Context: Adrenal insufficiency (AI) is an uncommon, life-threatening disorder requiring lifelong treatment with steroid therapy and special attention to prevent adrenal crisis. Little is known about the prevalence of AI in Canada or healthcare utilization rates by these patients. Objective: We aimed to assess the prevalence and healthcare burden of AI in Alberta, Canada. Methods: This study used a population-based, retrospective administrative health data approach to identify patients with a diagnosis of AI over a 5-year period and evaluated emergency and outpatient healthcare utilization rates, steroid dispense records, and visit reasons. Results: The period prevalence of AI was 839 per million adults. Patients made an average of 2.3 and 17.8 visits per year in the emergency department and outpatient settings, respectively. This was 3 to 4 times as frequent as the average Albertan, and only 5% were coded as visits for AI. The majority of patients were dispensed glucocorticoid medications only. Conclusion: The prevalence of AI in Alberta is higher than published data in other locations. The frequency of visits suggests a significant healthcare burden and emphasizes the need for a strong understanding of this condition across all clinical settings. Our most concerning finding is that 94.3% of visits were not labeled with AI, even though many of the top presenting complaints were consistent with adrenal crisis. Several data limitations were discovered that suggest improvements in the standardization of data submission and coding can expand the yield of future studies using this method.

Purpose: Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder and is associated with a variety of health disorders. The management of PCOS requires a multidisciplinary health care approach. The COVID-19 pandemic affected access and delivery of health care. The aim of this study was to assess the impact of the pandemic on the health and health care experience of those affected by PCOS. Patients and Methods: An online survey was conducted January 2021 to July 2022 in Canada, open to anyone who identified as having PCOS. Data collected in REDCap included questions on demographics, symptoms, and experience of PCOS management during the pandemic. Results: The majority (59%) of respondents (n=194, mean age 34± 8 years) experienced pandemic-related employment changes and self-reported a high stress level (73± 21/100). Of those who reported changes in body weight, 58% gained weight, which they attributed to unhealthy eating habits and a lack of exercise during the pandemic, and 16% lost weight, which they credited to increased physical activity and a shift towards healthier eating habits. The respondents ascribed the impact of COVID-related changes to clinic cancellations, delayed appointments, long wait times for referrals and lab work, lack of access to exercise facilities and insufficient social support. Some respondents voluntarily reduced access to health care services to limit COVID exposure. COVID-19-related health status was perceived as more important than their own PCOS-related symptoms. Virtual appointments via telehealth were regarded as beneficial for 20% of users. Conclusion: Individuals with PCOS reported an overall reduction in COVID-related access to health care and supports. Some adapted to the use of telemedicine, while others experienced increased stress due to a lack of access to health care and an inability to manage their PCOS symptoms. The pandemic further highlighted that those with PCOS often experience a lack of accessibility to multidisciplinary health care and supports needed to manage their condition. Plain Language Summary: Polycystic ovary syndrome (PCOS) is a complex disorder affecting up to 18% of women and can impact overall health and quality of life across the lifespan. It is characterized by irregular menstrual cycles, heavy menstrual bleeding, male-pattern hair growth, and acne due to excess production of male hormones. PCOS is associated with an increased risk of infertility, pregnancy complications, obesity, type 2 diabetes, cardiovascular diseases, and mental health disorders such as anxiety, depression, and negative self-image. Because of its complexity, PCOS requires a multidisciplinary health care approach including endocrinologists, gynecologists, dietician, exercise specialists, and psychologists/psychiatrists. In this paper, we describe the findings of a self-administered survey in those who self-reported having PCOS. The survey explores the patients’ view of the challenges in health care management during the COVID-19 pandemic. The COVID-19 pandemic caused disruptions in the delivery of health care and many patients struggled to find the support they needed. COVID-19 caused unprecedented challenges to the health care system but also presented opportunities for alternative health care delivery models. Our findings highlight the need to incorporate viable individualized and alternative care options for people with chronic conditions such as PCOS, to support self-management and prevent deterioration in health and well-being during times of unforeseen health crises. While the survey is restricted to respondents in Canada, the findings and proposed improvements provide distinct insights that are of international relevance as there is ample evidence of similar experiences regarding health care access and support during the COVID-19 pandemic around the world.

Objective: Adrenal insufficiency is a life‐threatening chronic disease with limited patient educational resources. We used human‐centered design (HCD) to co‐design an adrenal insufficiency patient education toolkit. Background: HCD encompasses methodologies centered around the user to co‐create tailored solutions to address the problem. In healthcare, HCD has been used to develop shared decision‐making tools and interventions. The aim of this study was to develop an educational toolkit for individuals living with adrenal insufficiency. To achieve this, academics and clinicians collaborated with patients and human‐centered designers to co‐create practical and intuitive patient educational resources and treatment plans. Methods: The toolkit was developed through a HCD process—discovery, ideation, prototyping, design iterations, usability testing, and implementation. At each step, the human‐centered designer worked alongside endocrinologists and patient partners in collaborative co‐design sessions. Results: The toolkit consisted of two handouts: a patient education resource including causes and symptoms of adrenal insufficiency/crisis, prevention and treatment, circumstances to seek healthcare, web resources, and a personalized treatment plan for stress dosing of adrenal hormone replacement with common scenarios and suggested dosing. Usability testing of the toolkit with 11 patients demonstrated that the toolkit was intuitive and practical, and all participants reported that they would use the toolkit to guide self‐management decisions. Conclusion: Our toolkit development process illustrates the value of HCD in healthcare. By collaborating with human‐centered designers and patient partners, we created an educational resource that was intuitive and practical for those affected by adrenal insufficiency.

Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being.