Type 2 diabetes (T2D) remission, which means that blood sugar levels return to sub-diabetes levels without taking any glucose-lowering medications, is possible for many people living with T2D through changes to diet/lifestyle. T2D remission can offer new hope to those living with diabetes and empower them to make positive lifestyle changes. Despite this potential, many individuals living with T2D and most importantly, their healthcare providers, remain unaware that remission is possible.
This research project will offer a new and complete approach to help people achieve T2D remission. Using social media, we will find and connect with individuals living with T2D, informing them about how changes in diet and lifestyle can lead to remission. They will then be referred to registered dietitians who have been specially trained in our program’s lifestyle strategies for T2D remission.
This project will greatly benefit health research, the healthcare system, and the overall well-being of individuals living with T2D. By closing a full circle of awareness, specialized healthcare training and personalized expert support, our program will empower people living with T2D to successfully reach and maintain remission.
Program: Health Professional-Investigator
Building Community Capacity to Support Patients and Families Considering and Receiving Medical Assistance in Dying (MAiD)
Since medical assistance in dying (MAiD) became legal in Canada in 2016, efforts have focused on training providers and creating protocols. However, areas like public awareness, family support, social impacts on health, and holistic care are often overlooked. Research shows that people who face health and social barriers or inequities and request MAiD often struggle to get the care they need. These struggles are worse for persons whose death is not foreseeable (or near). While they can legally request MAiD, they cannot access publicly funded palliative care. A community-based navigation program could help identify and address these gaps. By connecting patients with health and community resources, such a program could provide ongoing, holistic, and fair access to care. My research has three goals: 1) understand the emotional needs of families whose loved ones requested MAiD and whose natural death is not foreseeable, 2) explore the care needs and resources for those facing health and social inequities and requesting MAiD, and 3) create and evaluate a community-based program that offers ongoing support for people seeking MAiD and facing health and social inequities in Vancouver Island.
Post-intensive care clinical and functional outcomes in adults with sarcopenia.
Sarcopenia is a condition of weakness and a low amount of muscle in adults. Out of the hospital, adults with sarcopenia have more difficulty walking, higher hospitalization rates, and a lower life expectancy. When these adults are admitted to the hospital and need life support in an intensive care unit, sarcopenia can lower how far they can walk and may lower the chances of survival. However, the research on sarcopenia in the intensive care unit is minimal and there is limited guidance on its assessment and management. This research program aims to increase the knowledge of 1) the features of sarcopenia; 2) the influence of sarcopenia on survival, hospital discharge, and post-intensive care weakness; and 3) nutrition and physical therapies that may effectively be used to improve outcomes in adults with sarcopenia who are admitted to an intensive care unit and require life support. This research’s results will be shared widely among the intensive care community as we expect this research to inform how international intensive care clinicians assess and treat adults with sarcopenia. This research can also be used to develop future clinical trials on therapies targeted to adults with sarcopenia in the intensive care unit.
Acute intermittent hypoxia as a treatment of diabetic-induced sensory neuropathy, wound healing deficits, and motor system decline
Knowledge gap: Diabetes is a leading cause of amputation because it causes nerve damage (numbness, pain), skin wounds (infections), muscle loss (weakness), and bone thinning (fractures, osteoporosis). Acute intermittent hypoxia (AIH, breathing cyclical low & normal oxygen levels x2 hours) promotes healing and treats other diseases of the nervous system. We believe AIH will improve the effects of diabetes on the nerves, skin, muscle, and bone of the leg.
Aim 1 (Rodent Model): we will investigate if AIH treats nerve, skin, muscle, and bone of the diabetic leg. Animals with diabetes treated with AIH will be compared to no-AIH controls using behaviour testing, specialized imaging, and assessment of tissue samples.
Aim 2 (Clinical): we will investigate if AIH improves recovery of sensation, decreases pain and improves wound healing for human patients with diabetes. Fifty patients will be recruited from the multidisciplinary lower limb reconstruction program for inclusion.
Expected Outcomes: Based on preliminary data, we believe AIH is a safe and effective strategy to treat the diabetic leg.
Impact: Without the need for surgery or medications, AIH may provide treatment for diabetic patients to treat pain, infection and amputation.
Tele health for Emergency-Community Continuity of Care Connectivity via Home Telemonitoring Blood Pressure (TEC4HOME-BP)-a Randomized Controlled Trial
Around one in four Canadians have high blood pressure (BP), also known as hypertension. High BP is a major risk factor stroke, heart attack, and kidney disease. Lowering BP levels by a small amount, can reduce risk of heart disease and stroke. Hypertension control rates in Canada are the lowest that they have been in a decade. Patients with hypertension frequently need to visit the emergency department (ED) due to high BP. Hypertension is one of the chronic diseases that can be managed effectively with digital health technology. We do not know the best way to manage BP after people are discharged from the ED. Many doctors worry that their BP may go too high or low if we treat or do not treat their BP. We do not know if digital health technologies can be used to safely monitor these people as they transition from the hospital to home and help control their BP. We will test to see if home blood pressure telemonitoring (HBPT) plus pharmacist case management will result in better BP control for participants who are discharged from the ED with uncontrolled high BP compared to standard care. We hope to create a toolkit on how to implement a HBPT program for people discharged from the ED with high BP and inform guidelines on high BP.
Interactions between nutritional status, gut microbiota, and metabolomic profiles in patients with chronic kidney disease
Persons living with kidney disease may develop imbalances in gut bacteria, which in turn may produce substances (metabolites) that can increase inflammation, worsen health, and increase risk of kidney disease progression. We are conducting a study to assess the types of gut bacteria present in stool samples and types of metabolites in blood samples from people with kidney disease not on dialysis. We will include some people with normal nutritional status and some with a nutrition disorder called ‘protein-energy wasting’ that commonly occurs in kidney disease. This research program will assess the interactions between gut bacteria and metabolites in the blood, how they vary by nutritional status, and how they relate to kidney disease progression.
This work will help us develop personalized treatment strategies to improve nutrition in people with kidney disease, and to prevent progression to kidney failure. Throughout the research process, we have collaborated with 2 patient partners and consulted with the BC Renal Dietitians Committee. We plan to share study findings through publications, webinars and patient educational materials.
Clinical Genomics for Enhanced Infectious Disease Diagnosis
This research will use advanced DNA sequencing techniques to enhance the way we diagnose and treat infectious diseases. In many serious infections, the cause cannot be identified, and the patient must be treated with broad-spectrum antimicrobials, which can either kill the pathogen and harm the microbiome, or even fail and promote resistance. We will use a novel technique, metagenomic sequencing, to analyze patient samples and identify the exact cause of the infection, including those caused by rare and unknown microorganisms. DNA sequencing will also be used to study these microorganisms in real time and determine the genetic mechanisms by which they cause disease and develop resistance to antimicrobial drugs. Armed with the genetic information of these microorganisms, we will also be able to create new, rapid tests to quickly identify them in patient samples. This research will improve patient care by enabling faster and more accurate diagnosis of infectious diseases, leading to better treatment outcomes and potentially reducing the spread of antimicrobial resistance.
Immune Monitoring to Predict Risk of Clinically Significant CMV Events after Solid Organ Transplantation (The Predict-CMV SOT Study)
Cytomegalovirus (CMV) remains one of the most common infections after transplant and despite medical advances, still poses significant challenges. Currently, transplant patients at risk of developing CMV infection are either given antiviral medications or are monitored by blood tests that detect CMV. However, these medications can have serious side effects and may only delay but not eliminate CMV infection. Furthermore, monitoring the blood for CMV ideally requires weekly blood draws.
We are designing a blood test, the CMV-AIM assay, as a personalized approach to monitoring the immune system against CMV after transplant. This test will not require additional blood collections as it will be done concurrently with routine blood tests, and not more frequently than once monthly. We have previously shown in kidney transplant patients that the CMV-AIM assay done early after transplant can predict those patients that later go on to develop CMV infection requiring treatment. The goal of this study is to trial and expand the CMV-AIM assay to all solid organ transplant patients, including lung, heart, liver, and kidney transplant patients and to validate this test in the clinical immunology laboratory to incorporate it into patient care.
Dynamic functional brain imaging of the motor and cognitive effects of dopaminergic medications in patients with Parkinson’s disease
Parkinson’s disease (PD) is the fastest growing neurological disorder. A loss of dopamine producing brain cells is thought to cause movement difficulties and various nonmotor symptoms in PD, and the majority of patients are prescribed dopamine replacement therapy (DRT). Although DRT is effective, many patients develop fluctuations in its effects and different patients respond differently to DRT. This research program will use non-invasive imaging to investigate how brain activity changes in real-time after patients with PD take DRT, in terms of “on-target” effects on brain areas associated with symptom improvement and “off-target” effects on uninvolved areas. Magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) recordings, which provide detailed information about the “when” and “where” of brain activity, will be collected at multiple time points alongside measurements of movement and cognitive symptoms while a patient’s normal DRT takes effect. An understanding of how patients’ brains respond to DRT will help develop methods to more precisely determine an appropriate DRT regimen for patients who experience motor and cognitive fluctuations, and guide future research on PD medications and neuromodulation.
Integrating Genetics Care in Nephrology to Study and Empower Precision Medicine
One in ten Canadians have kidney disease which can ultimately require treatment with dialysis or kidney transplant or lead to death. Treatment of kidney disease depends on us understanding its cause. Genetic causes of kidney disease, due to changes in people’s genes or DNA, are increasingly recognized as important causes of adult and childhood disease. We do not know how many people in British Columbia have genetic kidney diseases or their impacts on health.
One in eight people with kidney disease do not have a clear explanation for the cause of their kidney disease, termed unexplained kidney disease. We think there are unidentified genetic changes that explain some of these peoples’ kidney disease.
We will look at how many people in British Columbia have genetic kidney diseases based on clinical genetic testing and how genetic kidney diseases impact their health . This will include a few pre-specified groups of people with common genetic conditions. We will then perform whole genome sequencing on people with unexplained kidney disease to try to find new genetic changes that explain why they have developed kidney disease. We expect these findings to improve the health of people living with kidney disease in British Columbia.