Healthcare, self-care, and health status of immigrants and non-immigrants with type 2 diabetes in the Canadian Community Health Surveys.

AIMS: To identify healthcare, self-care, and health status disparities between immigrants and non-immigrants with type 2 diabetes mellitus (T2DM) in Canada. METHODS: Immigrants and non-immigrants with T2DM were compared in the nationally representative 2005 and 2007 Canadian Community Health Surveys (N = 7658 representing 1,205,000 in 2005; N = 3605 representing 1,446,000 in 2007). RESULTS: No significant differences existed between immigrants and non-immigrants with T2DM in annual glycated hemoglobin testing, foot examination by a physician, urine protein testing, or eye examinations. Among self-care measures, immigrants were less likely to perform foot self-examination at least weekly (OR = 0.70 [0.50, 0.98] in 2005; OR = 0.65 [0.47, 0.91] in 2007) or smoke (OR = 0.63 [0.45, 0.87] in 2005; OR = 0.44 [0.25, 0.77] in 2007), but there were no differences in self-monitoring of blood glucose or physical inactivity. With respect to health status, immigrants were less likely to have a chronic condition in addition to T2DM (OR = 0.68 [0.54, 0.86] in 2005; OR = 0.59 [0.41, 0.84] in 2007), but there were no differences in self-perceived general or mental health. CONCLUSIONS: Healthcare, self-care, and health status were similar in immigrants and non-immigrants with T2DM in Canada; however, immigrants were less likely to regularly examine their feet. Culturally appropriate footcare education should be considered to prevent lower limb complications.

Low-dose combination therapy with rosiglitazone and metformin to prevent type 2 diabetes mellitus (CANOE trial): a double-blind randomised controlled study.

BACKGROUND: The evolving epidemic of type 2 diabetes has challenged health-care providers to assess the safety and efficacy of various diabetes prevention strategies. The CANOE (CAnadian Normoglycemia Outcomes Evaluation) trial investigated whether low-dose combination therapy would affect development of type 2 diabetes. METHODS: In this double-blind, randomised controlled trial undertaken in clinics in Canadian centres, 207 patients with impaired glucose tolerance were randomly assigned to receive combination rosiglitazone (2 mg) and metformin (500 mg) twice daily or matching placebo for a median of 3.9 years (IQR 3.0-4.6). Randomisation was computer-generated in blocks of four, with both participants and investigators masked to treatment allocation. The primary outcome was time to development of diabetes, measured by an oral glucose tolerance test or two fasting plasma glucose values of 7.0 mmol/L or greater. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00116932. FINDINGS: 103 participants were assigned to rosiglitazone and metformin, and 104 to placebo; all were analysed. Vital status was obtained in 198 (96%) participants, and medication compliance (taking at least 80% of assigned medication) was 78% (n=77) in the metformin and rosiglitazone group and 81% (n=80) in the placebo group. Incident diabetes occurred in significantly fewer individuals in the active treatment group (n=14 [14%]) than in the placebo group (n=41 [39%]; p<0.0001). The relative risk reduction was 66% (95% CI 41-80) and the absolute risk reduction was 26% (14-37), yielding a number needed to treat of 4 (2.70-7.14). 70 (80%) patients in the treatment group regressed to normal glucose tolerance compared with 52 (53%) in the placebo group (p=0.0002). Insulin sensitivity decreased by study end in the placebo group (median -1.24, IQR -2.38 to -0.08) and remained unchanged with rosiglitazone and metformin treatment (-0.39, -1.30 to 0.84; p=0.0006 between groups). The change in beta-cell function, as measured by the insulin secretion-sensitivity index-2, did not differ between groups (placebo -252.3, -382.2 to -58.0 vs rosiglitazone and metformin -221.8, -330.4 to -87.8; p=0.28). We recorded an increase in diarrhoea in participants in the active treatment group compared with the placebo group (16 [16%] vs 6 [6%]; p=0.0253). INTERPRETATION: Low-dose combination therapy with rosiglitazone and metformin was highly effective in prevention of type 2 diabetes in patients with impaired glucose tolerance, with little effect on the clinically relevant adverse events of these two drugs. FUNDING: GlaxoSmithKline.