Chronic Disease & DI

Diagnostic Imaging is an area that sees it all. From the chronic disease standpoint, we see patients with all the major diseases - cancer, diabetes, heart diseases, respiratory diseases and even mental health. Chronic diseases that effect the diagnostic imaging department (CT specifically) directly would be diabetes and hypertension. For the purposes of this blog post, I will discuss more so the diabetic factors.

"Diabetes increases the risk of end-stage renal disease (ESRD) up to 10 times." (Roglic, 2016)

Diabetes mellitus is a chronic illness characterized by elevated levels of glucose in the blood. It is accompanied by disturbed metabolism of fats and proteins and categorized into three types.Type 1 diabetes is characterized by the pancreas' inability to produce insulin - these patients will have insulin pumps. Type 2 diabetes generally occurs later in life and is due to the body progessively producing less insulin. This is due to the body cells being resisitant to the action of insulin. Type 2 diabetes is majorly caused by factors involving age, weight and activity levels. Type 3 - gestational diabetes - occurs during pregnany, and can increase the risk of the development of type 2 diabetes post partem in both mother and baby.

"Uncontrolled diabetes leads to complications in many organs. Damage to small and large blood vessels and nerves leads to loss of vision and kidney function, heart attacks, strokes, and lower limb amputations. Diabetes causes disability and shortens lives." (Roglic, 2016)

When a patient comes in for a CT scan with IV contrast, technologists will go through screening questions with each patient. These include questions about allergies, diabetes, dialysis, kidney disease, myasthenia gravis, and at some hospitals - heart disease, hypertension and thyroid problems. These all have to do with the way the contrast will affect the patient's body and to ensure they will be able to filter it out of their bodies.

Diabetes patients are at much higher risk for developing chronic kidney disease and eventually ending up in renal failure. This is why any patient that comes into diagnostic imaging for a contrast-enhanced CT scan is asked screening questions. If any screening question is answered with a 'yes' a serum creatinine level is required. For outpatients, these results are generally used for one-three months, but for emergency or inpatients, a much shorter span is used (in my hospital, 24 hours for emergency patients and up to one week for inpatients) due to the nature of the visit. Serum creatinine is used to calculate an eGFR value which will correlate to stages of chronic kidney disease as the image below shows.

Obtained from: "https://www.csnscn.ca/images/TABLES%20FOR%20THE%20CONVERSION%20OF%20SERUM%20CREATININE%20TO%20EGFR.pdf"

Canadian Trends

Below is a graph that shows the prevalence of diabetes in Canada from the 2013-2014 data.

Obtained from: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/diabetes-canada-highlights-chronic-disease-surveillance-system.html

Compared to the 2003-2004 data, Canadians living with diabetes do have a greater life expectancy - meaning that the management of diabetes has gotten better (Public Health Agency of Canada, 2017). Interestingly, Ontario has a higher rate of diagnoses than many other provinces.

"The proportion who reported being diagnosed with diabetes was higher than the national average in: New Brunswick (9.5%) & Ontario (8.0%)" (Brule, McDiarmid & McDonald, 2018)

A very interesting strategy was brought forth by the Canadian government in 2018 called 'Diabetes 360' and can be read about HERE.

Resources

Brule, S., McDiarmid, C., & McDonald, H. (2018, November 14). This is a Health Fact Sheet about diabetes among Canadians aged 12 and older. The results shown are based on data from the Canadian Community Health Survey. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2018001/article/54982-eng.htm

Public Health Agency of Canada. (2017, November 14). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/diabetes-canada-highlights-chronic-disease-surveillance-system.html

Roglic, G. (2016). WHO Global report on diabetes: A summary. International Journal of Noncommunicable Diseases,1(1), 3. doi:10.4103/2468-8827.184853