Diabetes

Diabetes and Unique Populations

Dr Lega’s research focuses on diabetes in unique populations with two main areas of research. Much of this work is done using linkage of large health care administrative data bases at ICES.

1. Diabetes overtreatment in older adults
   • More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to treatment. Focusing particularly on vulnerable populations (i.e., dementia, nursing home residents, frail elderly), the goal of Dr. Lega’s work is to identify ways to reduce the risk of adverse events related to diabetes treatment in older adults.

2. The interplay between diabetes and cancer
   • With a specific focus on breast cancer and the impact of diabetes on breast cancer treatments and outcomes, Dr. Lega led a study exploring the relationship between the timing of cancer and diabetes diagnosis. She found that cancer risk is highest prior to diabetes diagnosis and within the first 3 months following diagnosis. As an extension of her work in adults with cancer, she has also led a study that examined the risk of diabetes among childhood cancer survivors.

Diabetes and Pregnancy

Dr. Lipscombe’s CIHR-funded diabetes prevention program, Avoiding Diabetes After Pregnancy Trial in Moms (ADAPT-M), was inspired by the experiences she encountered within her own clinical practice. Frustrated with the lack of a better plan or resources to help her patients make changes to improve their health outcomes, Dr. Lipscombe designed and evaluated a new solution that was flexible enough to meet the needs of these patients. The innovative, home-based, coaching program is fully customizable to the available fitness and nutrition options for each participant, improving the odds for lowering their risk of developing type 2 diabetes. Like many other research projects at WCRI, the ADAPT-M program utilizes resources within the existing healthcare system to maximize impact and increase the ability for the program to be spread and scaled across the healthcare system.

Dr. Lipscombe is also conducting studies using population-based healthcare and cohort databases to identify risk factors for future type 2 diabetes in women after a pregnancy, and to create a prediction tool to help women and their providers estimate their risk of diabetes after a pregnancy.

Dr. Lipscombe was recently appointed as the inaugural Director for University of Toronto’s Novo Nordisk Network for Healthy Populations, which is a cross-disciplinary research network based at the University of Toronto Mississauga campus. This new network will unite academics with community stakeholders in Peel Region to address the burden of diabetes and other chronic diseases through community-based research.

• Prevalence and characteristics of Ontario nursing home residents with diabetes
• Regional trends in diabetes testing among nursing home residents in Ontario
• Avoiding Diabetes after Pregnancy Together with Moms
• Identifying risk of diabetes after pregnancy

Peer-reviewed publications – Lipscome

Peer reviewed publications – Lega

1. Lega IC, Campitelli MA, Matlow J, Na Y, Stall NM, Rochon PA, Lipscombe LL. Glycemic Control and Use of High-risk Antihyperglycemic Agents Among Nursing Home Residents With Diabetes in Ontario, Canada. JAMA Intern Med. 2021 Jul 1;181(7):992-994. Principal Author.
2. Lega IC, Campitelli MA, Austin PC, Na Y, Zahedi A, Leung F, Yu C, Bronskill SE, Rochon PA, Lipscombe LL. Potential diabetes overtreatment and risk of adverse events among older adults in Ontario: a population-based study. Diabetologia. 2021 May 1;64(5):1093-1102. Principal Author.
3. Lega IC, Lipscombe LL. Review: Diabetes, Obesity, and Cancer-Pathophysiology and Clinical Implications. Endocr Rev. 2020 Feb 1;41(1):bnz014. Principal Author.

   Publication received 906 downloads and a high Altmetric Attention Score (63). This lead to the publication being a feature article in a Dec 2020 thematic issue on Diabetes in Endocrine Reviews.

4. Lega IC, Bronskill SE, Campitelli MA, Guan J, Stall NM, Lam K, McCarthy LM, Gruneir A, Rochon PA. Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: A population-based study of older women and men with diabetes. Diabetes, Obesity and Metabolism. 2019 Nov;21(11):2394-2404. Principal Author.

   The publication was among the top 10% most downloaded papers from Diabetes, Obesity and Metabolism between January 2018 and December 2019. It received a high Altmetric Score (266).

5. Lega IC, Austin PC, Fischer HD, Fung K, Krzyzanowska MK, Amir E, Lipscombe LL. The impact of diabetes on breast cancer treatments and outcomes: A population-based study. Diabetes Care. 2018 Apr;41(4):755-61. Principal Author.

   This publication was awarded the Women’s College Research Institute Best Paper Award for being the best original research published in 2018 by a scientist at Women’s College Hospital

• Chen JTC, Austin PC, Luo J, Campitelli MA, Bronskill SE, Yu C, Rochon PA, Lipscombe LL, Lega IC. Patterns of diabetes testing for older adults without diabetes in Ontario’s nursing homes: a population-based study. Journal of the American Geriatrics Society (JAGS). 2022 Nov 6. In Press. Senior Responsible Author.

Abstract recently presented at the 25th Annual Diabetes Canada/Canadian Society of Endocrinology and Metabolism (CSEM) Professional Conference.