Jeffrey A Johnson

University of Alberta, Edmonton, Alberta, Canada

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Publications (231)813.43 Total impact

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    ABSTRACT: Epidemiological research has posited a 'healthy user' bias in patients receiving influenza vaccination; thus we sought to evaluate potential healthy-user attributes and their associations with influenza vaccination. Between 2011 and 2013, adults with type 2 diabetes were enrolled in a prospective cohort in Alberta, Canada. Information collected included sociodemographics, diabetes-related data (e.g., duration, complications), health behaviors (e.g., smoking status), functional health status, and satisfaction with healthcare. Data were collected by a mailed, self-administered survey. Multivariable logistic regression analyses were used to identify potential healthy-user attributes independently associated with influenza vaccination. From a cohort of 2040 patients, 1287 (63%) reported receiving the influenza vaccine in the previous year. Average age of the cohort was 64 years (standard deviation 11) and 55% were male. In multivariable analysis, attributes independently associated with influenza vaccination included receiving preventive medications: aspirin (64% vs 44%; adjusted odds ratio, aOR 1.65, 95% CI 1.34-2.04); blood pressure medications (76% vs 56%; aOR 1.36, 95% CI 1.07-1.71); and cholesterol-lowering medications (74% vs 53%; aOR 1.50, 95% CI 1.19-1.89), as well as having a healthcare professional check feet for lesions (47% vs 31%; aOR 1.39, 95% CI 1.12-1.74). Additional covariates independently associated with influenza vaccination included: age over 65 years, respiratory disease, the number of additional comorbidities, and higher ratings of healthcare experience. Vaccinated diabetic patients exhibit many postulated attributes of 'healthy users', which has implications for the interpretation of epidemiological studies of influenza vaccine effectiveness, as well as targeting future vaccination campaigns. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 06/2015; DOI:10.1016/j.vaccine.2015.05.047 · 3.49 Impact Factor
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    ABSTRACT: To identify which activities produced a significant improvement in blood pressure control in patients with type 2 diabetes when pharmacists were added to primary care teams. This prespecified, secondary analysis evaluated medication management data from a randomized controlled trial. The primary outcome was a change in treatment, defined as addition, dosage increase, or switching of an antihypertensive medication during the 1-year study period. The secondary outcome was a change in antihypertensive medication adherence using the medication possession ratio (MPR). The 200 evaluable trial patients had a mean age of 59 (SD, 11) years, 44% were men, and mean blood pressure was 130 (SD, 16)/74 (SD, 10) mm Hg at baseline. Treatment changes occurred in 45 (42%) of 107 patients in the intervention group and 24 (26%) of 93 patients in the control group (RR, 1.63; 95% CI, 1.08-2.46). Addition of a new medication was the most common type of change, occurring in 34 (32%) patients in the intervention group and 17 (18%) patients in the control group (P = 0.029). Adherence to antihypertensive medication was high at baseline (MPR, 93%). Although medication adherence improved in the intervention group (MPR, 97%) and declined in the control group (MPR, 91%), the difference between groups was not significant (P = 0.21). The observed improvement in blood pressure control when pharmacists were added to primary care teams was likely achieved through antihypertensive treatment changes and not through improvements in antihypertensive medication adherence.
    Journal of the American Pharmacists Association 04/2015; 55(3):e301-e304. DOI:10.1331/JAPhA.2015.14225
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    ABSTRACT: To the Editor: We thank Frans Pouwer for his comments on our study [1] exploring adherence to glucose-lowering drugs following a cancer diagnosis among individuals with diabetes [2]. Our findings revealed that there was a significant drop in the medication possession ratio at the time of cancer diagnosis, with the largest drops among patients with stage IV disease and gastrointestinal or pulmonary cancers. In his letter, Pouwer describes two potential mechanisms that could explain these results [1].As Pouwer indicates, weight loss has been associated with improvements in beta cell function and insulin sensitivity among individuals with diabetes. As a result, glucose levels decline, HbA1c values improve and less glucose-lowering drug treatment may be required to obtain optimal metabolic control. While weight loss is common among cancer patients, especially among those with gastrointestinal, lung or advanced cancer, as described by Pouwer, the impact of weight loss on metabolic control a ...
    Diabetologia 04/2015; 58(6). DOI:10.1007/s00125-015-3578-8 · 6.88 Impact Factor
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    ABSTRACT: To examine the association between socioeconomic factors and ophthalmic care services/visual impairment among patients with diabetes. Data from the Survey on Living with Chronic Disease in Canada (SLCDC)-Diabetes Component 2011 were used. A cross-sectional, nationally representative sample of patients with diabetes weighted to represent the civilian, noninstitutionalized Canadian population with self-reported type II diabetes. Socioeconomic factors were classified into predictive factors, need, and non-need factors. Factors associated with the ophthalmic care utilization and visual impairment were assessed using logistic regression models, weighted for the SLCDC sampling strategy. Among all patients with type II diabetes, factors associated with increased eye screening were: (i) discussion of diabetic complications with health professionals (odds ratio [OR] 2.02, 95% CI 1.28-3.19); (ii) having private insurance (OR 3.23, 95% CI 2.21-4.73); and (iii) duration of diabetes longer than 10 years (OR 1.53, 95% CI 1.04-2.25). Among asymptomatic patients (those who reported having no visual impairment), patients with lower income had 40% decreased odds of having eye screening services compared with those with higher income (OR 0.60, 95% CI 0.37-0.98). Among all patients with type II diabetes, visual impairment was more likely in females (OR 1.53, 95% CI 1.12-2.09), older patients (OR 18.12, 95% CI 6.63-49.51), and those with poor self-rated health (OR 3.10, 95% CI 1.62-5.96). Our study found that interactions between health professionals and patients, as well as having private health insurance, were the main factors associated with ophthalmic resource utilization, whereas age, sex, duration of diabetes, and self-rated health were associated with visual impairment in patients with type II diabetes. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
    Canadian Journal of Ophthalmology 04/2015; 50(2):119-126. DOI:10.1016/j.jcjo.2014.11.014 · 1.30 Impact Factor
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    ABSTRACT: Inadequate health literacy has been associated with poorer health behaviors and outcomes in individuals with diabetes or depression. This study was conducted to examine the associations between inadequate health literacy and behavioral and cardiometabolic parameters in individuals with type 2 diabetes and to explore whether these associations are affected by concurrent depression. The authors used cross-sectional data from a study of 343 predominantly African Americans with type 2 diabetes. Inadequate health literacy was significantly and modestly associated with diabetes knowledge (r = -0.34) but weakly associated with self-efficacy (r = 0.16) and depressive symptoms (r = 0.24). In multivariate regression models, there were no associations between health literacy and A1c, blood pressure, or body mass index or control of any of these parameters. There was no evidence that depression was an effect-modifier of the associations between health literacy and outcomes. Although inadequate health literacy was modestly associated with worse knowledge and weakly associated with self-efficacy, it was not associated with any of the cardiometabolic parameters the authors studied. Because this study showed no association between health literacy and behavioral and cardiometabolic outcomes, it is unseemly and premature to embark on trials or controlled interventions to improve health literacy for the purposes of improving patient-related outcomes in diabetes.
    Journal of Health Communication 03/2015; 20(5):1-8. DOI:10.1080/10810730.2015.1012235 · 1.61 Impact Factor
  • Fatima Al Sayah, Sumit R Majumdar, Jeffrey A Johnson
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    ABSTRACT: To examine the relationship of inadequate health literacy (HL) with changes in depressive symptoms, health-related quality of life and cardiometabolic outcomes in patients with type 2 diabetes mellitus recently screened positive for depression. Secondary analysis of data from a clinical trial (N=154) that compared a collaborative team care model and enhanced usual care for primary care for patients with type 2 diabetes and depression. The exposure of interest was inadequate HL, defined as a total summative score of 9 or more on the 3 brief screening questions. Outcomes of interest were differences in the changes in depressive symptoms (Patient Health Questionnaire-9 (PHQ-9) at 12 months, health-related quality of life (short-form health survey 12 [SF-12]) and European Quality of Life-5 Dimensions questionnaire (EQ-5D), glycemic control (A1C), low-density lipoprotein cholesterol and systolic blood pressure. The average age of patients was 58 years; 56% were women and were predominantly white. Only a small proportion (n=24; 16%) had inadequate HL. In adjusted random effects models, there were no statistically significant or clinically important differences in all outcomes between the HL groups. The between-group differences in change over 1 year were -0.55 points for PHQ-9; 0.76 points for physical and 0.56 points for mental summaries of the SF-12; 0.03 points for EQ-5D; -0.17 for A1C; -0.08 mmol/L for low-density lipoprotein; and -1.94 mm Hg for systolic blood pressure. Among primary care patients with type 2 diabetes who had been screened recently as being positive for depression, it is unlikely that HL impacts health outcomes over 1 year. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    03/2015; DOI:10.1016/j.jcjd.2014.11.005
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    ABSTRACT: Adherence to glucose-lowering drug (GLD) treatment regimens is crucial for metabolic control and improving prognosis. Because a diagnosis of cancer might have an impact on adherence to medication, this study explored changes in adherence to GLDs following a cancer diagnosis. All new users of GLDs between 1998 and 2011 who lived in the Eindhoven Cancer Registry-PHARMO Database Network catchment area were selected. Those with a primary cancer diagnosis during follow-up were considered cases and matched with eligible controls without cancer during follow-up. Medication possession ratio (MPR) was used as indicator for medication adherence. Segmented linear auto-regression analysis with interrupted time series was used to assess changes in MPR for cases compared with controls (i.e. overall trend) due to (any) cancer diagnosis and specific cancer types. From the 52,228 GLD users selected, 3,281 cases with cancer and 12,891 controls without cancer during follow-up were included in the study. In our analyses, before cancer diagnosis the MPR increased by 0.10% per month (95% CI 0.10, 0.10). Besides a significant drop in MPR at the time of cancer diagnosis of -6.3% (95% CI -6.5, -6.0), there was an ongoing, yet lower, monthly decline in MPR (-0.20%; 95% CI -0.21, -0.20) after cancer diagnosis. The largest drops in MPR at the time of cancer diagnosis, in the range of 11-15%, were seen among patients with stage IV disease and gastrointestinal or pulmonary cancers. Our findings indicate a clear decline in adherence to GLD treatment regimens following a cancer diagnosis. The reason for the decline in MPR needs to be further elucidated.
    Diabetologia 02/2015; 58(5). DOI:10.1007/s00125-015-3497-8 · 6.88 Impact Factor
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    ABSTRACT: Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality-of-life among survivors of critical illness. Prospective multicenter observational cohort study. ICUs in six hospitals from across Alberta, Canada. Four hundred twenty-one critically ill patients who were 50 years or older. None. Frailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality-of-life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality-of-life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality-of-life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months. Frail survivors of critical illness experienced greater impairment in health-related quality-of-life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.
    Critical Care Medicine 01/2015; 43(5). DOI:10.1097/CCM.0000000000000860 · 6.15 Impact Factor
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    ABSTRACT: Our purpose was to measure the effect of non-benefit drug use on observed associations between exposure and outcome, thereby documenting an empirical example of the potential magnitude of biases introduced when exposure status is misclassified from a restrictive drug coverage policy. New users of antidiabetic agents were identified with a 1-year washout period between January 1, 1995, and December 31, 2005, in Saskatchewan, Canada, and were followed until December 31, 2008. Within this population-based cohort, persons were classified as users of benefit or non-benefit thiazolidinediones (TZDs) according to their first prescription record between January 1, 2006, and December 31, 2006 (non-benefit prescription records were not captured before 2006). An intention-to-treat approach was used to categorize TZD exposure over time. We evaluated the potential bias introduced by drug exposure misclassification by evaluating bootstrapped differences in hazard ratio (HR) estimates of all-cause hospitalization or death between users and nonusers of TZDs obtained from analyses that contained complete drug use (non-benefit and benefit drug use) versus benefit drug use only (non-benefit drug use was misclassified as unexposed). All analyses were replicated within the same cohort of new users of antidiabetic agents for clopidogrel and β-blocker (bisoprolol or carvedilol) users versus nonusers because these agents were also subject to exposure misclassification from non-benefit drug use during the period of the study. Among 27,333 new users of antidiabetic agents, we identified 5759 TZD users (28% non-benefit) and 21,574 nonusers of TZDs. The crude HR for hospitalization or death among TZD users versus nonusers was higher in a database that contained benefit-only prescriptions than in a database that contained all prescriptions (HR = 1.11 [95% CI, 1.05-1.18] vs HR = 0.99 [95% CI, 0.94-1.04]). However, the differences in HRs after adjustment for demographic characteristics, health care utilization, comorbidities, and medications suggested minimal bias was introduced when TZD exposure was misclassified in the benefit-only database (adjusted HR [aHR] = 1.04 [95% CI. 0.98-1.10] vs aHR = 0.99 [95% CI, 0.94-1.04]; bootstrapped aHR difference = +0.05 [95% CI, 0.02-0.08]). Minimal differences in aHRs were also observed within analyses of clopidogrel (1551 users [24% non-benefit]; bootstrapped aHR difference = +0.01 [95% CI, -0.04 to 0.06]) and β-blocker users (351 users [42% non-benefit]; bootstrapped aHR difference = +0.06 [95% CI, -0.09 to 0.20]) versus nonusers. Although patient characteristics and outcomes differed between users of non-benefit and benefit drugs, misclassification of drug exposure did not meaningfully bias estimates of all-cause mortality and hospitalization after covariate adjustment in our study. Copyright © 2015 Elsevier HS Journals, Inc. All rights reserved.
    Clinical Therapeutics 01/2015; 37(3). DOI:10.1016/j.clinthera.2014.12.014 · 2.59 Impact Factor
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    ABSTRACT: The evidence on the association between pioglitazone use and bladder cancer is contradictory, with many studies subject to allocation bias. The aim of our study was to examine the effect of exposure to pioglitazone on bladder cancer risk internationally across several cohorts. The potential for allocation bias was minimised by focusing on the cumulative effect of pioglitazone as the primary endpoint using a time-dependent approach. Prescription, cancer and mortality data from people with type 2 diabetes were obtained from six populations across the world (British Columbia, Finland, Manchester, Rotterdam, Scotland and the UK Clinical Practice Research Datalink). A discrete time failure analysis using Poisson regression was applied separately to data from each centre to model the effect of cumulative drug exposure on bladder cancer incidence, with time-dependent adjustment for ever use of pioglitazone. These were then pooled using fixed and random effects meta-regression. Data were collated on 1.01 million persons over 5.9 million person-years. There were 3,248 cases of incident bladder cancer, with 117 exposed cases and a median follow-up duration of 4.0 to 7.4 years. Overall, there was no evidence for any association between cumulative exposure to pioglitazone and bladder cancer in men (rate ratio [RR] per 100 days of cumulative exposure, 1.01; 95% CI 0.97, 1.06) or women (RR 1.04; 95% CI 0.97, 1.11) after adjustment for age, calendar year, diabetes duration, smoking and any ever use of pioglitazone. No association was observed between rosiglitazone and bladder cancer in men (RR 1.01; 95% CI 0.98, 1.03) or women (RR 1.00; 95% CI 0.94, 1.07). The cumulative use of pioglitazone or rosiglitazone was not associated with the incidence of bladder cancer in this large, pooled multipopulation analysis.
    Diabetologia 12/2014; 58(3). DOI:10.1007/s00125-014-3456-9 · 6.88 Impact Factor
  • Florence Y Lai, Jeffrey A Johnson, Doug Dover, Padma Kaul
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    ABSTRACT: Background We assessed the prevalence and pregnancy outcomes of preexisting diabetes mellitus (pre-DM) and gestational diabetes mellitus (GDM) in Alberta, Canada, 2005-2011.Methods We conducted a retrospective analysis of 327,198 singleton and 5,552 twin pregnancies resulting in live/still births in Alberta. We evaluated the odds ratios of adverse outcomes comparing pre-DM vs. no diabetes and GDM vs. no diabetes, controlling for maternal characteristics.ResultsDiabetes complicated 6.3% of pregnancies, with 88% being GDM. In singleton pregnancies, pre-DM and GDM were associated with increased risks of preeclampsia (adjusted odds ratio (aOR)=3.38 and 1.83, respectively), Caesarean delivery (aOR=2.53, 1.55), spontaneous preterm (aOR=4.20, 1.71) and labour-induced preterm (aOR=3.82, 2.00) in the mother; and macrosomia (aOR=2.11, 1.30), shoulder dystocia (aOR=1.54, 1.32), congenital anomalies (aOR=1.61, 1.20), and neonatal intensive care unit (NICU) admissions (aOR=3.81, 1.60) in the infants. In addition, pre-DM was associated with increased likelihood of stillbirth (aOR=3.73) and neonatal death (aOR=2.00), compared with non-diabetic pregnancies. In twin pregnancies, pre-DM was associated with increased risks of spontaneous (aOR=3.54) and labour-induced preterm births (aOR=3.57), large-for-gestational-age (LGA) infants (aOR=3.73), congenital anomalies (aOR=3.05) and NICU admissions (aOR=2.91). GDM was associated with increased risk of preeclampsia (aOR=1.54), Caesarean delivery (aOR=1.57) and LGA infants (aOR=1.63).Conclusions Pre-DM confers higher risks than GDM. Diabetes is associated with adverse outcomes in singleton and twin pregnancies, and the increased risks are generally similar or less in twins, probably due to their higher ‘baseline’ risks and closer clinical monitoring.
    Journal of Diabetes 12/2014; DOI:10.1111/1753-0407.12255 · 2.35 Impact Factor
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    ABSTRACT: The identification of sex-based disparities in the use of effective medications in high-risk populations can lead to interventions to minimize disparities in health outcomes. The objective of this study was to determine sex-specific rates of cardioprotective medication use in a large population-level administrative-health database from a universal-payer environment. This observational, population-based cohort study used provincial administrative data to compare the utilization of cardioprotective medications between women and men in the first year following a diabetes diagnosis. Competing risks regression was used to calculate crude and adjusted sub-hazard ratios for time-to-first angiotensin-converting-enzyme inhibitor, angiotensin receptor blocker, or statin dispensations. There were 15,120 (45.4%) women and 18,174 (54.6%) men with diabetes in the study cohort. Overall cardioprotective medication use was low for both primary and secondary prevention for both women and men. In the year following a diabetes diagnosis, women were less likely to use a statin relative to men (adjusted sub-hazard ratio [aSHR] 0.90, 95% confidence interval [CI] 0.85 to 0.96), angiotensin-converting-enzyme inhibitors (aSHR 0.90, 95% CI 0.86 to 0.94), or any cardioprotective medication (aSHR 0.93, 95% CI 0.90 to 0.97). Cardioprotective medication use was not optimal in women or men. We also identified a health care gap with cardioprotective medication use being lower in women with diabetes compared to men. Closing this gap has the potential to reduce the impact of cardiovascular disease in women with diabetes.
    Diabetology and Metabolic Syndrome 11/2014; 6(1):117. DOI:10.1186/1758-5996-6-117 · 2.50 Impact Factor
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    ABSTRACT: This study aimed to describe the influence of social support on participants’ self-efficacy and motivation to perform physical activity before, during and after the Healthy Eating and Active Living for Diabetes in primary care networks (HEALD) programme.HEALD was a controlled trial of a 24-week primary care-based walking programme for people with type 2 diabetes, proven effective in increasing physical activity. Data used in this qualitative sub-study were derived from semi-structured interviews with purposefully selected HEALD completers (n = 13) six months after the programme ended. Qualitative data were analysed using content analysis.Prior to HEALD, participants reported feeling a lack of social support for diabetes management and fear of diabetes consequences. During the programme, they reported feeling supported by exercise specialists and peers in general and specifically to do physical activity; they reported weakening social support after HEALD ended. Accordingly, participants reported having self-efficacy and motivation to increase their physical activity during HEALD, but these did not persist after HEALD ended; many relapsed into former behaviours. Participants recommended a longer programme, with more contacts.Our findings are congruent with Social Cognitive Theory. Participants’ reported self-efficacy and motivation to adopt physical activity during HEALD were tied to feeling supported by the exercise specialists who led the programme and peers participating in the programme. However, these perceived improvements were compromised when social support was no longer available through HEALD. Periodic contacts with a health care provider post-programme may promote maintenance of positive behaviour changes following diabetes self-management programmes. Furthermore, an optimal mode of peer support requires study. Copyright © 2014 John Wiley & Sons, Ltd.
    11/2014; 31(9). DOI:10.1002/pdi.1905
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    ABSTRACT: Background: The use of the interactive communication loop has been recommended as an effective method to enhance patient understanding and recall of information. Objective: The aim of the study was to examine the application of interactive communication loops, use of jargon, and the impact of health literacy (HL) when nurses provide education and counseling to patients with type 2 diabetes in the primary care setting in Alberta, Canada. Methods: Encounters between nurses and patients with type 2 diabetes were audio recorded, and a patient survey including a HL measure was administered. Topics within each interaction were coded based on five key components of the communication loop and categories of jargon. Results: Nine nurses participated in this study, and encounters with 36 patients were recorded. A complete communication loop was noted in only 11% of the encounters. Clarifying health information was the most commonly applied component (58% often used), followed by repeating health information (33% often used). Checking for understanding was the least applied (81% never used), followed by asking for understanding (42% never used). Medical jargon and mismatched language were often used in 17% and 25% of the encounters, respectively. Patients' HL did not materially affect patterns of communication in terms of using communication loops; however, nurses used less jargon and mismatched words with patients with inadequate HL. Discussion: The overuse of medical jargon accompanied with underuse of communication loop components jeopardizes patients' comprehension and retention of information that they need to know to properly self-manage their diabetes. Nurses need to develop more effective ways to communicate concepts critical to chronic diabetes self-care education and management.
    Nursing Research 11/2014; 63(6):408-17. DOI:10.1097/NNR.0000000000000055 · 1.50 Impact Factor
  • Jeffrey A Johnson
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    ABSTRACT: Few clinical controversies have persisted as long as that of the safety of sulfonylurea drugs in the management of type 2 diabetes mellitus. It has been nearly 45 years since the report from the University Group Diabetes Project (UGDP) of a significantly higher rate of cardiovascular-related death in patients using tolbutamide compared with placebo [1]. The subsequent and much larger UK Prospective Diabetes Study (UKPDS) did not confirm those findings, and in fact suggested intensified therapy with glibenclamide was associated with reduced microvascular complications in type 2 diabetes compared with conventional therapy [2]. Thus, sulfonylureas have maintained a strong position among the growing treatment options, also in large measure owing to their low cost relative to newer therapeutic agents arriving on the market.Nonetheless, numerous reports, largely using observational study designs, have continued to explore the potential negative consequences of sulfonylureas, often attempting ...
    Diabetologia 10/2014; 58(1). DOI:10.1007/s00125-014-3417-3 · 6.88 Impact Factor
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    ABSTRACT: Background Guidelines and experts describe 5% to 10% reductions in body weight as `clinically important¿; however, it is not clear if 5% to 10% weight reductions correspond to clinically important improvements in health-related quality of life (HRQL). Our objective was to calculate the amount of weight loss required to attain established minimal clinically important differences (MCIDs) in HRQL, measured using three validated instruments.Methods Data from the Alberta Population-based Prospective Evaluation of Quality of Life Outcomes and Economic Impact of Bariatric Surgery (APPLES) study, a population-based, prospective Canadian cohort including 150 wait-listed, 200 medically managed and 150 surgically treated patients were examined. Two-year changes in weight and HRQL measures (Short-Form (SF)-12 physical (PCS; MCID¿=¿5) and mental (MCS; MCID¿=¿5) component summary score, EQ-5D Index (MCID¿=¿0.03) and Visual Analog Scale (VAS; MCID¿=¿10), Impact of Weight on Quality of Life (IWQOL)-Lite total score (MCID¿=¿12)) were calculated. Separate multivariable linear regression models were constructed within medically and surgically treated patients to determine if weight changes achieved HRQL MCIDs. Pooled analysis in all 500 patients was performed to estimate the weight reductions required to achieve the pre-defined MCID for each HRQL instrument.ResultsMean age was 43.7 (SD 9.6) years, 88% were women, 92% were white, and mean initial body mass index was 47.9 (SD 8.1) kg/m2. In surgically treated patients (two-year weight loss¿=¿16%), HRQL MCIDs were reached for all instruments except the SF-12 MCS. In medically managed patients (two-year weight loss¿=¿3%), MCIDs were attained in the EQ-index but not the other instruments. In all patients, percent weight reductions to achieve MCIDs were: 23% (95% confidence interval (CI): 17.5, 32.5) for PCS, 25% (17.5, 40.2) for MCS, 9% (6.2, 15.0) for EQ-Index, 23% (17.3, 36.1) for EQ-VAS, and 17% (14.1, 20.4) for IWQOL-Lite total score.Conclusions Weight reductions to achieve MCIDs for most HRQL instruments are markedly higher than the conventional threshold of 5% to 10%. Surgical, but not medical treatment, consistently led to clinically important improvements in HRQL over twoyears.Trial NCT00850356.
    BMC Medicine 10/2014; 12(1):175. DOI:10.1186/s12916-014-0175-5 · 7.28 Impact Factor
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    ABSTRACT: Depressive symptoms are common, and when coexisting with diabetes, worsen outcomes and increase health care costs. We evaluated a nurse case-manager-based collaborative primary care team model to improve depressive symptoms in diabetic patients.
    Diabetes Care 10/2014; 37(12). DOI:10.2337/dc14-1308 · 8.57 Impact Factor
  • Canadian Journal of Diabetes 10/2014; 38(5, Supplement):S74. DOI:10.1016/j.jcjd.2014.07.219 · 0.46 Impact Factor
  • Canadian Journal of Diabetes 10/2014; 38(5, Supplement):S55. DOI:10.1016/j.jcjd.2014.07.151 · 0.46 Impact Factor
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    ABSTRACT: To determine the effectiveness of an exercise specialist led lifestyle program for adults with type 2 diabetes in primary care. Eligible participants from four primary care networks in Alberta, Canada were assigned to either a lifestyle program or a control group. The program targeted increased daily walking through individualized daily pedometer step goals for the first 3 months and brisk walking speed, along with substitution of low-relative to high-glycemic index foods over the next 3 months. The outcomes were daily steps, diet, and clinical markers, and were compared using random effects models. 198 participants were enrolled (102 - intervention and 96 - control). For all participants, (51% were women), mean age 59.5 (SD 8.3) years, A1c 6.8% (SD 1.1), BMI 33.6 kg/m2 (SD 6.5), systolic BP 125.6 mmHg (SD 16.2), glycemic index 51.7 (4.6), daily steps 5879 (SD 3130). Daily steps increased for the intervention compared to the control at 3-months (1292 [SD 2698] vs. 418 [SD 2458] and 6-months (1481 [SD 2631] vs. 336 [SD 2712]; adjusted p=0.002). No significant differences were observed for diet or clinical outcomes. A 6-month lifestyle program delivered in primary care by an exercise specialist can be effective for increasing daily walking among adults with recently diagnosed type 2 diabetes. This short-term increase in daily steps requires longer follow-up to estimate the potential impact on health outcomes.
    Canadian Journal of Diabetes 10/2014; 38(5 Supplement):S26. DOI:10.1016/j.jcjd.2014.07.071 · 0.46 Impact Factor

Publication Stats

6k Citations
813.43 Total Impact Points


  • 1997–2015
    • University of Alberta
      • • School of Public Health
      • • Department of Public Health Sciences
      • • Department of Medicine
      • • Faculty of Pharmacy and Pharmaceutical Sciences
      Edmonton, Alberta, Canada
  • 2013
    • The Ottawa Hospital
      Ottawa, Ontario, Canada
    • TEC Edmonton
      Edmonton, Alberta, Canada
    • Athabasca University
      • Centre for Nursing and Health Studies
      Атабаска, Alberta, Canada
  • 2010
    • Statistics Canada
      • Division of Health Analysis
      Ottawa, Ontario, Canada
  • 2000–2008
    • Institute of Health Economics
      Edmonton, Alberta, Canada
  • 2007
    • University of Illinois at Chicago
      • Department of Pharmacy Administration
      Chicago, Illinois, United States
  • 2005
    • National Cancer Institute (USA)
      • Division of Cancer Control and Population Sciences
      Bethesda, MD, United States
    • Thomas Jefferson University
      Filadelfia, Pennsylvania, United States
    • The University of Western Ontario
      • Department of Medicine
      London, Ontario, Canada
  • 2003
    • University of Iowa
      Iowa City, Iowa, United States