common and has increased over the last ten years. Despite its absence in Canada's diabetes screening recommendations, HbA1c testing among individuals without diabetes is increasing rapidly, and OGTT, which is recommended, is rarely performed.</p

Trends in laboratory testing for diabetes in Ontario, Canada 1995–2005: A population-based study

Abstract Background There are concerns that testing for type 2 diabetes is low and many people with diabetes are not diagnosed. We sought to describe the rates of diabetes-related lab testing in Ontario from 1995–2005, among adults without diabetes, and to explore the extent to which the Canadian clinical practice guidelines for screening are being followed. Methods Descriptive counts of outpatient diabetes laboratory tests performed within Ontario's publicly funded, provincial health insurance program were recorded. The study population was Ontario residents, 20 years and older from 1995 to 2005 (9.3 million people in 2005). The Ontario Diabetes Database, a cumulative registry derived from administrative health records, was used to exclude people who had physician-diagnosed diabetes (n = 839,127 in 2005) from the primary analyses. Diabetes tests included serum blood glucose (SBG), hemoglobin A1c (HbA1c), and oral glucose tolerance tests (OGTT). Results In 2005, 37% of Ontario adults without pre-existing diabetes were tested with an SBG test, a 28% increase from 1995. The age-adjusted proportion of adults without diabetes undergoing a HbA1c test increased from 1.7% in 1995 to 6.0% in 2005. In 2005, a similar number of HbA1c tests were performed for individuals with diabetes (483,746) and without diabetes (496,616) despite large differences in the two groups' denominators. Less than 1% of Ontarians underwent OGTT testing in any year between 1995–2005. Nearly two-thirds of adults age 40 years and over had an SBG test over a 3-year period (April 1, 2002–March 31, 2005), in accordance with the Canadian Diabetes Association recommendations. Conclusion Diabetes testing is common and has increased over the last ten years. Despite its absence in Canada's diabetes screening recommendations, HbA1c testing among individuals without diabetes is increasing rapidly, and OGTT, which is recommended, is rarely performed

Findings from single studies

This is associated with a manuscript submitted for peer review.Context: In 1996, the American Thyroid Association (ATA) released the first practice guidelines that included initial treatment for differentiated thyroid cancer (DTC), with updates in 2006 and 2009 (and 2015, published the same year as the review’s search). Since controversy exists for the initial treatment of DTC, we synthesized evidence to understand ATA guideline adherence for its initial treatment among adult patients in the United States and Canada. Evidence Acquisition: A peer reviewed search strategy for medical databases (e.g. Medline, Embase, etc.) and grey literature up to December 2016. Risk of bias domains for the included studies were assessed using the Newcastle-Ottawa Scale and its modified version. Evidence Synthesis: The review included 15 studies. Here, findings extracted from single studies included in the review are described for completion thyroidectomy, radioiodine dose and need to refer a patient. Each reported guideline concordance of approximately 70%. Conclusions: More studies are required to synthesize the evidence for these treatments or, perhaps, a systematic review specifically designed to identify studies that examined these treatments.This work was supported by a Doctoral Research Award from the Health Services and Policy Research Institute, Canadian Institutes of Health Research (CIHR)