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j.jcjd.2017.08.049

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Abstracts / Can J Diabetes 41 (2017) S2?S16
Rationale: The purpose of this study was to test the hypothesis that
obesity-risk in adolescence is elevated in children expose to adverse
events, in a dose-response manner.
Methods: We performed a prospective analysis of 6942 adolescents and their primary care givers in the Growing Up in Ireland
child cohort study with measurements obtained in children at 9 and
13 yrs of age. Main exposures were adverse experiences before 9
yrs including several Adverse Child Experience (ACEs) exposures.
Main outcome was Objectively measured overweight and obesity
at 13 years of age determined using World Health Organization criteria for age and sex. Confounding included objectively measured
parental weight status, self-reported physical activity and diet, household income, gender, and family structure.
Results: More than 75% of the youth experienced an adverse experience and 17% experienced an ACE- experience before 9 yrs of age.
After adjusting for confounding, exposure to any adverse experience was associated with increased odds of overweight/obesity (aOR:
1.15; 95% CI: 1.00?1.32) and obesity (aOR: 1.35; 95% CI: 1.09?
1.69). These associations were stronger among adolescents living
in lower income households and if children were exposed to ACEspeci?c adverse experiences (overweight/obesity- aOR: 1.21; 95%
CI: 1.01?1.46; obesity- aOR: 1.50; 95% CI: 1.13?1.98).
Conclusions: Childhood adverse experiences, particularly severe
adverse experiences, are independently associated with an increased
risk of obesity in early adolescence. Increased efforts to assess and
address these experiences may improve treatment and prevention efforts for adolescent obesity.
41
Lay- or Expert-Led Interventions for Weight Loss in
Overweight Youth, What Works? A Systematic Review and
Network Meta-Analysis
BHUPENDRASINH F. CHAUHAN, RASHEDA RABBANI,
AHMED M. ABOU-SETTA, RYAN ZARYCHANSKI,
JONATHAN MCGAVOCK
Winnipeg, MB
42
Pregnancy Characteristics and Maternal Risk of Type 2
Diabetes Mellitus
CHRISTY WOOLCOTT*, SARAH D. MCDONALD, HUDE QUAN,
MOHAMED ABDOLELL, TREVOR DUMMER, LINDA DODDS
Halifax, NS
Background: Gestational diabetes mellitus (GDM) is known to be
associated with an approximately seven-fold increased risk of developing type 2 diabetes mellitus (T2DM) in women. Our objective was
to examine other pregnancy characteristics in addition to GDM in
relation to T2DM.
Methods: A population-based retrospective cohort study was conducted with information about women?s ?rst and subsequent pregnancies from the Nova Scotia Atlee Perinatal Database (1988?
2009) and later T2DM from physician claims and hospital discharge
databases (1989?2012). Hazard ratios (HR) with 95% con?dence intervals (CI) adjusted for maternal weight, age at ?rst birth, area-level
income, smoking, and other pregnancy characteristics were estimated.
Results: Among 78,977 women without pre-existing diabetes and
complete data, 2969 (3.8%) developed T2DM over a median 14.8
years of follow-up. GDM was associated with the risk of developing T2DM (HR 7.50, CI 6.90?8.15). Among women with a history of
GDM, pregnancy characteristics also associated with the risk of T2DM
included any history of: Caesarean section (HR 1.16, CI 1.01?1.34);
birthweight for gestational age >90th percentile (HR 1.29, CI 1.11?
1.49); neonatal hypoglycemia (HR 1.40, CI 1.16?1.69); and
breastfeeding (HR 0.79, CI 0.69?0.91). These characteristics were
similarly associated with T2DM risk among women without a history
of GDM; additionally, pre-eclampsia (HR 1.54, CI 1.28?1.84) and gestational hypertension (HR 1.69, CI 1.52?1.87) were associated with
T2DM in this group.
Conclusions: Pregnancy characteristics are associated with the risk
of developing T2DM, including hypertensive disorders of pregnancy among women without a history of GDM.
43
Background: Lay or peer-led approaches are an attractive
option for public health interventions however their effectiveness
for weight loss among overweight youth remains unclear. We conducted a systematic review and network meta-analysis to address
this issue.
Methods: We searched MEDLINE, Embase, the Cochrane Library, and
CINAHL from January 1, 1996 to May 20, 2016 for randomized clinical trials (RCTs) of behavioural weight loss interventions lasting 12
weeks in youth <18 years and strati?ed into 3 arms:1) lay-led; 2)
expert-led; and 3) standard of care. The primary outcomes were
change from baseline in weight and body mass index (BMI). Secondary outcomes were BMI-z score, BMI %tile, percent fat, and study
withdrawals.
Findings: Of 25,586 citations retrieved, 64 RCTs representing 5598
overweight or obese children and adolescents were analyzed (mean
age 11.4 years; 40.7% male). Compared to standard weight loss interventions, expert-led interventions yielded signi?cant reductions in
weight [median difference (MD) ?2.45 Kg, 95% credible interval (CrI)
?3.69 to ?1.32; 15 RCTs] and BMI [MD ?0.90 Kg/m2, 95% CrI ?1.60
to ?0.28; 14 RCTs]. The magnitude of weight reduction associated
with expert-led intervention was maintained even after termination of intervention [MD ?2.50, 95% CrI ?4.40, ?0.83, 6 RCTs]. Layled interventions failed to reach a statistically signi?cant reduction
in weight or BMI, compared to control [MD ?0.71 kg, 95% CrI ?3.40,
1.90 and MD ?1.74 kg/m2, 95% CrI ?4.56, 0.96]
Interpretation: Expert-led approaches are the most effective for
weight reduction among overweight youth. Sparse data on layled weight loss intervention warrants further research.
Implementation and Evaluation of the Metformin First
Protocol for Management of Gestational Diabetes Mellitus
REHA KUMAR, JULIA LOWE, FIONA THOMPSON-HUTCHISON,
DAPHNA STEINBERG, ILANA HALPERIN*
Toronto, ON
Background: In light of growing evidence recommending metformin
as ?rst-line drug therapy for gestational diabetes mellitus(GDM),
the Diabetes in Pregnancy Clinic at Sunnybrook Hospital implemented the ?Metformin First? protocol. Metformin is now offered
to all patients requiring medication for management of GDM.
Objectives & Methods: A retrospective chart review was conducted of GDM patients seen at the clinic prior to(Jan-Jul2015) and
following(Jan-Sept2016) implementation of the protocol to compare
pregnancy outcomes. A prospective patient survey was also administered to evaluate impact on patient satisfaction and clinic e?ciency.
Results: 264 patient charts were reviewed: 159 patients (60%) were
treated with lifestyle modi?cations, 46(17%) with metformin, 40(15%)
with insulin and 19(7%) with metformin+insulin. There were no signi?cant differences in rates of pregnancy complications (obstructed
labour, infants born large for gestational age, NICU admissions and
infant hypoglycemia) or gestational weight gain. Blood glucose
control was also comparable and satisfactory across groups.
Of the 65 patients initially started on metformin, 21(32%) were
switched to or provided supplemental insulin therapy. However, the
overall percentage of patients started on insulin?thus requiring individualized patient training?has decreased signi?cantly(33% in 2015
vs 17% in 2016, p=0.003). Following implementation of the protocol,
Abstracts / Can J Diabetes 41 (2017) S2?S16
patient satisfaction scores at the clinic have also increased(4.68/5
in 2016 vs 4.3/5 in 2013, p=0.01).
Conclusions: Metformin is comparable to insulin in glycemic control
and pregnancy outcomes for management of GDM. Introduction of
this protocol has resulted in improved patient satisfaction and clinic
e?ciency.
44
?
Conjoint Associations of Gestational Diabetes and
Hypertension with Diabetes, Hypertension, and Cardiovascular
Disease in Parents: A Retrospective Cohort Study
ROMINA PACE*, ANNE SOPHIE BRAZEAU, SARA MELTZER,
ELHAM RAHME, KABERI DASGUPTA
Montreal, QC
Background: The conjoint association of gestational diabetes (GDM)
and gestational hypertension (GH) with cardiometabolic disease has
not been well studied.
Objective: To evaluate combined GDM/GH risk indicator in both
mothers and in fathers given shared spousal behaviours and
environments.
Methods: In this population-based retrospective cohort study, GH
was identi?ed in matched pairs (GDM vs. no GDM, matched on age
group, health region, year of delivery) of mothers with singleton
live births (Quebec, Canada; 1990?2007). 64,232 couples were categorized based on GDM/GH status (?neither?; ?either?; or ?both?).
Associations with diabetes, hypertension, and cardiovascular disease
(CVD) and mortality composite were evaluated (12 weeks postpartum to March 2012; Cox proportional hazard models).
Results: Compared to the ?neither? category, having ?either? GDM
or GH was associated with incident diabetes (HR:14.7, 95% CI: 12.9,
16.6), hypertension (HR:1.9, 95% CI:1.8, 2.0), and CVD and mortality (HR:1.9, 95%CI:1.5, 2.4). Having ?both? demonstrated associations of greater magnitude (diabetes: HR:36.9, 95%CI:26.0,52.3;
hypertension HR:5.7, 95%CI:4.9,6.7; CVD HR: 3.5, 95%CI:2.0, 6.0).
Associations with diabetes were also observed in fathers (either
HR:1.2,9 5%CI 1.1, 1.3; both HR1.8, 95%CI:1.4, 2.3;).
Conclusions: A combined GDM/GH indicator demonstrates associations with cardiometabolic disease in mothers and diabetes in
fathers, with stronger associations when both GDM and GH occur.
45
Early Diabetes Screening, Before Hospital Discharge, in
Postpartum Women with Gestational Diabetes: A New
Validated Method
JEAN-LUC ARDILOUZE, GARRY X. SHEN, LORRAINE LIPSCOMBE,
ILANA HALPERIN, ELIZABETH SALAMON, SORA LUDWIG,
VINCENT WOO, JULIE MENARD, ANNIE OUELLET,
MARIE-HELENE PESANT, MARIE-FRANCE HIVERT,
JEAN-PATRICE BAILLARGEON
Sherbrooke, QC
Rationale: Diabetes screening with an oral glucose tolerance test
(OGTT) is recommended 6?24 weeks after gestational diabetes (GD).
However, screening rates are low. We hypothesized that an OGTT,
performed before hospital discharge, can identify women with higher
risk of glucose intolerance.
Objectives: 1) To determine and validate the optimal 2-hour plasma
glucose (2-hPG) threshold value before hospital discharge (OGTT-1)
that rules out glucose intolerance at 6?24 weeks (OGTT-2); 2) to
assess women?s preferred time for testing.
Methods: Prospective multicenter cohort study of women with GD
who performed both OGTTs and were randomly allocated to the
determination (n=110) or validation (n=220) cohort. A satisfaction questionnaire was completed after each OGTT. ROC curves were
used to determine OGTT-1 2-hPG thresholds, using OGTT-2 as the
reference standard.
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Results: Determination and validation cohorts had similar age
(32.2�4/31.5�1 years), BMI (28.9�0/29.0�4 kg/m2), ethnicity (78.2/78.2% Caucasian), OGTT values and timing. In the determination cohort, the optimal 2-hPG cut-off value was 8.0 mmol/L.
In the validation cohort, only 3.6% of the 53% who were below this
cut-off had glucose intolerance on OGTT-2. Sensitivity was 84.0%,
speci?city 57.9%, positive predictive value (PV) 20.4%, negative PV
96.6%. Most women (81%) preferred the early test.
Conclusion: An OGTT before hospital discharge accurately rules out
glucose intolerance in half of postpartum GD patients, eliminating
the need for later testing. A 2-hPG threshold of 8.0 mmol/L identi?es higher-risk women who may bene?t from targeted interventions.
46
Moms in Motion-Social Media-Assisted Prenatal Education
Program Increases Participation of Pregnant Women in
Prenatal Education in Manitoba First Nations Communities
AMY HUI, BRANDY WICKLOW, ELIZABETH SELLERS, JON MCGAVOCK,
NATHAN NICKEL, SORA LUDWIG, MARGARET MORRIS, LARRY WOOD,
WANDA PHILIPS-BECK, RHONDA CAMPBELL, FRANCES DESJARLAIS,
GLORIA MUNROE, MAXINE ROULETTE, DOLORIS BEAULIEU,
CONNIE KUZDAK
Winnipeg, MB
Previous studies have demonstrated that First Nations (FN) pregnant women urgently need feasible and culturally appropriate prenatal education. However, the prenatal class attendance rate is low
in many FN communities, or the program is not active in some communities. Socioeconomic and geographic barriers have been identi?ed as major underlying mechanism for the low access to prenatal
education in rural-living FN pregnant women in Manitoba. Access
to the internet and Facebook is widespread. We developed a
Facebook-linked website, www.momsinmotion.ca, to deliver prenatal and breastfeeding in the communities. The content includes
video/audio education on healthy eating, physical activity, diabetes/
obesity prevention and breastfeeding promotion. The website was
advertised through community radio/TV station and workshops in
3 FN communities. Pregnant women in the communities can sign
up through internet to access the information 81/220 of pregnant
women signed up for the e-education from the 3 FN communities
from July, 2015 to December, 2016, which represented 37% of total
pregnancies in the 3 FN communities. The prenatal education delivery rate was increased by 3 times (p<0.001) compared to that in
2011-13 in those communities (12%). Preterm birth and microsomia and macrosomia were reduced in the communities by 32%, 37%
and 5% after the launch of e-education compared to that before, but
the differences were not statistically different. In conclusion,
e-education increases the participation of prenatal education of ruralliving FN pregnant women and potentially improves neonatal outcomes in the communities.
Supported by the Lawson Foundation.
47
Perception of Stigma is Associated with Poor Diabetes Control
Among Adolescents and Young Adults with Type 1 Diabetes
ANNE-SOPHIE BRAZEAU, MICHAEL WRIGHT, MERANDA NAKHLA,
MELANIE HENDERSON, CONSTADINA PANAGIOTOPOULOS,
DANIELE PACAUD, ELHAM RAHME, DEBORAH DA COSTA,
KABERI DASGUPTA
Montreal, QC
Aim: Stigma related to chronic disease is rejection, judgement, or
exclusion related to the chronic disease itself. We aim to determine the prevalence of stigma among youth and young adults with
type 1 diabetes (T1D) in Canada and its association with diabetes
control.
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