CIRCLE: A Partnership Between First Nation Communities & Researchers to Better Understand and Improve On-Reserve Diabetes Care CIRCLE Diabetes Report Card for Oujé-Bougoumou
CIRCLE Summary The CIRCLE study is a partnership between researchers and 19 First Nation communities. Funding was provided by the Aboriginal Diabetes Initiative (ADI), First Nations and Inuit Health Branch (FNIHB), Health Canada. The study looked at randomly selected medical charts from consenting patients in your community to see whether adults with type 2 diabetes get the tests and treatments they need. Figure 1: Diabetes Treatment in Oujé-Bougoumou Tested with diabetes who received ALL the recommended tests*. At Target with diabetes at healthy levels in ALL their tests. Exams with diabetes who had their eyes, feet and kidneys checked. * A1c, Blood Pressure, LDL-C The Bottom Line: First Nations are working together to study and fight diabetes. There are things your community can do to help people who have diabetes live long, healthy lives. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 2
Table of Contents About the CIRCLE Study... 4 ABCs of Diabetes... 5 Blood Sugar [A1c]... 7 Blood Pressure... 8 Cholesterol... 9 Diabetes Kidney, Eye and Foot Exams... 10 Immunizations... 11 Five Things You Can Do!... 12 Figures Figure 1: Diabetes Treatment in Oujé-Bougoumou. 2 Figure 2: Who was in the study?... 4 Figure 3: Blood Sugar [A1c]... 7 Figure 4: Blood Pressure... 8 Figure 5: Cholesterol... 9 Figure 6: Diabetes Kidney, Eye and Foot Exams. 10 Figure 7: Immunizations... 11 Canadian First Nations Diabetes Clinical Management Epidemiologic Study 3
About the CIRCLE Study CIRCLE Communities treatments they need. Chief and Council and people in your community and 18 other First Nation communities across Canada joined researchers to see if people with diabetes are getting the tests and What s in this Report? This report describes diabetes care in your community. What Comes Next? This is the beginning! Information in this report can help identify what your community does well and opportunities for your community to improve diabetes care. There is a lot you can do to help people with diabetes in your community live long, healthy lives. Here s some information to help you get started! Figure 2: Who was in the Study? Audit Years 2002-7 # Charts Audited 50 Average Age 43.3 % Female 62.0 % Male 38.0 Average Duration of Diabetes (years since diagnosis) 5.9 % Smokers in 2007 51.2 Canadian First Nations Diabetes Clinical Management Epidemiologic Study 4
ABCs of Diabetes What We Measured 1c (Blood A Sugar) A1c measures the three month average blood sugar. Keeping A1c at around 7.0% protects eyes and kidneys. A1c levels should be checked every 3 to 6 months. B lood Pressure C holesterol (LDL) Blood pressure is the force of blood against arteries. Keeping blood pressure at or below 130/80 reduces heart disease, stroke, kidney damage and death. Medications can keep blood pressure at the right levels. Cholesterol is a fat-like substance made in the body. Too much LDL ( bad ) cholesterol increases chances that a person will get heart disease. Keeping LDL cholesterol lower than 2.0 mmol/l is important. People with diabetes need cholesterol checked every 1 to 3 years. Medications can lower cholesterol and reduce deaths. D iabetic Kidney Test ye Exam E oot Exams F Diabetic kidney failure is a serious complication from diabetes. The kidney acts as a filter for the body and people with diabetes need to have urine tests every year to make sure their kidneys are working. Diabetes can damage the eyes. Having an eye check every 1 to 2 years can find and treat damage to the eye before it causes blindness. People with diabetes are at risk for infections that can lead to amputation if not found early. It is important for people with diabetes to have their feet and the nerves on their feet checked every year to prevent ulcers or amputation. I mmunizations People with diabetes need to get immunized against the flu (every year) and a one-time pneumonia vaccine. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 5
The Bottom Line: Diabetes is a disease that can affect many parts of the body kidneys, heart, eyes, feet, brain but with regular tests and medications these complications can be prevented! Keep in mind about information in this report It s from 2002 2007, some people may have gotten better or worse. Your community may have new programs. It s from medical charts. Some information (e.g. whether people take their medication, whether people show up for their appointments, whether people follow prescribed treatments, etc) is not always written in charts. Medical information is private. People gave us permission to look at their charts and Chief and Council gave us permission to do this study. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 6
Blood Sugar [A1c] Different tests measure blood sugar. The A1c test measures average blood sugar over three months. People with diabetes need an A1c test every three to six months. Keeping A1c at a healthy level (around 7%) is important for preventing diabetes complications like blindness or kidney failure. Healthy eating, physical activity and medications can help keep blood sugar at the right levels. People whose A1c is over 9% often benefit from insulin. Figure 3: Blood Sugar [A1c] % Tested who had an A1c test in 2007. % At Target whose most recent blood sugar test (2002-2007) showed blood sugar at or below 7%. % On Insulin whose most recent (2002-2007) A1c was above 9%, who were prescribed insulin. Only 47.8% of patients with A1c 9.0% are on insulin. Insulin or insulin intensification should be considered for patients with A1c 9.0% in order to achieve target A1c levels. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 7
Blood Pressure Blood pressure is the force of blood against arteries. Keeping blood pressure at or below 130/80 reduces the chances of heart disease, stroke, kidney damage and death. Blood pressure medications are recommended for all people with high blood pressure and diabetes because they help keep blood pressure at the right levels and prevent complications. Figure 4: Blood Pressure % Tested Percent of people who had blood pressure tested in 2007. % At Target whose most recent blood pressure test (2002-2007) showed blood pressure at or below 130/80. % Treated diagnosed with hypertension or whose most recent (2002-2007) blood pressure was above 130/80, and who were prescribed three or more blood pressure medications. More than half of patients have not reached target blood pressure. Treatment intensification is recommended. The percent of patients targeted for blood pressure treatment could be increased. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 8
Cholesterol Cholesterol is a fat-like substance made in the body (it is also in some foods). People with diabetes need to get their cholesterol checked every 1 to 3 years to make sure their LDL (sometimes called bad ) cholesterol level is not too high. Reducing high cholesterol levels lowers the chances that a person with diabetes will get heart disease. Medications can lower LDL cholesterol and are important in reducing deaths from heart disease. Figure 5: Cholesterol % Tested who had cholesterol tested in the last three years (2005-2007). % At Target whose most recent cholesterol test (2002-2007) showed LDL (bad) cholesterol was at a healthy level. % Treated whose cholesterol is not at a healthy level who are receiving treatment. The population of patients not meeting cholesterol targets and receiving treatment should be the focus of care. Treatment intensification should be considered. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 9
Diabetes Kidney, Eye & Foot Exams Kidney failure is a serious complication from diabetes. People with diabetes need to have urine tests regularly to make sure their kidneys are working. Diabetes can damage the eyes. Having an eye check at least every two years can find and treat damage to the eye before it causes blindness. It is important for people with diabetes to have their feet and the nerves on their feet checked every year to prevent infections and amputations. Figure 6: Diabetes Kidney, Eye & Foot Exams % Having Kidney Test (2007) % Having Eyes Tested (2006-2007) % Having Foot Test (2007) Your community is doing great at screening patients for kidney disease. However, many patients are not meeting the recommended screening schedules for eyes and feet. It is recommended that a screening program be developed and implemented. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 10
Immunizations It is recommended that people with diabetes get a flu shot every year and a one-time pneumonia vaccine. Figure 7: Immunizations 100.0% 80.0% 68.0% 78.0% 60.0% 40.0% 20.0% 32.0% 22.0% 0.0% % Having Flu Shot (2007) % Not Available Percent of people whose information on the flu vaccine was not recorded in their chart. % Having Pneumonia Shot (Lifetime) % Not Available Percent of people whose information on the pneumonia vaccine was not recorded in their chart. The majority of patients charts do not indicate whether patients have received their pneumococcal immunizations or their annual influenza vaccinations. It is recommended that better documentation protocols be put in place in order to track whether patients are receiving their recommended immunizations. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 11
Five Things You Can Do! Many people with diabetes in your community have a high risk for diabetes complications. Working together, communities and healthcare teams can do a lot to make sure that people with diabetes get the support, physical activity, food, treatments, medication, and tests they need to live long, healthy lives. Here are some suggestions about improving care in your community. 1) Be a Health Advocate SUMMARY The best thing you can do for yourself and your community is to take your health into your own hands. Start by getting your diabetes check-up (eyes, kidneys and feet) and support public education to encourage others to do the same. 2) Ask About Blood Pressure Management More than half of the patients in your community have not reached the blood pressure target. It is recommended that providers intensify treatment in order to bring more people to target. If you have high blood pressure, talk to your healthcare provider and discuss treatment options. Encourage others to do the same. 3) Ask About Lowering Blood Sugar More than half of the patients with very high blood sugar levels in your community are not on insulin. It is recommended that patients with very high blood sugar be started on insulin. If you or someone you know is in this situation, consider insulin as a treatment option. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 12
4) Ask About Immunizations More than three quarters of the patients in your community did not get an annual influenza vaccine or a one-time pneumonia vaccine. Getting these shots helps you reduce the risk of complications associated with these illness. 5) Talk to Providers SUMMARY Your input is important! The quality of diabetes care depends on a partnership between the individual with diabetes and the healthcare team. The best results occur when people fully participate in their own diabetes management. Consider the following questions and try discussing some of your ideas with your community s healthcare providers: What do you think might help improve diabetes in your community? Where do you think care could use improvement? What goals would you like to focus on? Acknowledgements The Coordinating Centre at the University of Western Ontario thanks our team of co-investigators, site investigators, participating communities, Chiefs and Councils, research assistants and others for their help and support. We would particularly like to thank Jean- Pierre Desormiers for all of his hard work and dedication during data collection. Funding was provided by the Aboriginal Diabetes Initiative (ADI), First Nations and Inuit Health Branch (FNIHB), Health Canada in the form of a contribution agreement. Thank you for your continued support and participation! Canadian First Nations Diabetes Clinical Management Epidemiologic Study 13
Contact Information If you have questions about diabetes care in your community, please call the Oujé-Bougoumou Healing Centre at: 418-745-3901 If you have questions about this report, contact: Ms. Joceline Piché Oujé-Bougoumou Healing Centre 68 Opataca Meskino Oujé-Bougoumou, Quebec G0W 3C0 Telephone: 418-745-3901 Ext. 238 Dr. Stewart Harris, Mariam Naqshbandi, Jim Esler & Marnie Orcutt Centre for Studies in Family Medicine Schulich School of Medicine & Dentistry University of Western Ontario Suite 245 100 Collip Circle London, ON N6G 4X8 Telephone: 519-661-2111 Ext. 22115 Fax: 519-858-5029 Thank you for your ongoing efforts in helping to improve diabetes care in Oujé-Bougoumou. Canadian First Nations Diabetes Clinical Management Epidemiologic Study 14