Abstracts / Can J Diabetes 37 (2013) S13eS84S14

implementation strategy, possible impedance of CPOE on userperformance and the generation of new errors unique to comput-erized systems. Future research areas include conducting usabilityheuristic evaluations and developing platforms for continuousquality improvement.

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Effectiveness of a Multidisciplinary Preoperative GlycemicOptimization Clinic in Patients with Type 2 DiabetesUndergoing Bariatric SurgerySTEPHANIE DIZON*, ROBYN HOULDENKingston, ON

Background: Bariatric surgery is an effective treatment for pa-tients with type 2 DM and refractory obesity; however, many ofthese patients have non-optimal glycemic control. As hyperglyce-mia is a recognized risk factor for postoperative complications, wecreated a multidisciplinary Glycemic Optimization Clinic for thispopulation staffed by an endocrinologist, diabetes nurse educatorand registered dietitian. Patients are seen monthly by the team andreceive a weekly phone call.Objective: We conducted a pilot study to determine the effec-tiveness of the clinic.Methods: Data were analyzed for the first 22 patients with 3-month followup. Primary outcome measures included change inA1C from baseline and percent change in weight.Results: At 1 month, the mean absolute change in A1C was e1.14%,which equated to an 11.7% reduction from baseline. At 2 and 3months, the mean reduction from baseline was 12.6% and 18.4%,respectively. By 3 months, 75% had achieved an A1C �7.5%. Meandecrease in body weight was 1.7 kg and 9 kg, and mean percentageweight loss was 1.2% and 6.1% from baseline at 1 and 3 months,respectively. The majority of patients (50%) were using only 1antihyperglycemic agent at baseline. Use of GLP-1 analogues was4.5% at baseline and 75% at 3 months. Patients were highlycompliant with follow-up visits, monitoring and medication.Conclusion: Glycemic optimization for bariatric surgery candi-dates with DM is possible in a short time period with modificationof antihyperglycemic medication and diet by a multidisciplinarydiabetes team without weight gain.

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Effect of Providing Supplemental Physical Activity & ExerciseResources in Diabetes Centres on Physical Activity Levels ofPatientsJONATHON R. FOWLES*, K. LISETTE D’ENTREMONT, CHRIS A. SHIELDS,STEPHANIE L. MCQUAID, PEGGY DUNBARWolfville, NS; Halifax, NS

Purpose: This study aimed to determine the extent to whichproviding diabetes centres (DCs) with supplemental physical ac-tivity and exercise resources affects levels of physical activity andexercise of patients with diabetes.Methods: Questionnaires reporting physical activity and exerciselevels, confidence and clinical values were completed at baseline(n¼180) and 6 months (n¼118) by patients at 8 DCs across NovaScotia. DCs were provided with physical activity resources, such asinformational brochures, counselling from a kinesiologist and ex-ercise classes. Paired and mixed-method statistical analysis iden-tified differences in variables between baseline and 6 months, andbetween those who did and those who did not make use of thesupplemental resources.Results: Patients reported increased aerobic exercise (baseline ¼1.5�2.0 days/week; 6 months ¼ 2.0�2.4 days/week; p¼0.038) andresistance exercise (baseline ¼ 0.5�1.4 days/week; 6 months ¼

1.3�1.9; p¼0.000) at 6 months. Those who attended exercise classesreported greater overall health compared to those who did not(p¼0.046). Further, those who received resistance exercise instruc-tion froma kinesiologist (n¼15) reported greater task, self-regulatoryand overall efficacy at 6 months (p¼0.023; p¼0.026; p¼0.021,respectively) and reduced A1C (from 7.5�1.4% to 7.1�1.2%; p¼0.047).Conclusions: Providing DCswith supplemental resources increasedexercise involvement and confidence in patients with diabetes andproduced clinical outcomes. Future implications include providingDCs standard access to these resources on a wider scale.

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Physiotherapists as Certified Diabetes Educators in CardiacRehabilitationMIREILLE LANDRY*, SHELLEY THAKRAR, FAITH DELOS-REYES,JENNIFER A.D. PRICEToronto, ON

Background: Diabetes (DM) carries a burden for the healthcaresystem and society. Physical activity is a key intervention inaddressing DM. Cardiac rehabilitation (CR) programs have a largeproportion of patients with DM. Certified diabetes educators (CDEs)are not commonly found in CR teams. Physiotherapists, as spe-cialists in human activity andmovement, are ideal professionals forthe CDE designation in CR.Objective: To describe the need for and the role of the physio-therapist as a CDE in a CR setting.Description: Between 2008 and 2012, 35% (n¼238, mean age 59years, +/e 10.6 years) of the patients attending a women’s-only CRin this urban setting had DM, of which 6% had pre-diabetes (n¼50).Of the patients presenting with DM, 56% were managed with oralmedication, 16% on oral medication and insulin, 13% on insulin onlyand 15% with diet only. Patients with DM had significantly lowerfunctional capacity compared to the CR group as a whole (6.4 METscompared to 7 METs; p<0.001).Observation: In a CR setting, physiotherapists are skilled ataddressing issues that can affect participation in an exercise pro-gram. Physiotherapists are experts in exercise prescription andcounselling for optimal glycemic control, vascular protection riskfactor reduction and in managing neuromusculoskeletal issues.Conclusion: CR benefits people with DM. Inclusion of a CDE on theteam is of value to assist with DM-specific considerations aroundexercise. Physiotherapists are ideal professionals to hold the CDEdesignation due to the high overlap of knowledge, skills and abil-ities, and high self-efficacy in exercise prescription and counselling.

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Optimizing Insulin Absorption and Insulin Injection Techniquein Older AdultsLEE ANN TRIMBLE*, GRAYDON S. MENEILLYVancouver, BC

Extensive research has been conducted in children and middle-aged people with diabetes assessing issues related to variability ofinsulin absorption in different anatomic sites. No studies haveassessed insulin absorption in abdominal and deltoid sites in elderlypeople. Current literature is mixed on the best technique for needleinsertion.No studies have investigated this issue in older adultswithdiabetes. The objective of this study was to determine whetheranatomic site or injection technique alters absorption of insulin inadults over age 70. Twenty insulin naïve subjects were recruited(mean age 79.9 years; 13 m/7 f). Each subject 3 euglycemic clampstudies in random order: once with an abdominal insulin injectionwith a skin lift, another without a skin lift and lastly an upper arminjectionwithout a skin lift. The investigator conducting the clamps