Abstracts / Can J Diabetes 38 (2014) S29eS74 S55

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Level and Predictors of Diabetic Foot Self-Care and ClinicalMonitoring in Type 2 Diabetes Patients: The ABCD Cohort StudyFATIMA AL SAYAH, SUMIT R. MAJUMDAR, WEIYU QIU,ALLISON SOPROVICH, JEFFREY A. JOHNSONEdmonton, AB

Objective: To examine the level and predictors of self-care andclinical monitoring for diabetic foot in type 2 diabetes (T2DM)patients in Alberta.Data source & measures: Baseline data from a 5-year prospectivecohort of T2DM patients (n¼2080) was used. The Summary ofDiabetes Self-Care Activities was used to assess foot self-care,dichotomized at the sample mean to indicate “good self-care”.Clinical monitoring by a healthcare professional was assessed byself-report of checking feet for sores/irritations and use of mono-filament test in the past year.Results: Mean age of respondents was 64 (SD 11) years, 45%female, 90% Caucasian. 49% of participants performed good footself-care, 41% reported clinical monitoring for sores/irritationsand 34% received the monofilament test. In adjusted logisticregression models, female sex (OR¼1.4; 95%CI: 1.07, 1.73), highself-efficacy (2.0; 1.2, 3.4), checking feet for sores/irritations (1.6;1.1, 2.2) and self-reported hyperlipidemia (0.75; 0.58, 0.98) wereassociated with good self-care. Female sex (0.77; 0.60, 0.98),urban address (1.4; 1.06, 1.89) and good foot self-care (1.7; 1.3,2.1) were associated with clinical monitoring of feet for sores/irritations. Urban address (1.4; 1.01, 1.85), good foot self-care(1.5; 1.2, 1.9), longer diabetes duration (1.03; 1.01, 1.04) and self-reported neuropathy (1.7; 1.2, 2.3) were associated withreceiving a monofilament test.Conclusion: Foot self-care is generally low in this cohort of T2DMpatients, and clinical monitoring is performed for less than half ofthese patients, with significant variations by patient demographicsand clinical presentation.

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Differences in Preconceptual Counselling and PregnancyPlanning Advice Between Women with Pregestational Type 1Diabetes and Pregestational Type 2 DiabetesDANIELLE STRINGER*, LEIGH MINUK, LAURA KERR, RACHELLE GOVIA,MAUREEN HEAMAN, MARGARET MORRIS, SORA LUDWIG,VINCENT WOO, CURTIS OLESCHUK, SILVANA HANSON, BRENDA ELIAS,SHAYNE TABACKWinnipeg, MB

Poor preconceptual and early gestational glycemic control in-creases risk of congenital malformations; therefore, effectivepreconceptual counselling to achieve adequate glycemic controlis essential. Our objective was to assess the proportion ofwomen with type 1 diabetes (T1D) and type 2 diabetes (T2D)receiving preconceptual counselling and pregnancy planningadvice consistent with clinical practice guidelines for diabetes inpregnancy. We surveyed 36 pregnant women with T1D (n¼8) orT2D (n¼28) at a large tertiary care hospital in Winnipeg, Man-itoba. Questions regarding preconceptual care and pregnancyplanning advice were based on the 2008 CDA clinical practiceguidelines for diabetes in pregnancy. Differences in proportionsof responses were assessed using X2 tests. While 71% of womenwith T1D reported being advised to take birth control untilachieving optimal glycemic control, only 18% of women withT2D reported being advised of the same (p<0.01). Sixty-threepercent of women with T1D were advised to take 5 mg folicacid 3 months before becoming pregnant, while only 11% ofwomen with T2D reported receiving the same advice (p¼0.004).There were no significant differences in the proportion of

women with T1D or T2D who reported receiving informationregarding specific diabetes management practices, meeting withan interdisciplinary healthcare team, advised to see an eyedoctor or who were given a urine test to monitor for ketonesbefore conceiving. While most preconceptual counselling andpregnancy planning advice were consistent between womenwith T1D and T2D, differences did exist regarding birth controluse and folic acid supplementation preconception.

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Evaluating the Role of Clinical Practice Guidelines for Diabetesin Pregnancy: A Survey of Specialist PhysiciansDANIELLE STRINGER*, LEIGH MINUK, LAURA KERR, RACHELLE GOVIA,MAUREEN HEAMAN, MARGARET MORRIS, SORA LUDWIG,VINCENT WOO, CURTIS OLESCHUK, SILVANA HANSON, BRENDA ELIAS,SHAYNE TABACKWinnipeg, MB

Introduction: Despite the existence of national clinical practiceguidelines (CPG) for diabetes in pregnancy (DIP), local imple-mentation of CPGs faces several barriers, including perceived utilityof CPGs and healthcare system constraints. Our objective was toassess attitudes and beliefs regarding CPGs for DIP as a startingpoint to create solutions for perceived barriers to guidelineimplementation.Methods: We surveyed 10 endocrinologists and obstetricians withexpertise in DIP at 2 tertiary care hospitals in Winnipeg, Manitoba.Surveys were based on the 2008 CDA CPGs for DIP. Physicians alsocompleted the Assessment of Chronic Illness Care Survey (ACIC) toevaluate the organization of care for DIP.Results: All physicians were aware of the CDA CPGs and agreedon their use in clinical practice. The majority believed theguidelines to be supported by scientific evidence, applicable totheir patients, unbiased, practical and economically responsible.The 3 most prominent barriers to CPG use identified were non-applicability to patients of lower socioeconomic status, imprac-ticality for rural/northern patients and healthcare system orga-nizational constraints. Accordingly, ACIC results indicated basicsupport for chronic illness care. Qualitative analysis revealedcommon opinions among physicians, including the need for aManitoba provincial strategy addressing the increased preva-lence of DIP.Conclusions: Although confident in the CDA CPGs for DIP, therewas a consensus that guidelines need to be modified to a localcontext for successful implementation in specialized pop-ulations and to fit with the current basic level of support forchronic illness care for treating diabetes in pregnancy inManitoba.

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An Interprofessional Shared Decision-Making and Goal-SettingDecision Aid for Patients with Diabetes: Preliminary Results ofa Feasibility StudyCATHERINE H. YU*, SUSAN HALL, DAWN STACEY, JOANNA SALE,SHARON E. STRAUSToronto, ON; Ottawa, ON

Background: Competing disease priorities and competing patient-physician priorities present challenges in the care of the complexpatient. An individualized approach to the patient with diabetesand comorbid conditions using shared decision-making (SDM) andpriority setting has been advocated as a patient-centred approachthat may facilitate prioritization of treatment options.