Jean-François Yale

University of Manitoba, Winnipeg, Manitoba, Canada

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Publications (46)107.73 Total impact

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    ABSTRACT: This retrospective chart audit examined the demographics, investigations, management and outcomes of adult patients with diabetes mellitus presenting to Canadian emergency departments (EDs).
    Canadian Journal of Diabetes 08/2014; 39(1). · 0.46 Impact Factor
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    ABSTRACT: Background Diabetes and non-diabetic dysglycaemia are risk factors for accelerated cognitive decline. In this planned substudy of the Outcome Reduction with Initial Glargine Intervention (ORIGIN) trial, we assessed whether normalising glucose with insulin glargine or administering omega-3 fatty acids in this population may slow this process or affect the development of cognitive impairment. Methods The ORIGIN trial recruited participants older than 50 years with dysglycaemia who were taking either no or one oral glucose-lowering drug, who had additional risk factors for cardiovascular events, whose HbA1c was less than 9%, and who were not taking insulin. Participants were recruited from 573 sites in 40 countries. Participants were randomly assigned to either titrated basal insulin glargine targeting a fasting plasma glucose concentration of 5·3 mmol/L or lower or standard care and to either omega-3 fatty acid (1 g) or placebo by a factorial design. Outcome adjudicators and data analysts were masked to treatment allocation. Cognitive function was assessed by the Mini-Mental State Examination (MMS) and Digit Symbol Substitution (DSS). The effect of insulin glargine or omega-3 fatty * acid on cognitive function over time, the annualised change in test scores, and the development of probable cognitive impairment were measured. All analyses were restricted to those participants who had a cognitive measurement at both baseline and at least one follow-up visit. The ORIGIN trial is registered with, NCT00069784. Findings Participants were randomly assigned between Sept 1, 2003, and Dec 15, 2005. MMSE and DSS were assessed in 11 685 and 3392 ORIGIN participants (mean age 63·4 years [SD 7·7]), who were followed up for a median of 6·2 years (IQR 5·8–6·7). There was no difference in the rate of change of cognitive test scores between the insulin glargine and standard care groups (for the MMSE 0·0046, 95% CI −0·0132 to 0·0224, p=0·39; and for the DSS −0·0362, −0·2180 to 0·1455, p=0·34) or between the omega-3 fatty acid and placebo groups (for the MMSE 0·0013, 95% CI −0·0165 to 0·0191, p=0·21; and for the DSS −0·0605, −0·2422 to 0·1212, p=0·72). Similarly, the incidence of probable cognitive impairment did not differ between the insulin glargine and standard care groups (p=0·065) or the omega-3 fatty acid and placebo groups (p=0·070). In a subgroup analysis, allocation to insulin glargine versus standard care seemed to reduce the decline in the MMSE (but not the DSS) in participants with dysglycaemia but without evidence of diabetes (pinteraction=0·024). Interpretation In this relatively young cohort of people with dysglycaemia, insulin mediated normoglycaemia and omega-3 fatty acid for over 6 years had a neutral effect on the rate of cognitive decline and on incident cognitive impairment. Future studies should assess the effect of these interventions in an older cohort or the effect of other glucometabolic interventions on cognitive decline. Funding Sanofi.
    The Lancet Diabetes & Endocrinology. 07/2014;
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    ABSTRACT: The Transcultural Diabetes Nutrition Algorithm (tDNA) is a clinical tool designed to facilitate implementation of therapeutic lifestyle recommendations for people with or at risk for type 2 diabetes. Cultural adaptation of evidence-based clinical practice guidelines (CPG) recommendations is essential to address varied patient populations within and among diverse regions worldwide. The Canadian version of tDNA supports and targets behavioural changes to improve nutritional quality and to promote regular daily physical activity consistent with Canadian Diabetes Association CPG, as well as channelling the concomitant management of obesity, hypertension, dyslipidemia, and dysglycaemia in primary care. Assessing glycaemic index (GI) (the ranking of foods by effects on postprandial blood glucose levels) and glycaemic load (GL) (the product of mean GI and the total carbohydrate content of a meal) will be a central part of the Canadian tDNA and complement nutrition therapy by facilitating glycaemic control using specific food selections. This component can also enhance other metabolic interventions, such as reducing the need for antihyperglycaemic medication and improving the effectiveness of weight loss programs. This tDNA strategy will be adapted to the cultural specificities of the Canadian population and incorporated into the tDNA validation methodology.
    International Journal of Endocrinology 01/2014; 2014:151068. · 1.52 Impact Factor
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    ABSTRACT: Objective Diabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes unable to achieve optimal glycemia control with a basal insulin.Research Design and Methods Patients with type 2 diabetes, a HbA1c above 7% (53 mmol/mol) and with either nocturnal hypoglycemia episodes or on sufficient basal insulin glargine (±oral agents) to achieve a fasting plasma glucose ≤6 mmol/L (108 mg/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration versus physician titration. The primary outcome was HbA1c ≤7% (53 mmol/mol) without severe hypoglycemia.ResultsAfter a mean (SD) follow-up of 159.4 days (36.2), 28.4% of participants in the self-titration arm versus 21.2% in the physician titration arm achieved HbA1c ≤7% (53 mmol/mol) without severe hypoglycemia (between-group absolute difference = 7.2%; 95% CI: -3.2 to 17.7). The lower end of this 95% composite interval was within the predetermined noninferiority boundary of -5% (p noninferiority=0.011).Conclusions In patients with type 2 diabetes on stable doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-driven titration algorithm is as effective as a physician-driven algorithm.
    Diabetes care 10/2013; · 7.74 Impact Factor
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    ABSTRACT: Obesity is common in type 2 diabetes (T2DM) and is associated with increased risk of morbidity and all-cause mortality. This analysis describes weight changes associated with insulin detemir initiation in real-life clinical practice. Study of Once-Daily Levemir (SOLVE) was a 24-week international observational study of once-daily insulin detemir as add-on therapy in patients with T2DM receiving oral hypoglycaemic agents (OHAs). 17,374 participants were included in the analysis: mean age 62 ± 12 years; weight 80.8 ± 17.6 kg; body mass index (BMI) 29.2 ± 5.3 kg/m2; diabetes duration 10 ± 7 years; HbA1c 8.9 ± 1.6%. HbA1c decreased by 1.3 ± 1.5% during the study, with insulin doses of 0.27 ± 0.17 IU/kg. Patients with higher BMI had higher pre-insulin HbA1c, and similar reductions in HbA1c with insulin therapy. Weight decreased from 80.8 ± 17.6 kg to 80.3 ± 17.0 kg (change of -0.6 [95% CI -0.65; -0.47] kg), with 35% of patients losing >1 kg. Patients with the highest pre-insulin BMI lost the greatest amount of weight: BMI < 25: +0.8 [95% CI: 0.6; 0.9] kg, 25 ≤ BMI < 30: -0.2 [95% CI: -0.3; -0.8] kg, 30 ≤ BMI < 35: -1.0 [95% CI: -1.1; -0.8] kg; BMI ≥ 35: -1.9 [95% CI: -2.2; -1.6] kg. Minor hypoglycaemia decreased with increasing BMI: 2.3 and 1.3 events per patient year for BMI <25 and ≥ 35, respectively. Overall, patients with poorly controlled T2DM achieved significant reductions in HbA1c after initiation of once-daily insulin detemir therapy, without weight gain. The favourable impact of insulin detemir on weight may not apply to other insulin preparations., NCT00825643 and NCT00740519.
    Diabetology and Metabolic Syndrome 10/2013; 5(1):56. · 2.50 Impact Factor
  • Canadian Journal of Diabetes 10/2013; 37S4:S27. · 0.46 Impact Factor
  • Canadian Journal of Diabetes 10/2013; 37S4:S27-S28. · 0.46 Impact Factor
  • Canadian Journal of Diabetes 10/2013; 37:S428–S436. · 0.46 Impact Factor
  • Canadian Journal of Diabetes 10/2013; 37S4:S39. · 0.46 Impact Factor
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    ABSTRACT: To gain insight into the current management of patients with type 2 diabetes mellitus by Canadian primary care physicians. A total of 479 primary care physicians from across Canada submitted data on 5123 type 2 diabetes patients whom they had seen on a single day on or around World Diabetes Day, November 14, 2012. Mean glycated hemoglobin (A1C) was 7.4%, low-density lipoprotein (LDL-C) was 2.1 mmol/L and blood pressure (BP) was 128/75 mm Hg. A1C ≤7.0% was met by 50%, LDL-C ≤2.0 mmol/L by 57%, BP <130/80 mm Hg by 36% and the composite triple target by 13% of patients. Diet counselling had been offered to 38% of patients. Of the 87% prescribed antihyperglycemic agents, 18% were on 1 non-insulin antihyperglycemic agent (NIAHA) (85% of which was metformin), 15% were on 2 NIAHAs, 6% were on ≥3 NIAHAs, 19% were on insulin only and 42% were on insulin + ≥1 NIAHA(s). Amongst the 81% prescribed lipid-lowering therapy, 88% were on monotherapy (97% of which was a statin). Among the 83% prescribed antihypertensive agents, 39%, 34%, 21% and 6% received 1, 2, 3 and >3 drugs, respectively, with 59% prescribed angiotensin-converting enzyme inhibitors and 35% angiotensin II receptor blockers. The Diabetes Mellitus Status in Canada survey highlights the persistent treatment gap associated with the treatment of type 2 diabetes and the challenges faced by primary care physicians to gain glycemic control and global vascular protection in these patients. It also reveals a higher use of insulin therapy in primary care practices relative to previous surveys. Practical strategies aimed at more effectively managing type 2 diabetes patients are urgently needed.
    Canadian Journal of Diabetes 04/2013; 37(2):82-9. · 0.46 Impact Factor
  • Dale Clayton, Vincent Woo, Jean-François Yale
    Canadian Journal of Diabetes 04/2013; 37:S69–S71. · 0.46 Impact Factor
  • Canadian Journal of Diabetes 04/2013; 37:S61–S68. · 0.46 Impact Factor
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    ABSTRACT: AIMS: Canagliflozin is a sodium glucose co-transporter 2 inhibitor in development for treatment of type 2 diabetes mellitus (T2DM). This study evaluated the efficacy and safety of canagliflozin in subjects with T2DM and Stage 3 chronic kidney disease (CKD; estimated glomerular filtration rate [eGFR] ≥30 and <50 mL/min/1.73 m2 ). METHODS: In this randomized, double-blind, placebo-controlled, Phase 3 trial, subjects (N=269) received canagliflozin 100 or 300 mg or placebo daily. The primary efficacy endpoint was change from baseline in HbA1c at Week 26. Pre-specified secondary endpoints were change in fasting plasma glucose (FPG) and proportion of subjects reaching HbA1c <7.0%. Safety was assessed based on adverse event (AE) reports; renal safety parameters (eg, eGFR, blood urea nitrogen, albumin/creatinine ratio) were also evaluated. RESULTS: Both canagliflozin 100 and 300 mg reduced HbA1c from baseline compared with placebo at Week 26 (-0.33%, -0.44%, and -0.03%; P <0.05). Numerical reductions in FPG and higher proportions of subjects reaching HbA1c <7.0% were observed with canagliflozin 100 and 300 mg versus placebo (27.3%, 32.6%, and 17.2%). Overall AE rates were similar for canagliflozin 100 and 300 mg and placebo (78.9%, 74.2%, and 74.4%). Slightly higher rates of urinary tract infections and AEs related to osmotic diuresis and reduced intravascular volume were observed with canagliflozin 300 mg compared with other groups. Transient changes in renal function parameters that trended toward baseline over 26 weeks were observed with canagliflozin. CONCLUSION: Canagliflozin improved glycaemic control and was generally well tolerated in subjects with T2DM and Stage 3 CKD.
    Diabetes Obesity and Metabolism 03/2013; · 5.18 Impact Factor
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    ABSTRACT: OBJECTIVES: Older patients are particularly vulnerable to hypoglycaemia. The aim of this study was to evaluate the response to initiation of once-daily insulin detemir in patients aged ≥75 years with type 2 diabetes mellitus (T2DM) treated with one or more oral antidiabetic drugs (OADs). METHODS: A sub-analysis was conducted using data from SOLVE (Study of Once daily LeVEmir), a 24-week observational study involving 3,219 investigators and 2,817 project sites from ten countries. Routine clinical practice was followed; there were no study-prescribed procedures. The total cohort comprised 17,374 participants, of whom 2,398 (14 %) were aged ≥75 years. The physicians collected information from patient recall, the patients' medical records and their self-monitored blood glucose diaries (if kept). RESULTS: Pre-insulin glycated haemoglobin (HbA(1c)) was similar between participants aged ≥75 years and those aged <75 years (HbA(1c) 8.8 ± 1.5 % vs. 8.9 ± 1.6 % [mean ± SD], respectively). After 24 weeks of treatment, similar reductions in HbA(1c) were observed in the two subgroups: 7.6 ± 1.1 % and 7.5 ± 1.2 % in participants aged ≥75 years and those aged <75 years, respectively. The incidence of severe hypoglycaemia (episodes per patient-year) decreased during the study in both age groups (from 0.057 to 0.007 in patients aged ≥75 years; from 0.042 to 0.005 in patients aged <75 years), while minor hypoglycaemia increased from 1.1 to 2.0 and from 1.7 to 1.8 episodes per patient-year in the older and younger age groups, respectively. Average weight reduction was similar in both groups: -0.5 kg (≥75 years) and -0.6 kg (<75 years). CONCLUSION: In both the older and younger age groups, the addition of once-daily insulin detemir to existing OAD regimens was effective and safe. In older patients, an improvement in HbA(1c) of 1.2 % was not associated with an increased risk of severe hypoglycaemia or weight gain.
    Drugs & Aging 02/2013; · 2.50 Impact Factor
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    ABSTRACT: Limited evidence exists on the effectiveness of external diabetes support provided by diabetes specialists and community retail pharmacists to facilitate insulin-prescribing in family practice. A stratified, parallel group, randomized control study was conducted in 15 sites across Canada. Family physicians received insulin initiation/titration education, a physician-specific 'report card' on the characteristics of their type 2 diabetes (T2DM) population, and a registry of insulin-eligible patients at a workshop. Intervention physicians in addition received: (1) diabetes specialist/educator consultation support (active diabetes specialist/educator consultation support for 2 months [the educator initiated contact every 2 weeks] and passive consultation support for 10 months [family physician initiated as needed]); and (2) community retail pharmacist support (option to refer patients to the pharmacist(s) for a 1-hour insulin-initiation session). The primary outcome was the insulin prescribing rate (IPR) per physician defined as the number of insulin starts of insulin-eligible patients during the 12-month strategy. Consenting, eligible physicians (n = 151) participated with 15 specialist sites and 107 community pharmacists providing the intervention. Most physicians were male (74%), and had an average of 81 patients with T2DM. Few (9%) routinely initiated patients on insulin. Physicians were randomly allocated to usual care (n = 78) or the intervention (n = 73). Intervention physicians had a mean (SE) IPR of 2.28 (0.27) compared to 2.29 (0.25) for control physicians, with an estimated adjusted RR (95% CI) of 0.99 (0.80 to 1.24), p = 0.96. An insulin support program utilizing diabetes experts and community retail pharmacists to enhance insulin prescribing in family practice was not successful. Too few physicians are appropriately intensifying diabetes management through insulin initiation, and aggressive therapeutic treatment is lacking. NCT00593489.
    BMC Health Services Research 01/2013; 13:71. · 1.66 Impact Factor
  • Canadian Journal of Diabetes 10/2012; 36(5):S12–S13. · 0.46 Impact Factor
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    Robert J Ligthelm, Marcel Kaiser, Jiten Vora, Jean-François Yale
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    ABSTRACT: Hypoglycemia is a significant problem in elderly adults with diabetes mellitus. Elderly individuals with diabetes mellitus are at greater risk than younger adults for hypoglycemic events. Several factors contribute to this risk, including the high prevalence of comorbidities, polypharmacy, cognitive impairment, and concomitant use of agents that interfere with glucose metabolism. To minimize the risk of hypoglycemia and maximize the benefits of glycemic control, guidelines typically recommend individualizing glycosylated hemoglobin (HbA1c) targets based on life expectancy, functional status, and individual goals. Although many individuals with type 2 diabetes mellitus will ultimately require insulin therapy to achieve and maintain glycemic control, earlier insulin initiation in elderly individuals may be warranted, particularly in those with renal, cardiovascular, or hepatic concerns that could interfere with the use of oral agents. There are few data on the use of insulin-or other glucose-lowering agents-in elderly adults, but limited evidence suggests that the use of insulin, especially insulin analogs, may be appropriate in this population. Insulin analogs offer a better pharmacokinetic profile, greater convenience, and less variable glycemic control than human insulin. Because of the high prevalence of cognitive impairment and other geriatric syndromes in elderly adults, clinicians should perform a comprehensive assessment of patients' ability to administer and monitor insulin therapy and recognize and treat hypoglycemia.
    Journal of the American Geriatrics Society 08/2012; 60(8):1564-70. · 4.22 Impact Factor
  • Amir Hanna, Vincent Woo, Jean-François Yale, Elaine M. Cooke
    Canadian Journal of Diabetes 02/2012; 36(1):9–14. · 0.46 Impact Factor
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    ABSTRACT: The Coalition for Clinical Research--Self-Monitoring of Blood Glucose Scientific Board convened a meeting in San Francisco, CA, July 20-21, 2011, to discuss the current practice of self-monitoring of blood glucose (SMBG) in non-insulin-treated (NIT) type 2 diabetes mellitus (T2DM). Twelve physician panel members from academia, practice, and government attended this meeting. These experts came from the United States, Brazil, Canada, France, Germany, Italy, and the United Kingdom. In addition, three consultants from Australia, Germany, and the United States contributed to the group's final report. This coalition was organized by Diabetes Technology Society. Self-monitoring of blood glucose was studied from eight perspectives related to patients with NIT T2DM: (1) epidemiological studies; (2) randomized controlled trials (RCT)s and meta-analyses; (3) targets, timing, and frequency of SMBG use; (4) incidence and role of SMBG in preventing hypoglycemia with single-drug regimens and combination regimens consisting of antihyperglycemic agents other than secretagogues and insulin; (5) comparison of SMBG with continuous glucose monitoring; (6) technological capabilities and limitations of SMBG; (7) barriers to appropriate use of SMBG; and (8) methods and end points for appropriate future clinical trials. The panel emphasized recent studies, which reflect the current approach for applying this intervention. Among the participants there was consensus that: SMBG is an established practice for patients with NIT T2DM, and to be most effective, it should be performed in a structured format where information obtained from this measurement is used to guide treatment; New, high-quality efficacy data from RCTs have demonstrated efficacy of SMBG in NIT T2DM in trials reported since 2008; Both patients and health care professionals require education on how to respond to the data for SMBG to be effective; and Additional well-defined studies are needed to assess the benefits and costs of SMBG with end points not limited to hemoglobin A1c.
    Journal of diabetes science and technology 11/2011; 5(6):1529-48.
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    ABSTRACT: To evaluate vascular protection treatment patterns and attainment of the 2003 Canadian Diabetes Association's recommended targets in ambulatory patients with type 2 diabetes. Between 2005 and 2006, 3002 outpatients with type 2 diabetes were enrolled by 229 primary health care settings across Canada. Baseline characteristics, therapeutic regimens and treatment success - defined as the achievement of a blood pressure (BP) of 13080 mmHg or lower, glycosylated hemoglobin (A1C) of 7% or lower, low-density lipoprotein cholesterol (LDL-C) lower than 2.5 mmolL and total cholesterolhigh-density lipoprotein cholesterol ratio lower than 4.0 - are reported. Overall, 46% of individuals had a BP that was above the Canadian Diabetes Association's recommended target. Of these, 11% were untreated, 28% were receiving monotherapy, 38% were not receiving an angiotensin-converting enzyme inhibitor and 16% were not receiving either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Optimal A1C levels were achieved in 53% of patients. Of those who did not attain A1C targets, 3% were not on glucose- lowering pharmacotherapy and 27% were receiving monotherapy. A total of 74% of patients were treated with statins. Overall, 64% and 62%, respectively, met the target LDL-C and the target total cholesterolhigh-density lipoprotein cholesterol ratio. Statins were not prescribed to 43% of patients with LDL-C above target. Antiplatelet therapy was implemented in 81% of patients. In total, 21% achieved the combined targets for BP, A1C and LDL-C. A substantial proportion of patients did not achieve guideline-recommended targets and were not receiving evidence- based therapy for vascular protection two years after publication of the Canadian guidelines. More research is warranted, and novel and effective strategies must be tested and implemented to correct this ongoing treatment gap.
    The Canadian journal of cardiology 06/2010; 26(6):297-302. · 3.12 Impact Factor

Publication Stats

616 Citations
107.73 Total Impact Points


  • 2014
    • University of Manitoba
      Winnipeg, Manitoba, Canada
    • McGill University Health Centre
      Montréal, Quebec, Canada
  • 2013
    • Laval University
      Quebec City, Quebec, Canada
    • The University of Western Ontario
      • Department of Family Medicine
      London, Ontario, Canada
  • 2003–2013
    • McGill University
      • Department of Medicine
      Montréal, Quebec, Canada
    • Université du Québec à Montréal
      Montréal, Quebec, Canada
  • 2009
    • Université de Montréal
      • Center for Mathematical Research
      Montréal, Quebec, Canada
  • 2005
    • The University of Calgary
      • Department of Paediatrics
      Calgary, Alberta, Canada
    • University of Miami
      • Department of Medicine
      Coral Gables, FL, United States