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Community Health Awareness of Diabetes (CHAD): Description of a Community-Wide Diabetes Awareness Demonstration Program and its Feasibility

      Abstract

      Objective

      This article describes the Community Health Awareness Diabetes (CHAD) program and its feasibility. Developing and testing the feasibility of strategies to detect diabetes in the community is an important primary care issue. The CHAD program was designed to be a feasible and reproducible, low-cost community program to identify high-risk individuals for subsequent diabetes screening by their family doctors.

      Methods

      Participants from Grimsby, Ontario, older than age 40, were invited to self-risk-assess for diabetes using a validated questionnaire and 2 near-patient blood tests (capillary blood glucose and glycosylated hemoglobin). Some participants were self-selected, having seen advertising for the program, others were invited by a letter from their family doctor. None of the participants had pre-existing diabetes. Numbers and characteristics of participants, numbers found at risk and satisfaction of participants were examined.

      Results

      There were 588 participants in CHAD. Of these, the majority had received invitation letters, the majority of participants were seniors and were females, 526 did not have pre-existing diabetes and 16% of participants (n=84 of 526) were identified as being at high risk for diabetes. Participants at high risk of diabetes had significantly more modifiable risk factors, including higher fat, fast food and salt intake, and higher systolic blood pressure. Satisfaction with the program was high.

      Conclusions

      The CHAD program was feasible and participants were satisfied with it. Participants had a large number of modifiable risk factors. This program could be repeated in other communities and modified to suit the infrastructure of the area.

      Résumé

      Objectif

      Cet article décrit le programme CHAD (Community Health Awareness Diabetes) et sa faisabilité. Développer et vérifier la faisabilité des stratégies pour détecter le diabète dans la communauté est un enjeu important des soins primaires. Le programme CHAD était désigné comme étant un programme communautaire à faible coût, réalisable et reproductible pour identifier les individus exposés à un risque élevé lors d’un dépistage du diabète par leurs médecins de famille.

      Méthodes

      Les participants âgés de plus de 40 ans de Grimsby, en Ontario, étaient invités à évaluer eux-mêmes le risque de diabète en utilisant un questionnaire validé et 2 analyses sanguines hors laboratoire (glycémie capillaire et hémoglobine glyquée). Certains participants s’étaient autosélectionnés après avoir consulté la publicité du programme, les autres avaient reçu une invitation écrite de leur médecin de famille. Aucun des participants n’avait un diabète préexistant. Le nombre et les caractéristiques des participants, le nombre étant exposé à un risque et la satisfaction des participants étaient examinés.

      Résultats

      Il y avait 588 participants au CHAD. Parmi ceux-ci, la majorité avait reçu des lettres d’invitation, la majorité des participants était des personnes âgées et était de sexe féminin, 526 participants n’avaient pas un diabète préexistant et 16 % de ces derniers (n = 84 des 526) étaient reconnus comme étant exposés à un risque élevé de diabète. Les participants exposés à un risque élevé de diabète avaient significativement plus de facteurs de risque modifiables, incluant les matières grasses, les repas rapides et l’apport en sel plus élevés, et une pression artérielle systolique plus élevée. Le niveau de satisfaction concernant le programme était élevé.

      Conclusions

      Le programme CHAD était réalisable et les participants en étaient satisfaits. Les participants avaient un grand nombre de facteurs de risque modifiables. Ce programme pourrait être répété dans d’autres communautés et modifié pour s’adapter à l’infrastructure de la région.

      Keywords

      Mots clés

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      References

        • Lipscombe L.
        • Hux J.
        Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study.
        Lancet. 2007; 369: 750-756
        • Hogan P.
        • Dall T.
        • Nikolov P.
        American Diabetes Association. Economic costs of diabetes in the US in 2002.
        Diabetes Care. 2003; 26: 917-932
        • Harris R.
        • Donahue K.
        • Rathore S.S.
        • et al.
        Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2003; 138: 215-229
        • Knowler W.C.
        • Barrett-Connor E.
        • Fowler S.E.
        • et al.
        Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle and metformin.
        N Engl J Med. 2002; 346: 393-403
        • Canadian Diabetes Association Clinical Practice Guidelines Expert Committee
        Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.
        Can J Diabetes. 2003; 27: s2
        • American Diabetes Association
        Screening for type 2 diabetes.
        Diabetes Care. 2003; 26: S21-S24
        • Chen T.H.
        • Yen M.F.
        • Tung T.H.
        A computer simulation model for cost-effectiveness analysis of mass screening for type 2 diabetes mellitus.
        Diabetes Res Clin Pract. 2001; 54: S37-S42
        • Kuo H.S.
        • Chang H.J.
        • Chou P.
        • et al.
        A Markov chain model to assess the efficacy of screening for non-insulin dependent diabetes mellitus (NIDDM).
        Int J Epidemiol. 1999; 28: 233-240
        • Edelman D.
        • Olsen M.K.
        • Dudley T.K.
        • et al.
        Utility of hemoglobin A1c in predicting diabetes risk.
        J Gen Intern Med. 2004; 19: 1175-1180
        • Ealovega M.W.
        • Tabaei B.P.
        • Brandle M.
        • et al.
        Opportunistic screening for diabetes in routine clinical practice.
        Diabetes Care. 2004; 27: 9-12
        • Tabaei B.P.
        • Burke R.
        • Constance A.
        • et al.
        Community based screening for diabetes in Michigan.
        Diabetes Care. 2003; 26: 668-670
        • Lawrence J.M.
        • Bennet P.
        • Young A.
        • et al.
        Screening for diabetes in general practice: cross sectional population study.
        BMJ. 2001; 323: 548-551
        • Tsuyuki R.T.
        • Johnson J.A.
        • Teo K.K.
        • et al.
        A randomized trial of the effect of community pharmacist intervention on cholesterol risk management: the Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP).
        Arch Intern Med. 2002; 162: 1149-1155
        • Grant T.
        • Soriano Y.
        • Marantz P.R.
        • et al.
        Community based screening for cardiovascular disease and diabetes using HbA1c.
        Am J Prev Med. 2004; 26: 271-275
        • Feig D.S.
        • Palda V.A.
        • Lipscombe L.
        • et al.
        Screening for type 2 diabetes mellitus to prevent vascular complications.
        CMAJ. 2005; 172: 177-180
        • Lindstrom J.
        • Tuomilehto J.
        The diabetes risk score, a practical tool to predict type 2 diabetes risk.
        Diabetes Care. 2003; 26: 725-731
        • Park P.
        • Griffin S.
        • Sargeant L.
        • et al.
        The performance of a risk score in predicting undiagnosed hyperglycaemia.
        Diabetes Care. 2002; 25: 984-988
        • Peters A.L.
        • Davidson M.B.
        • Schriger D.L.
        • et al.
        A clinical approach for the diagnosis of diabetes mellitus: an analysis using glycosylated hemoglobin levels. Meta-Analysis Research Group on the Diagnosis of Diabetes Using Glycated Hemoglobin Levels.
        JAMA. 1996; 276: 1246-1252
        • Rolka D.B.
        • Narayan K.M.
        • Thompson T.J.
        • et al.
        Performance of recommended screening tests for undiagnosed diabetes and dysglycemia.
        Diabetes Care. 2001; 24: 1899-1903
        • Fereday J.
        • Muir-Cochrane E.
        Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development.
        Int J Qual Methods. 2006; 5: 1-11
      1. SPSSversion 14.

      2. Statistics Canada. 2001 community profiles. Released June 27, 2002. Last modified: 2005-11-30. Statistics Canada catalogue no. 93F0053XIE. 2002.

        • Janssen P.G.
        • Gorter K.J.
        • Stolk R.P.
        • et al.
        Low yield of population-based screening for type 2 diabetes in The Netherlands: the ADDITION Netherlands study.
        Fam Pract. 2007; 24: 555-561
        • Berglund G.
        • Nilsson P.
        • Eriksson K.-F.
        • et al.
        Long-term outcome of the Malmö Preventive Project: mortality and cardiovascular morbidity.
        J Intern Med. 2000; 247: 19-29
        • Tsuyuki R.T.
        • Johnson J.A.
        • Teo K.K.
        • et al.
        Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP): a randomized trial design of the effect of a community pharmacist intervention program on serum cholesterol risk.
        Ann Pharmacother. 1999; 33: 910-919
        • Waugh N.
        • Scotland G.
        • McNamee P.
        • et al.
        Screening for type 2 diabetes: literature review and economic modelling exercise.
        Health Technol Assess. 2007; 11 (iii–iv, ix–xi): 1-125
        • Glumer C.
        • Jorgensen T.
        • Borch-Johnsen K.
        Targeted screening for undiagnosed diabetes reduces the number of diagnostic tests.
        Diabet Med. 2004; 21: 874-880
        • Kaczorowski J.
        • Karwalajtys T.
        • Chambers L.
        • et al.
        Community strategies to monitor high blood pressure among older adults (abstr).
        Pharmacy Practice Research Symposium, Toronto, OntarioFebruary 1, 2002
        • Posavac E.
        • Kattapong K.
        Peer -based interventions to influence health-related behaviors and attitudes: a meta-analysis.
        Psychol Rep. 1999; 85: 1179-1194
        • World Health Organization
        Report of a WHO Consultation. Part 1: diagnosis and classification of diabetes mellitus.
        World Health Organization, Geneva1999
        • Ekoe J.
        • Punthakee Z.
        • Ransom T.
        • et al.
        Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada: screening for type 1 and type 2 diabetes.
        Can J Diabetes. 2013; 37: S12-S15
        • Robinson C.A.
        • Agarwal G.
        • Nerenberg K.
        Validating the CANRISK prognostic model for assessing diabetes risk in Canada's multi-ethnic population.
        Chronic Dis Inj Can. 2011; 32: 19-31
        • Goldenberg R.M.
        • Cheng A.Y.Y.
        • Punthakee Z.
        • et al.
        Position statement: use of glycated hemoglobin (A1C) in the diagnosis of type 2 diabetes mellitus in adults.
        Can J Diabetes. 2011; 35: 247-249