Ontario Ministry of Health & Long Term Care Archives | Research & Innovation

New diabetes study on Type 2 diabetes, high-risk populations and fitness enters second phase

fmaquito — Tue, 04 May 2010 08:00:00 +0000

Could screening high-risk populations for pre-diabetes and setting them up with culturally preferred fitness regimes prevent people from developing Type 2 diabetes and the secondary complications of heart and kidney disease, blindness and stroke?

That’s what several 91��ɫ researchers are hoping to find out. If successful, their Pre-Diabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) Program could become the model for provincewide intervention.

91��ɫ Professors Michael Riddell, Norman Gledhill, Veronica Jamnik, Chris Ardern, Jennifer Kuk and Paul Ritvo in the School of Kinesiology & Health Science’s Physical Activity & Chronic Disease Unit in the Faculty of Health, along with 91��ɫ PhD candidate Chip Rowan, PRE-PAID project coordinator, are now deep into Phase 2 of their study and so far the results are promising. They have found there is an overwhelming need for programs such as PRE-PAID, as a high percentage of the participants tested already had pre-diabetes. In addition, there is a real lack of close and affordable fitness programs.

Right: From left, Michael Riddell, Veronica Jamnik, Chip Rowan and 91��ɫ students and certified exercise physiologists Ajay Rampersad and Thomas Bok

The researchers also found that to reach people in high-risk areas they need to tap into existing social networks and make community contacts, as traditional media campaigns are not that helpful. With community engagement, they were able to increase their visibility and build partnerships to fight diabetes.

The goal of the PRE-PAID program is to identify those individuals from the highest risk populations, including Chinese, South Asian, African and African-Caribbean, who have pre-diabetes, and to provide them with targeted, accessible and monitored fitness programs, and hopefully prevent them from developing Type 2 diabetes.

It could save lives and millions of health-care dollars. Health-care costs for the treatment of persons with diabetes in Canada amounts to $9 billion annually. In recognition of this burden, the Ontario Ministry of Health & Long-Term Care has made the treatment and management of diabetes a priority.

“The costs are anywhere between $2,000 and $15,000 a year per person with diabetes in direct and indirect costs, but if we can get that down to around $200 a year in investment for those with pre-diabetes to prevent the disease, that would save a lot. Not only that, but we can probably prevent six cases out of 10,” says Riddell. “We have to show this model will work and will save money in the long run over the health-care costs caused by the complications of diabetes. If we invest now in treating pre-diabetes, it will cost less in the future.”

Left: A participant undergoes a finger prick blood test to check sugar levels

The PRE-PAID Program has screened some 428 people, aged 35 to 64, from the communities of 91��ɫ, Jane and Finch, Malvern in Scarborough, and Agincourt for high risk, and are looking for more participants. A further 350 were given a finger-prick blood test, which measures the amount of sugar coating on red blood cells as a measure of average blood sugar control over the last three months. Of these, 238 were found to be pre-diabetic – all of whom were previously undiagnosed.

Right now, there is no outreach screening or treatment program in the province for people with pre-diabetes. This study, funded by the Ontario Ministry of Health Promotion and the Ontario Trillium Foundation, is an important step toward changing that, say Riddell and Rowan.

Through community partnerships, all of those screened through the PRE-PAID Program with pre-diabetes are being given educational training on diabetes prevention and are provided with accessible and culturally preferred exercise sessions for six months.

Right: PRE-PAID participants in a bollyfit class

“The advantage of having the study at 91��ɫ is they can use the students from the School of Kinesiology to hold the classes and many of them are of the same ethnicity as the participants, so we’re breaking down some of the cultural and language barriers,” says Rowan. “Because we are so multicultural here, that really works.”

So instead of expecting study participants to join a gym and run on the treadmill for half an hour a day, the project offers things like bollyfit, socasize, reggaerobics, line dancing and tai chi in easily accessible community centres with certified exercise physiologists, for free. The participants are also asked to incorporate walking into their weekly routine.

Through the PRE-PAID Program, participants who have been identified as pre-diabetic are “provided with the opportunity and the encouragement. Then we track them to see how they comply,” says Rowan. “If it’s going to be sustainable, they really have to make that decision and that commitment.” The participants are assessed at the beginning, at three months and again at six months.

Some of the factors that stand in the way of participating in fitness programs are cost, time and priorities. “People are busy and have other pressing priorities, priorities we can’t even imagine,” says Riddell. “We’re trying to alleviate some of these barriers.”

By looking at studies done in the United States, India and China, “we know that by doing 150 minutes of moderate intensity exercise per week, about 30 minutes a day, five days a week, we can lower the risk of developing diabetes from a state of pre-diabetes by about 50 per cent,” says Riddell. “What is novel about this approach is we want to give them physical exercise that taps into culturally preferred activities. This is the first study I’m aware of that has done that.”

The incidence of pre-diabetes and Type 2 diabetes continues to rise in Canada. It is estimated that about seven per cent (two million) of Canadians have diabetes with about half of them undiagnosed, while another five to seven per cent have pre-diabetes.

“All the research has shown that exercise is the most effective preventative tool, even independent of dietary change,” says Riddell. So it makes sense that people at the highest risk of becoming pre-diabetic would be caught early on.

The researchers are currently seeking funding for Phase 3 of the project. In Phase 3, the team will recruit an additional 500 to 1,000 subjects and will extend the eligible age range to 18 to 64, as recent findings have shown there is an increasing incidence of diabetes in young people.

The group is presenting some of their preliminary results at the International Congress on Physical Activity & Public Health, May 5 to 8 in Toronto.

For more information, visit the Diabetes Prevention Program Web site or contact Chip Rowan at 647-378-6777 or stopdiab@yorku.ca. For more information about diabetes, visit the Web site.

By Sandra McLean, YFile writer

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

The post New diabetes study on Type 2 diabetes, high-risk populations and fitness enters second phase appeared first on Research & Innovation.

Math prof receives grant to study West Nile virus and global warming

fmaquito — Thu, 07 Jan 2010 10:00:00 +0000

91��ɫ math Professor Huaiping Zhu is working on understanding why there are outbreaks of the West Nile virus some years and not others. What goes into the mix – temperature, precipitation, mosquito population – to trigger the exact conditions needed for the virus to thrive?

Knowing the answer could help in the development of mosquito density and control strategies as well as improvements to the current surveillance system for West Nile virus and other vector-borne diseases that may emerge, not only in Ontario, but across the country. It could also lead to a real-time warning system and better disease management by public health agencies.

Recently awarded a $100,000 research grant from the Public Health Agency of Canada (PHAC), Zhu will conduct a two-year research project, "Modeling and Risk Assessment of West Nile Virus Transmission Under Global Warming", as part of PHAC’s Pilot Infectious Disease Impact & Response Systems Program and its Clean Air Agenda. The objective is to conduct data mining and analysis, develop models for expected mosquito density given certain meteorological and environmental conditions, and establish a set of threshold conditions and criteria that are likely to be present before and during an outbreak.

Left: Huaiping Zhu

“Part of the pilot project is related to seeing how climate change will affect the virus in Ontario,” says , a professor in 91��ɫ’s Department of Mathematics & Statistics. Warmer weather makes a more conducive environment for mosquito breeding and virus incubation, and that holds true for other vectors as well. With global warming, mosquitoes are likely to expand their range and spread the virus into new areas.

In Ontario, there have been two outbreaks of the West Nile virus – one in 2003 and another in 2007. The curious thing about those two outbreaks, says Zhu, is “we didn’t have the maximum amount of mosquitoes in those years.” It seems counterintuitive that the outbreaks would occur during times when mosquitoes were not at peak levels. That, he says, may indicate that temperature and precipitation play a larger role in driving the spread of the disease than previously thought.

Zhu has the West Nile virus incidence data from the Ministry of Health & Long Term Care, the study’s collaborator, as well as the data on the temperature and amount of precipitation in Peel Region in Ontario since 2002. The first case of West Nile virus appeared in Ontario in 2001, with surveillance data collecting beginning the following year. With the data, Zhu and his research team can create models to assess the most likely scenario of when incidents of West Nile virus will surge. Once they have an idea of what is happening in Peel Region, they hope to expand the research to all of Ontario and eventually Canada. Part of the difficulty will be the narrow time frame Zhu has to work with each year – 16 weeks when mosquitoes are active in Ontario.

The preparation of the data has already been done using 91��ɫ’s Laboratory of Mathematical Parallel Systems (LAMPS) as part of Zhu’s 2007 Ministry of Research & Innovation research project, "Modeling, Surveillance, Prediction and Control of West Nile Virus in Ontario". LAMPS is a high-power parallel computing lab in the Department of Mathematics & Statistics, which Zhu, along with 91��ɫ Professors Steven Wang and Zijiang Yang, set up using a $250,045 grant from the Canada Foundation for Innovation and a matching grant from the Ontario Innovation Trust.

Zhu now needs to design models to plug the data into, which will hopefully tell him more about how the virus is spread to birds and the optimum temperature and amount of precipitation needed for an outbreak to occur. Another, part of the equation is mosquito reproduction and how that fluctuates with the weather. Then the information will need to be analyzed.

The whole idea, says Zhu, is to discover “what are the conditions that are needed to cause the West Nile virus.” To do this, it’s imperative to understand how the climate influences the host. “Only when this is clear, can we go on from there,” he says. Then they can begin to understand some of the other variables, such as how different landscapes affect mosquitoes across the country, what their preferred habitat is and whether it is true for all species of mosquito, and how the rate of evaporation plays into the equations.

“For that part it is more complicated,” says Zhu. “So depending on the results from the first part, we will know if it will be possible to develop it into a larger project taking into account those other factors.”

Although West Nile virus was first isolated in Uganda in 1937, it has progressively spread to Egypt, Israel, South Africa, Europe and North America.

By Sandra McLean, YFile writer

Reprinted courtesy of YFile, 91��ɫ’s daily e-bulletin.

The post Math prof receives grant to study West Nile virus and global warming appeared first on Research & Innovation.