Impact of the Diabetes Canada Guideline Dissemination Strategy on the prescription of vascular protective medications : a retrospective cohort study, 2010-2015

Funding: Diabetes CanadaOBJECTIVE: The 2013 Diabetes Canada guidelines launched targeted dissemination tools and a simple assessment for vascular protection. We aimed to 1) examine changes associated with the launch of the 2013 guidelines and additional dissemination efforts in the rates of vascular protective medications prescribed in primary care for older patients with diabetes and 2) examine differences in the rates of prescriptions of vascular protective medications by patient and provider characteristics. RESEARCH DESIGN AND METHODS: The study population included patients (≥40 years of age) from the Canadian Primary Care Sentinel Surveillance Network with type 2 diabetes and at least one clinic visit from April 2010 to December 2015. An interrupted time series analysis was used to assess the proportion of eligible patients prescribed a statin, ACE inhibitor (ACEI)/angiotensin receptor blocker (ARB), or antiplatelet prescription in each quarter. Proton pump inhibitor (PPI) prescriptions were the reference control. RESULTS: A dynamic cohort was used where participants were enrolled each quarter using a prespecified set of conditions (range 25,985-70,693 per quarter). There were no significant changes in statin (P = 0.43), ACEI/ARB (P = 0.42), antiplatelet (P = 0.39), or PPI (P = 0.16) prescriptions at baseline (guideline intervention). After guideline publication, there was a significant change in slope for statin (-0.52% per quarter, SE 0.15, P < 0.05), ACEI/ARB (-0.38% per quarter, SE 0.13, P < 0.05) and reference PPI (-0.18% per quarter, SE 0.05, P < 0.05) prescriptions. CONCLUSIONS: There was a decrease in prescribing trends over time that was not specific to vascular protective medications. More effective knowledge translation strategies are needed to improve vascular protection in diabetes in order for patients to receive the most effective interventions.PostprintPeer reviewe

Obesity moderates the complex relationships between inflammation, oxidative stress, sleep quality and depressive symptoms

Abstract Background The relationship between obesity and depression is complex. This study assessed the impact of body mass index (BMI) on the link between BMI, inflammation, oxidative stress, sleep quality and self-reported depressive symptoms. Methods We used data from the U.S. National Health and Nutritional Examination Survey 2005–2008 cycles (n = 9133; ≥20y). Depressive symptoms and sleep quality were determined from questionnaires. C-reactive Protein (CRP) was used as a biomarker of inflammation and γ-glutamyltransferase was used to assess oxidative stress. The relationship between depressive symptoms, sleep quality, and biomarkers were assessed with regression models. The moderating effects of BMI and sex were tested. Results BMI was a significant moderator of the relationship between γ-glutamyltransferase and depressive symptoms (p = 0.02), but not CRP or sleep quality. Higher BMI increased odds of depressive symptoms in women (OR (95% CI): 3.92 (1.85–8.30) for BMI ≥25 to < 30 kg/m2; 3.17 (1.53–6.58) for BMI ≥30 to < 35 kg/m2; and 7.38 (2.11–25.76) for BMI ≥35 kg/m2). BMI was also a significant moderator of γ-glutamyltransferase levels in those with vs without depressive symptoms. Those with depressive symptoms had 24% poorer sleep quality compared to those without depressive symptoms after adjusting for inflammation, oxidative stress and other confounders. Conclusions The link between oxidative stress and depressive symptoms may be particularly relevant for females and people living with obesity. People with depressive symptoms also have a substantial reduction in sleep quality. Thus, research should examine these relationships prospectively to inform and improve the mental health of the adult population in developed countries