diabetes complications challenges and innovations · vol.2, no. 4, september 2012 t his issue of...

Vol.2, No. 4, September 2012

This issue of The Champlain DRCC newsleTTeR focuses on diabetes complications, challenges and

innovations. Proper diabetes management and regular monitoring can reduce the risk of diabetes complications. For people living with diabetes, keeping track of all of their diabetes information and any questions that arise can be challenging. It is a complex disease, and good diabetes care requires preparation, organization and follow-up by both patients and their primary care providers. One way to address this challenge is to be prepared when visiting a health care provider.

http://www.diabetes.ca/documents/about-diabetes/patientToolcontentFINAL.pdf

Diabetes complications, challenges anD innovations

Champlain DRCC Newsletter

Introduction

INSIDE THIS ISSUE

Diabetes and the kidney: an endocrinologist’s perspective

To Drive or Not to DriveWhat is New in Champlain?

Update on our WebsiteRegional Chiropody Update

From the CDACoordination and Communication: Two good

reasons for the use of a Referral/Consult Form for Retinopathy Assessment

Community EndocrinologistsInnovations in diabetes care

Champlain Diabetes SCREEN ProjectNew Members

Training OpportunitiesTools

Resources

Champlain Diabetes Regional Coordination Centre420 Cooper St, Ottawa K2P 2N6Website: www.champlaindrcc.ca Twitter: ChamplainDRCC

Newsletter publication dates: January, March, May, September, and November. Submissions must be received by the 15th of the previous month and sent to [email protected]

The content and opinions expressed within the DRCC Newsletter articles are those of the authors and are not necessarily endorsed by the Champlain DRCC.

Contact information:

Champlain DRCC Newsletter - September 20122

Diabetes anD the kiDney: an enDocrinologist’s perspectiveBy DRCC Specialist Lead Dr. Phyllis Hierlihy

i like To Think of myself as a preventative nephrologist.

From the standpoint of renal disease in diabetes, there is still a lot of work to be done. Evidence from the Diabetes Control Complications Trial (DCCT) and United Kingdom Perspective Diabetes Study (UKPDS), further supported by

ADVANCE, and ACCORD demonstrated the significant impact of improved glycemic and blood pressure control on the prevention and reduction of adverse renal outcomes (proteinuria and reduction in GFR). In spite of the potential to be most preventable cause of End Stage Renal Disease (ESRD), at least 50% of patients coming to end stage renal disease today have diabetes. How are we to understand this care gap? More importantly, what can be done to reduce these numbers?

Renal disease in diabetes takes two distinct forms. The first is vascular or ischemic nephropathy characterized by longstanding hypertension, progressive loss of renal function, and minimal proteinuria. The second is the more classical diabetic nephropathy in which case the deterioration in renal function is preceded and accompanied by greater degrees of proteinuria. Of note, the common underlying feature in both type is a genetic predisposition to hypertension.

The prevention of renal disease, in addition to optimizing glycemic control, should focus on hypertension. Landmark studies in the 1980’s and 1990’s have demonstrated the additional protective effect of anti-hypertensive agents inhibiting the renal-angiotensin aldosterone system (ACE-inhibitors, ARB’s, and direct renin inhibitors such as aliskerin). More recently, a significant added benefit above and beyond blood pressure control has been demonstrated with the addition of a calcium channel blocker (CCB), amlodipine. (ACCOMPLISH).

Evidence of reduced renal function (decrease in eGFR) and or the persistence of micro or macroproteinuria

(ACR greater than 2-20 in males, 2.8-28 in females) is associated with a progressive and linear increase in total cardiovascular events and death. In fact, the presence of microalbuminuria increase the odds ratio of an adverse event 10 fold as compared to 6.5 for smoking, 3.2 for hypertension, and 2.3 for cholesterol. In other words, detection of proteinuria provides insight into total vascular health or risk.

Significant measures to prevent renal disease in diabetes include moderate sodium restriction, smoking cessation, weight management, optimal glucose control, and maintenance of normal blood pressure <130/80 mm Hg. For those with proteinuria, optimization of therapy with RAAS blockers and addition of a CCB. For those with reduction in eGFR, document stability and avoid nephrotoxic agents such as NSAID’s. Referral to nephrology is recommended for those with progressive loss of eGFR less than 60 ml/min, all with eGFR <30, and those with a more serious prognosis (increasing proteinuria and decreasing eGFR).

Individuals with the first appearance of sustained hypertension and/or microalbuminuria should be reassured that conscientious attention to optimal control of diabetes and blood pressure and principles of vascular protection (lipid, smoking, etc) have been demonstrated to greatly improve prognosis. (Steno 2). As care givers to individuals with diabetes, our message should be straight forward and encouraging. The morbidity and premature mortality experienced in diabetes is primarily a result of premature aging of the blood vessels. Early and consistent achievement of targets with respect to vascular protection and glycemia promises significant improvement in quality of life and long term prognosis. To some extent, the prevalence of diabetes observed today in patients with ESRD reflects the improved prognosis from the standpoint of reduction in Cardio Vascular Disease (CVD). In other words, more patients are living long enough to develop kidney failure at an older age.

3Champlain DRCC Newsletter - September 2012

to Drive or not to Drive By Dr. Mark Silverman

oveR The lasT few yeaRs TheRe has been muCh DisCussion abouT wheTheR oR noT, anD The exTenT To which, diabetes may be an important factor in determining driver ability and driver’s license eligibility. Most

nations have restrictions on driver’s licenses for people living with diabetes. The possibility of hypoglycemia due to diabetes medications and insulin and the potential risk due to diabetic complications (primarily vision) make diabetes a possible disability affecting the medical fitness to drive. Reduced hypoglycemia awareness and recurrent severe hypoglycemia could place drivers at high risk for accidents. Studies have demonstrated neuropsychological and driving simulation impairments at minor levels of hypoglycemia (3.6 mmol/L). Several studies have explored the impact of diabetes on driving. The suggestion in two reviews was that diabetic drivers on insulin therapy have a small but statistically significant increased risk of moving vehicle violations. These reviews stressed the fact that intensive insulin therapy is associated with more frequent hypoglycemia. Previous studies did not separate type 1 and type 2 diabetes, oral therapy or insulin and whether or not it was intensive, the age or gender of diabetic drivers, or other driving risk factors. In addition, these studies were conducted before publication of the Diabetes Control and Complications Trial and the U.K. Prospective Diabetes Study, whose results encourage intensive therapy and have influenced diabetes management

Insulin therapy often results in hypoglycemia, which can be quite severe, and some diabetic patients are at higher risk for severe hypoglycemic episodes, in particular anyone with a previous episode or individuals with hypoglycemia unawareness. Severe hypoglycemia while driving may lead to accidents. As well, even mild hypoglycemia can cause dangerous driving. In addition, diabetic retinopathy or neuropathy may affect the ability to drive. Several studies have concluded that diabetes increases the risk for accidents, with a relative risk between 1.5 and 2.0.

The consequences of this may be wide reaching. The question posed from a legislative perspective is whether or not diabetic individuals should be allowed to drive. Society already accepts a much higher risk with drivers of young or older age in people without diabetes.

Specific clinical practice guidelines for commercial driving were published by the Canadian Diabetes Association in 2003. These state that the fitness of diabetic individuals to drive must be assessed on a case-by-case basis. Specific recommendations are presented for both private and commercial drivers, which include assessment, eligibility criteria and measures to reduce the risk of accidents. For instance, the recommendations state that individuals with hypoglycemia unawareness or a previous episode of severe hypoglycemia within the last 2 years are ineligible to drive commercial vehicles. Reporting fitness to drive is mandatory in all provinces and territories except Alberta, Nova Scotia and Quebec, where it is discretionary.

For clinicians, identifying those at highest risk would permit interventions to decrease these risks. As an example, diabetic individuals with hypoglycemia unawareness could have interventions to reduce the risk of hypoglycemia and try to correct hypoglycemia awareness: increasing the frequency of self-monitoring of blood glucose, less rigorous glycemic targets to avoid hypoglycemia, and consideration of psycho-behavioural intervention programs, such as blood glucose awareness training.

continues on page 4

Champlain DRCC Newsletter - September 20124

From a legislative perspective, questions persist about whether, and under what conditions, people living with type 1 diabetes may be permitted to drive. The risk of driving accidents in those with type 1 diabetes is lower than for drivers without diabetes <30 years of age, which implies that this is a level of risk our society can allow. Type 1 diabetic drivers with a history of driving incidents require instruction about ways to minimize hypoglycemic reactions while driving, (i.e. more flexible insulin regimens to circumvent the impact of delayed meals or missed snacks and prevention of hypoglycemia while driving.)

Drivers with diabetes treated with insulin or insulin secretagogues should measure their blood glucose level immediately before and at least every 4 hours during long drives, more frequently in those with hypoglycemia unawareness. Blood glucose monitoring equipment and supplies of rapidly absorbable carbohydrate should be within easy reach. No one should drive if their blood glucose level is <4.0 mmol/L, and prophylactic carbohydrate treatment is mandatory before driving when the blood glucose level is 4.0 - 5.0 mmol/L. Drivers must stop and treat themselves immediately when hypoglycemia and/or impaired driving is suspected. After the treatment of mild to moderate hypoglycemia (glucose 2.5-4.0 mmol/L) drivers should wait 45 to 60 minutes before resuming driving. Diabetic individuals with a history of severe hypoglycemia during the past year, hypoglycemia unawareness or recurrent previous hypoglycemic reactions must be aware they are at high risk of experiencing severe hypoglycemia while driving. Education on how to avoid hypoglycemia while driving must be included in all educational programs for diabetes for those who are treated with insulin or insulin secretagogues. Drivers with a history of severe hypoglycemia during the past year, hypoglycemia unawareness or recurrent previous hypoglycemic reactions should be informed that they are at high risk of experiencing severe hypoglycemia when driving.

The annual medical examination of a driver with diabetes must include an assessment of retinopathy, nephropathy and cardiovascular disease, and a decision must be made as to whether or not the severity of these complications could increase accident risk.

Diabetic individuals who are well controlled with diet alone or a combination of diet and oral antihyperglycemic medications are at minimal risk for severe hypoglycemic reactions and they can usually drive all types of motor vehicles with relative safety, as long as they remain under regular medical supervision, i.e. a minimum of 2 clinic visits during the last year.

The Canadian Diabetes Association (CDA) has guidelines for both private and commercial drivers. Following these guidelines can help you and your patients to insure everything possible is being done to keep us all safe while driving. http://www.diabetes.ca/Files/DrivingGuidelines.pdf

ReferencesAmerican Diabetes Association; Diabetes and Driving Diabetes Care January 2012 vol. 35 no. Supplement 1 S81-S86 Begg, IS et. al. , Canadian Diabetes Association’s Clinical Practice Guidelines for Diabetes and Private and Commercial Driving. Canadian Journal of Diabetes. 2003;27(2):128-140Clarke W et. al, Hypoglycemia and the decision to drive a Motor Vehicle by Persons with Diabetes. JAMA 1999;282:750-54Stork A et. al., Diabetes and Driving: Desired data, research methods and their pitfalls, current knowledge, and future research, Diabetes Care 29: 1942-48, 2006Cox DJ et. al., Diabetes and Driving Mishaps: Frequency and correlations from a multinational survey Diabetes Care 26:2329–2334, 2003Yale JF (Editorial) Diabetes and Driving: The Ongoing Debate Canadian Journal of Diabetes. 2003;27(1):18-19

To Drive or Not to Drive - continued


What is neW in champlain?Champlain Client ChampionsOne of the strategies in our region is to highlight and promote community members, people living with diabetes, who can serve as Champlain Client Champions, sharing their successes, challenges and journeys in managing their condition. The Champlain Client Champions (CCC) will share, guide and assist in the planning of the most appropriate strategies and how best to disseminate useful information and knowledge to others who are living with diabetes in the region. The Champlain Client Champions will meet 3-4 times a year to discuss, share and guide our tools and resources for those living with diabetes. We look forward to this new initiative.

LTC Diabetes 101 DVDThe regional DRCCs have collaborated with the Senior Health Research Transfer Network (SHRTN) Community of Practice for Diabetes, to promote and disseminate webinars based on the LTC Diabetes 101 DVDs, starting September 2012. There will be 10 webinars, one each month, to provide educational sessions to LTC and Retirement Homes staff so that they can improve the care of their residents who are living with diabetes.

If your organization would like to take part please contact Olga Nikolajev, Outreach [email protected]

LTC Diabetes 101 DVD Webinar session schedule

Date Topic Date and time September Understanding Diabetes Thursday Sept 27 2012, 3:00 – 4:00 October Monitoring Blood Glucose Thursday October 25 2012, 3:00 – 4:00 November Hyperglycemia Thursday November 22 2012, 3:00 – 4:00 December Hypoglycemia Thursday December 20 2012, 3:00 – 4:00 January Nutrition and Physical Activity Thursday January24, 2013, 3:00 – 4:00 February Oral Diabetes Medications Thursday February 28, 2012, 3:00 – 4:00 March Insulin Therapy Thursday March 28, 2012, 3:00 – 4:00 April Sick Day Management Thursday April 25, 2012, 3:00 – 4:00 May Medical Emergencies Thursday May 23 2013, 3:00 – 4:00 June Chronic Complications Thursday June 27, 2013, 3:00 – 4:00

SHRTN completed a needs assessment with LTC to determine dates and times that would work best.


Update on our website

Since the launch of the Champlain DRCC website in April, we have had close to 2,000 visits to the site, with close to 10,000 downloads. We hope that people living with diabetes and healthcare providers in the Champlain region will continue to visit the site to access the lists of services, links to tools and useful information.

For people living with diabetes, we have added a direct link to Health Care Connect to find a physician or nurse practitioner in your area.

For health care providers, we have added a page describing some of our Quality Improvement resources, including a link to an Endocrinology consult, and a direct link to the SharePoint portal.

We will continue to update the site with relevant information, resources and tools for all.

New Foot Care Resources for People living with Diabetes in the Champlain Region

Diabetes is a growing challenge, affecting approximately eight per cent of the population in the Champlain region. Hospitalization rates for diabetes-related foot problems such as infection, ulcers and amputations is high in the Champlain region compared to other areas of Ontario. An inventory of foot-care services conducted by the Champlain Diabetes Regional Coordination Centre showed significant gaps in foot care for people living with diabetes, particularly outside of the Ottawa. People with diabetes and providers of care have told us that it is difficult to get the foot-care services they need.

In response, the Champlain LHIN recently added resources for two new chiropodists in our region to expand foot care services to underserviced areas in rural communities. This funding, amounting to $239,900 annually, complements resources provided by the Ministry of Health and Long-Term Care in 2011 to address the current foot-care needs of people living with diabetes in the Champlain area.

New Survey Reveals Canadians Living with Diabetes Aren’t Putting Their Best Foot Forward When it Comes to Proper Foot Care

in a new suRvey of CanaDians living wiTh Type 1 anD Type 2 DiabeTes ConDuCTeD by légeR maRkeTing, sponsored by Eli Lilly Canada and being released in collaboration with the Canadian Diabetes Association,

results indicate that while 9 in 10 Canadians with diabetes are aware they are at an increased risk of serious foot injuries, 4 in 10 admit to having their feet examined by a doctor less than once a year, only when something is wrong and for some, never. Of equal concern is 7 in 10 do not examine their feet for blisters, cuts, temperature differences or other injuries on a daily basis and less than 1 in 10 admit to never following a daily nail or foot care regimen.

“Clearly more needs to be done to assist Canadians living with diabetes to take the necessary precautions to protect their feet,” says Michael Cloutier, President and CEO, Canadian Diabetes Association. “Even small unnoticed and untreated foot injuries can potentially lead to serious complications. Prevention is the best medicine as a good daily nail and foot care regimen will keep your feet healthy.”


in memory of jessica fitzgeralD

A few words about the loss of my dear and talented colleague:Of course, all RD & RN diabetes educator teams tend to become very close after working together for several years and we were no different. Jessica’s enthusiasm is hard to describe, but it made our tiny workspace lots of fun to be in. One of the hardest things for me in the aftermath of this tragedy has been comforting the patients. They needed to express their deep sense of loss and they shared with me how her words and actions helped them in their life with diabetes. It stirred my grief anew, yet I was comforted by their stories - we don’t always realize how profound an influence we may have for these people we try to help every day. Jessica’s great passion was learning more about diabetes so that she could share it with patients and colleagues. That fatal morning she was making a special trip in to work to set up an educational event for the nurses at RVH. We hope to set up an annual education day about diabetes here at the hospital in Jessica’s honour. We shared a tiny space, You made it a fun place.I envied your energy and drive,In tough times you seemed to thrive.We drank coffee ‘cause we couldn’t drink wine,A crazy schedule somehow worked out fine.You were a shining star that was meant to go far,- An inspiration to us allFun memories, too many to list,My ‘diabuddy’, you are so dearly missed

Donna Reid at Renfrew Victoria Hospital with the Renfrew County Diabetes Education Program

From the Diabetes Education team in Renfrew County:

Jessica Fitzgerald, Diabetes Nurse Educator extraordinaire at the Renfrew Victoria Hospital, wife, daughter and devoted mom to two beautiful daughters aged 2 1/2 years and 5 years was senselessly killed in a motor vehicle accident on her way to work. Jess was truly, a unique vivacious young woman killed in her prime. Jess was a committed, gifted young woman who helped and touched so many across Renfrew County and beyond.

We will all miss Jessica’s contribution and care she provided to those living with diabetes.

8 Champlain DRCC Newsletter - September 2012

opTimal CaRe foR people living wiTh DiabeTes is Complex RequiRing CooRDinaTion anD CommuniCaTion among many health care professionals and organizations. Coordination of care is often managed by

primary care providers such as physicians, nurse practitioners, nurses, diabetes educators and allied health care providers. In larger centres, endocrinologists or internists may provide coordination. It is evident that to address the multiple concerns facing most people living with diabetes, coordinators of their care need to use the most efficient approaches to access other health professionals and community resources. They also need to know whether their patients get the care they have recommended and the results of those referrals.

A Working Group for Improving Retinopathy Assessment in the Champlain LHIN** examined the many factors that support one of the issues facing people living with diabetes ie. access to eye care, and created several solutions to address the challenges that disrupt patients receiving regular eye examinations. In addition to educational programs and tools, the group designed a referral/consult form that, if used, could enhance communication among those responsible for eye health care as well make it easier for the coordinators of care to know their patients’ status following eye care assessments an treatments.

Download the form at:http://www.champlaindrcc.ca/downloads/toolbox_providers/Referral%20Consult%20template_EH_V1.2.pdf

** A collaboration led by the Office of CME, Faculty of Medicine, University of Ottawa, the DRCC and the Eye Health Council of Ontario (EHCO)

Coordination and Communication:Two good reasons for the use of a Referral/Consult Form for Retinopathy Assessment

Use of this form can accomplish the following:

• Ensure all optometrists and ophthalmologists receive a referral document from the health care provider who has requested a retinopathy assessment.

• This referral form provides the name of the provider referring, their contact information as well as key patient data and requests information regarding the outcome of the assessment and treatment.

• The optometrist or ophthalmologist can use the space and checkboxes provided to efficiently note the outcome of the assessment and then fax it back to the referring provider, who would then be able to relay the information to the primary care provider ie. family physician.

• If the patient requires further assessment or treatment, the form is designed to then become a referral to the ophthalmologist who will next see the patient. The name of this primary care provider and contact info will be inserted into the caregiver list at the top of the page.

• Although the form provides space for treatment information, ophthalmologists or optometrists will often want to use their usual documentation procedures. We suggest that the details of treatment be attached to the referral form and faxed to the primary care providers or optometrists.


community enDocrinologists

From the DEC team at Winchester District Memorial Hospital

We are very pleased to welcome endocrinologist, Dr. Clara Irobi to our team. We are excited to have the opportunity to learn and work with Dr. Irobi. Her calm manner and patient centered philosophy are just what the doctor ordered for the DEC (pun intended!). Having access to an endocrinologist in our facility is a dream come true for both, the educators, and our patients who have often expressed a desire for these services close to home. So welcome aboard Dr. Irobi!

Dr. Clara Irobi, Endocrinologist.Winchester District Memorial Hospital (WDMH)566 Louis Street, Winchester, ON, K0C 2K0Fax: 613- 774- 6536Phone: 613-774-2420 Ext. 6765

Type of Practice: Management of Type 1 & Type 2 Diabetes, General Endocrinology and Metabolism.

Note: All referrals should include the most recent lab work of patient.

For our Diabetes Education program you can register yourself or you can have your doctor, a pharmacist, an optometrist or a home care nurse send us a referral by Fax at 613- 774- 6536. To register yourself, simply call 613-774-2420 Ext. 6765.

From the Rideau Valley Health Centre

Dr. Patricia Peticca has been a resident of Ottawa for over a decade, completing both her undergraduate and postgraduate medical training at the University of Ottawa. She is trained in Internal Medicine, with subspecialty training in Endocrinology and Metabolism. She was the recipient of the Peter Garner Award upon completion of her fellowship, in recognition of her active involvement in and contributions to research. In particular, she holds clinical and research interests in obstetric medicine.

Dr. Peticca has a primary community practice at the Rideau Valley Health Center (RVHC), located at 1221 Greenbank Road. Diabetes care and management at RVHC includes services of a registered dietician and diabetes nurse educator. For patients on insulin pump therapy, the RVHC will be a recognized ADP site as of Fall 2012. Dr. Peticca is currently accepting referrals (adult - minimum age 18 years old) for general internal medicine, diabetes care, and general endocrinology. She looks forward to working with primary care providers to deliver exceptional health care to patients in Ottawa and surrounding communities.

Dr. Patricia Peticca, Endocrinologist.Rideau Valley Health Centre (RVHC)1221 Greenbank Road, Barrhaven, ON, K2J 5V7Fax: 613-440-3238Phone: 613-258-8710


From the Greenbelt FHT

Dr Nadia Malakieh was born is Sudbury, Ontario. She completed her Bachelor’s of Science at Laurentian Univer-sity. She then completed her Medical Doctorate, Internal Medicine residency and Endocrinology Fellowship at the University of Ottawa. She has now established a General Endocrinology and Diabetes practice in Barrhaven. She is fully bilingual in English and French. She is happy to see patients with type 2 diabetes, with all ranges of complexities, as well as those patients with pituitary, adrenal, hypogonad or thyroid disorders, and osteoporosis.

Dr. Nadia Malakieh, EndocrinologistGreenbelt Family Health Team3500 Fallowfield Rd., Barrhaven, ON, K2J 4A7Fax: 613-843-0201Phone: 613-843-1718

Community Endocrinologists - continued

innovations in Diabetes care

CDEP-O’s new Initiative to reduce the barriers of high risk ethnic population-Chinese to access the Community Diabetes Education Program of Ottawa (CDEP-O) and promote the self-management of diabetes

Numerous barriers to accessing healthcare services have been well documented for the Chinese population in Canada. These include lack of information about the community healthcare services, lack of socioeconomic resources, self-care challenges, degree of acculturation, healthy literacy, and language communication difficulty(1). It is not therefore surprising that a large number of the Chinese with diabetes who have immigrated to Canada over the last 20 years have never heard about the Community Diabetes Education Program of Ottawa (CDEP-O). To target some of those barriers, CDEP-O has been launching some new initiatives since February 2012.

Increase the visibility of CDEP-O within Chinese community:The Health Times is a Chinese Newspaper published weekly in Ottawa. To make CDEP-O more visible and to promote the program through Chinese media, the CDEP-O Chinese speaking registered nurse wrote an article in Chinese about the program. She emphasised the importance of attending diabetes education to learn the essential skills for diabetes self-management, to increase their knowledge in order to prevent both the short-term and long-term complications associated with diabetes, and how to live well in Canada. The article was published in Health Times in February. Shortly thereafter, CDEP-O received significantly more phone calls from the Ottawa Chinese population with diabetes requesting to register for the program. A few participants with a medical background, who attended the program, were very impressed with how much they had learned about diabetes self-management that they wanted to become volunteers to promote CDEP-O within Chinese community in order that more people could benefit from the program.

Mobilizing the Community Diabetes Education program:Chinese seniors and people with impaired physical mobility have difficulty travelling to the various community sites to attend the community diabetes education particularly in winter. Furthermore, newcomers are not familiar with the


new environment in which they live and it is hard for them to find the locations of the community diabetes education program across Ottawa. Language barriers also prevent those people from going out to get information and the adequate healthcare services they need.

In order to reduce these barriers CEDP-O first approached the Aging in Place in Ottawa and identified the residential buildings in which most Chinese seniors live. By collaborating with Aging in Place, CDEP-O had diabetes group education sessions at 280 Rochester Street. There were 8 people with diabetes who attended the group with their family members. These Chinese seniors and their family appreciated that the community diabetes education program was able to come into the building in which they live, saying it made their lives much easier. Most importantly was that they said they learned diabetes self-care skills in their own language and cultural context, which they were able to easily understand and apply to their daily living activities.

With the success of the partnership with Aging in Place, CDEP-O then partnered with the both Ottawa Public Health and Yet Keen Senior Day Centre, providing a diabetes prevention and management workshop in April. More than 20 Chinese seniors attended the workshop, five of whom had diabetes, and many who were at high risk to develop diabetes. Those people with diabetes who attended, began actively promoting CDEP-O to their friends with diabetes and spreading the word about CDEP-O. In May CDEP-O had a diabetes group with 16 clients with diabetes, plus family members, totaling more than 20 people attending the group. Both participants and Yet Keen Senior Day Centre appreciated CDEP-O mobilizing its program.

In June 2012 CDEP-O offered a diabetes self-management education group at the Ottawa Public Library in Kanata, along with 2 other outreach events at which CDEP-O conducted diabetes screening and continued to increase the public awareness in diabetes prevention and management amongst the Chinese community. CDEP-O is looking for more opportunities to collaborate with the Ottawa Chinese Community Service Centre to offer diabetes group education in both Kanata and Barrhaven in the near future.

Conclusion and recommendations: Studies have shown individuals from high-risk ethnic populations, such as the Chinese population, develop diabetes complications, particularly CVD and renal failure, much earlier than other populations. Diabetes self-management education can increase an individual’s involvement in, confidence with, and motivation for, control of their diabetes, its treatment, and its effect on their lives (1). Focusing on self-management helps the Chinese population living with diabetes obtain optimal blood glucose control, which can result in significant public health benefits including lower rates of cardiovascular disease (CVD), renal failure, blindness, and premature mortality1. CDEP-O is in an optimal position to help the ethnically diverse population who have diabetes by providing easily accessible diabetes self-management education and by extending its capacity (eg. increasing its visibility and mobilizing SME) by establishing and sustaining Chinese community partnerships, as well as maximizing it’s use of diabetes educator’s knowledge and skills.

Zhouping Huang, RN, BScN, CRRNDiabetes Nurse EducatorCommunity Diabetes Education Program of OttawaCentretown Community Health Centre

References: 1. Canadian Diabetes Association 2008 Clinical Guidelines for the Prevention and Management of Diabetes

CDEP-O’s new initiative... - continued


Diabetes Access Line Launched in Renfrew County

A new toll free access line for diabetes services in Renfrew County is now available for those seeking information, referrals and more. Launched by the Renfrew County Diabetes Education Program, the new access line follows the recent implementation of a central intake and scheduling system across all diabetes education sites in Renfrew County. Now, to access services, one phone call to one number is all it takes to find the answers you are looking for - 1-855-293-7838.

The Renfrew County Diabetes Education Program is a regional program administered by the Pembroke Regional Hospital which offers diabetes education services across five hospital sites in Renfrew County - Arnprior Memorial, Deep River & District, Renfrew Victoria, Pembroke Regional and St. Francis Memorial.

Services are also offered at nine outreach sites - Arnprior Villa, Quail Creek in Renfrew, Fairfield’s in Eganville, Pikwakanagan in Golden Lake, Rainbow Valley CHC in Killaloe, Whitewater Bromley CHC in Beachburg, Petawawa Centennial FHT, Riverview Heights (Pembroke) and Supple’s Landing in Pembroke.

Diabetes education services including screening, assessment, individual and group classes, follow-up consults, telemedicine services with specialists and public awareness sessions for the community, are provided by diabetes education teams consisting of registered nurses and registered dietitians.

The educators work in collaboration with family physicians, endocrinologists, pharmacists, other healthcare professionals and family members to deliver client-centred self-managed care for individuals living with or at risk of developing diabetes.Referrals to any diabetes education clinic can be self-directed or physician and provider directed.

To access services which help prevent diabetes or improve diabetes control by achieving a healthy lifestyle, or for more information: Call 1-855-293-7838 or Fax 1-855-293-7839

Karen Roosen, Diabetes Education CoordinatorPembroke Regional Hospital(613) 732-3675 ext. 6530 or [email protected]


a one-yeaR pRojeCT CalleD aDDRessing DiabeTes in high Risk eThniC populaTions was iniTiaTeD in 2010/11 to evaluate the literature and cultural appropriateness of diabetes prevention and education pro-

grams. The project sought innovative community-based approaches to improve diabetes care within the Cham-plain region, specifically the city of Ottawa. Four immigrant communities at high risk of diabetes were involved in the project: South Asian, Latin American, Nepalese and Somali.1

The project concluded that there was a need to explore the value of community outreach/link workers and culturally appropriate diabetes programs for high risk, low health literacy and low-income immigrant groups. In August 2011, the Champlain Local Health Integration Network (LHIN) and Diabetes Regional Coordination Centre (DRCC) presented the Ministry of Health and Long Term Care with a proposal to undertake the development and implementation of a diabetes screening and risk management program for these four high risk ethnic populations in the Champlain region.

The Champlain LHIN has now received funding approval to undertake this important work. Centretown Community Health Centre is managing the project with additional in-kind supports from the Diabetes Regional Coordinating Centre and involvement from multiple partners such as Ottawa Public Health, Canadian Diabetes Association, Catholic Immigrant Centre and the OLIP (Ottawa Local Immigration Partnership) and others. Screening events will take place in four immigrant communities across the region starting in October 2012 and continuing through March 2013. Funding totals $256,000.

The Champlain Diabetes SCREEN project components:• Screening: Identify people at high risk of diabetes or with diabetes• Capacity Building: Build knowledge among high risk communities and providers of diabetes services• Risk Management: Improve the ability of people at risk of diabetes or with diabetes from high risk ethnic

communities to manage their risk factors and diabetes • Education: Increase access to diabetes education programs and linking people to appropriate resources,

programs and follow up including primary care and diabetes services• Evaluation: Assess the results of this program (process and impact)• Networking: work in partnership with communities, health service providers and organizations and primary

care providers

In recent years, the City of Ottawa received a large number of immigrants from around the world. They come primarily from South Asia, the Middle East, sub-Saharan Africa and Latin America. It has been reported that these ethnic communities have a 3 to 4 times greater risk for developing Type 2 diabetes compared to the general Canadian population. Targeted diabetes prevention and management strategies are widely considered appropriate to reach these high risk groups focusing on awareness raising, early case finding, and chronic diabetes management with clear links to primary health care.

1 Persons of South Asian, Latin American, and African-Caribbean descent are at highest risk for developing type 2 diabetes and often suffer poorer health outcomes. (Pottie et al. CMAJ 2011)

continues on page 14

champlain Diabetes screen project


Changes at The Ottawa Hospital Diabetes TeamAnnie Garon-Mailer has moved to North Bay.Mary Ann Laplante will join our team on August 20, 2012Patricia Vilaysane –Truong is on Maternity Leave and will be replaced by Melissa Harley from August 2012 to Sept 2013.

From Arnprior District and Memorial HospitalAt Arnprior we have added a new team member. Karen Brunke who was the Diabetes Educator has moved on to become Nurse Manager of Emergency and Operating Room.We have welcomed Janet James Whalen as the new Nurse Diabetes Educator. She started in her new position on July 9th. Janet completed the Michener Institute Diabetes Educator Program in 2009 while living in Calgary. She comes with a varied nursing background but most recently prior to assuming her present role was working in the Emergency Department at The Ottawa Hospital and also in the Emergency Department here.

Champlain Diabetes SCREEN Project - continued

The Champlain Diabetes SCREEN Project provides diabetes screening events and risk management in partnership with high risk immigrant communities in the Champlain region. The diabetes screening events can include: diabetes risk assessments, education about healthy eating and physical activity, cooking demonstrations, a community meal and identification of people with existing diabetes using a blood glucose test. People with pre-diabetes or diabetes who are found to need assistance are connected with existing diabetes education and self-management programs in their area. Each community has an opportunity to decide which activities they want based on their needs. The Champlain Diabetes SCREEN project also provides training to health care providers to increase their understanding of the communities they serve and help them provide more culturally sensitive care.

To complement the screening events, there will be resource kits created with each community to address their particular needs. All of the information will be hosted on the Champlain DRCC website once it is finalized. www.champlaindrcc.ca/SCREEN.html

In addition to community representatives and participants, there are many partners in this program including the Champlain Local Health Integration Network (LHIN), the Canadian Diabetes Association (CDA), Ottawa Public Health, Ottawa local Immigration Partnership (OLIP), Catholic Immigration Centre of Ottawa, Champlain Diabetes Regional Coordination Centre (DRCC), Centretown Community Health Centre, Projenesis, and local diabetes education programs.

The project is truly a group effort!

If you have any questions or concerns, feel free to contact us at: 613-238-3722 or [email protected]

neW members to the champlain Diabetes team


Community Diabetes Education Program of Ottawa (CDEP-O)

As most of you know, after 13 years of contribution to the community health sector at Centretown CHC, Betty MacGregor will be retiring effective September 28th, 2012. Over the past 13 years, Betty has provided excellent leadership to the Community Diabetes Education Program of Ottawa through its expansion of services and also in developing strong partnerships with key stakeholders like yourselves. Her commitment to delivering the right care and support for the diversity of people who have diabetes through an effective team and hand in hand with multiple partners is truly one of Betty’s legacies to the program. We will certainly miss her quiet wisdom, strong sense of collaboration and passion for people’s health and well-being. I’m sure that you’ll have a chance to send your best wishes to Betty in the next couple of months. In moving forward, the hiring committee has successfully found a candidate to replace Betty which was no small feat. I am pleased to introduce you to Barbara Neuwelt as the new Director of the CDEP-O effective September 24th. Barbara brings a wealth of experience to CDEP-O with more than 25 years of experience in health and social policy and programs in the voluntary sector. As a Senior Policy & Research Analyst with the Mental Health Commission of Canada, Barbara had the opportunity to make the link between chronic disease and mental health. She also worked collaboratively in strategic alliances in her position as Policy Analyst with the Canadian Mental Health Association of Ontario where she raised the profile of mental health on the chronic disease agenda in Ontario, particularly in the area of diabetes. She also held the position of Senior Manager of a multidisciplinary team at East End Community Health Centre in Toronto where she developed multiple partnerships in the area of diabetes and other innovative programs. Barbara also worked at Centretown CHC in the 1990’s as a Health Promoter in the Community Health Promotion program where she also had the opportunity to work with key stakeholders in the community.

Barbara looks forward to working with our diabetes education team and all of our partners in the Fall.

A new Bilingual RN joined CDEPO in July. Diane Brisson Adam is a fully bilingual RN. She has 30 years experience as a nurse. She is skilled and experienced as an educator. Much of her work has been with the Birthing Unit at the Montfort. She is also a Certified Lactation Consultant. She has worked in community settings – most recently at Overbrook-Forbes CRC. She loves teaching in a group setting as well as with individuals.

Chantal Pinel and Rita Dagher joined our team on June 18th as Administrative staff. Chantal comes to us with experience for the Ottawa Youth Services Bureau for the last 5 years and will be covering a maternity leave until the summer of 2013. Rita works par-time at a pharmacy and will work with us 2 days a week. They are both fluently bilingual. Rita is also able to provide service in Arabic.

We are also pleased to announce a returning member to our team. Carole Labelle started on July 16th as an Admin Assistant. Carole has worked briefly for our program in the past, but has a wealth of knowledge about the Centre, having previously worked in PC, IDP, LESA and Social Services. She has a great sense of humour and is will be a welcome addition to the team.

more neW members...


training opportunities

The Diabetes Regional Coordination Centre (DRCC) in collaboration with the University of Ottawa, and supported by Sanofi Pharmaceutical would like to invite:

All Champlain Nurse Practitioners to the Diabetes Education 2012 Fall Sessions with the DRCC Specialist Lead: Dr. Phyllis Hierlihy.

Event Dates & Topics: • Glycemic Management with Dr. Hierlihy

Thursday September 20th 6 to 8 pm (dinner provided)

• Insulin Initiation with Dr. HierlihyWednesday October 17th 6 to 8 pm (dinner provided)

• Managing the Complex Patient with Dr. HierlihyWednesday November 21st 6 to 8 pm (dinner provided)

The Specialists will provide the education sessions in-person at an Ottawa location AND each session will be acces-sible via the Ontario Telehealth Network (OTN) OR live Webcast. In addition, sessions will be videotaped for later viewing.

Please contact Olga Nikolajev, DRCC Outreach Coordinator: [email protected]

Professional Education Workshop: Physical Activity and Exercise in DiabetesFriday September 21, 2012 with Dr. Chris ShieldFor more information: : http://www.diabetes.ca/for-professionals/workshops/physical-activity-and-exercise-workshops/And to reserve your spot: [email protected]

A Lunch and Learn Presentation by Dr. Jeremy Grimshaw:Friday November 16th from 11:30 to 1:00 pm at Centretown Community Health Centre and OTNDr. Grimshaw will be presenting his recently published research highlighting the impact of quality improvements (QI) interventions on diabetes management. Many QI initiatives including case management, team changes, patient education and promotion of self-management had significant effects on HbA1c, LDL cholesterol and blood pressure. Effectiveness of QI initiatives on client populations with poor control will also be discussed.

8th Annual Update in Endocrinology & Diabetes – REGISTRATION NOW OPEN!Target Audience: Family Physicians and other Healthcare ProfessionalsDate: Friday, November 23, 2012Location: Hampton Inn Ottawa & Conference CentreRegistration: http://events.cmeuottawa.ca/website/index/ENDO2012


Living Healthy Champlain NEW workshops and training

NEW in Champlain: The Living a Healthy Life with Diabetes workshop helps people living with diabetes to better manage their symptoms and their daily life. Workshop groups meet once a week for 2½ hours, over a six week period. A manual at no cost is also provided.

Some of the topics covered include: Preventing complications, skin and foot care, making an action plan, preventing low blood sugar, nutrition and healthy eating.

The Self-Management Program will not conflict with existing programs or treatment. It is designed to enhance regular treatment. The program gives participants the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

Here is how one Diabetes Educators views the NEW workshop in their region:A main focus of diabetes education IS self-management. The Living a Healthy Life with Diabetes Workshop could provide support and direction for those wanting to take control of their diabetes management and discussion with peers regarding diabetes can help form life-long friendships and a sturdy support system. Learning to trouble-shoot and brainstorm are very practical tools in diabetes management. In addition possessing the ability to manage stress can possibly have a beneficial outcome on blood glucose and Hemoglobin A1C values. The fact that the program is focused only on diabetes as the chronic disease is helpful because clients can become more disease specific which is important with such a complex illness and opens the doors to further referrals to diabetes education programs.

Visit www.livinghealthychamplain.ca for a schedule of workshops in Champlain

NEW Training: Diabetes Cross Training in Ottawa; Monday Oct. 29 and Tuesday Oct. 30, 2012 from 8:30-4:00 pm This will be an 8 hour session each day for 2 days, for current Peer leaders who have already been trained in the general chronic disease workshop. This training will allow you to also provide the Diabetes Self-Management workshop.Registration deadline is October 19, 2012http://www.livinghealthychamplain.ca/getInvolved/register/register.aspx?id=168


The DRCCs across Ontario collaborate on a number of provincial initiatives and share best practices and provincial resources such as the OTN archived events which focus on Diabetes:http://www.sedrcc.ca/index.php/links-professional/otn-archived-diabetes-events

Interdisciplinary Management of the patient with Diabetes and ComplicationsTSM#19440824_TIM_NDHN_An Outreach Coninuing Education Program in Interprofessi.. Diabetes Management for Primary Care Providers _Live and Archived_6/19/2012 http://mediasite.otn.ca/Mediasite/Play/b09e80e9040c4985814442e38880b6821d?catalog=fd668812-d87c-47f9-b1ba-6d979fed9af4

Interdisciplinary Management of the patient with diabetes on insulinTSM #: 19610723_TIM_NDHN_2874_RCN_01_Interprofessional Diabetes Management Series for Primary Care Providers_Live and Archived_5/22/2012http://mediasite.otn.ca/Mediasite/Play/808d5830f7794168a12266bd7156235e1d?catalog=fd668812-d87c-47f9-b1ba-6d979fed9af4

Care of the elderly patient with diabetesTSM #: 20946757_Providence Care -MHS_The Care of Elderly Patients with Diabetes_Live and Archived_4/27/2012http://mediasite.otn.ca/Mediasite/Play/6e2bbbe0775f4649a478e5e082e3b5f71d

aDDitional resources - otn sessions

For Healthcare Providers:

Updated Achieving Glycemic Control in Type 2 Diabetes tool from the Centre for Effective Practice:http://www.effectivepractice.org/index.cfm?pagepath=PROJECTS/Diabetes_Tool_Update&id=43593

For People Living with Diabetes:Diabetes Funding Resources: http://ww.champlainrcc.ca/people_diabetes/funding_assistance.html

Cardiovascular Self-Assessment Tool:http://www.diabetes.ca/documents/about-diabetes/FINAL_PATIENT_TOOL_FOR_WEBSITE.pdf

tools

diabetes complications challenges and innovations · vol.2, no. 4, september 2012 t his issue of...

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