JDRF launches new mental health strategy to support Canadians with type 1 diabetes

For the 300,000 Canadians living with type 1 diabetes (T1D), each day brings challenges – challenges that many others don’t understand. People living with T1D must follow a strict lifelong treatment plan that includes constant blood sugar monitoring, counting carbohydrates and taking insulin multiple times a day to stay alive. Due to this heavy burden of self-management and other factors such a social stigma, people living with type 1 diabetes are more likely to experience mental health challenges than their peers without T1D.

However, there are currently many gaps in knowledge, the healthcare system, and community support that mean this critical aspect of diabetes management is often overlooked. This is why JDRF Canada is pleased to announce that it has launched a $2 million fundraising campaign exclusively to support of the development of its first mental health strategy.

2021 marks the 100th anniversary of the discovery of insulin in Canada. Earlier this year, in honour of this anniversary, JDRF Canada, the largest charitable funder of T1D research in Canada, launched its $100M Campaign to Accelerate to build upon a long legacy of outstanding Canadian diabetes research, accelerating towards cures and improving the lives of those living with T1D. The Campaign takes a six pillar approach towards aggressively funding research into cures, while also helping people with T1D live healthier lives now – and given the importance of mental health in T1D, it is the focus of one of the Campaign’s pillars.

T1D never takes a day off, and constant and continual management coupled with worries about diabetes-related complications can take a toll on mental and emotional health. Compared to those without the condition, those with diabetes are more likely to experience depression or develop an eating disorder,1-3 and one in five youth with T1D suffer from anxiety.4

Why we are launching a Mental Health Strategy

“I’m okay, but I’m not happy. We’ve figured things out – mostly – after ten long years. Diabetes takes a lot out of me, emotionally and physically, and gets in my way every single day. I’ve cried a lot, and I’ve gotten frustrated, and sad, and angry. Diabetes takes up a lot of my emotional bandwidth and I’m tired of it…Diabetes makes me feel inadequate, but I’m doing my best.” 

Maryna Ell, a young adult who lives with T1D

Despite mental health being a crucial component of holistic diabetes management, it is often overlooked in diabetes care. Routine diabetes appointments frequently focus on the urgent aspects of diabetes care such as glucose-management and lack time to address emotional wellbeing and mental health. On top of this, there are only a handful of mental health care providers in Canada who specialize in the needs of the diabetes community.

There is currently no standard pathway for identification, screening and referral of mental health concerns for people with T1D. Finally, research in the area of mental health and T1D is woefully under-funded.

“Mental health challenges together represent one of the most pervasive health issues affecting Canadians today. When you add a chronic condition like T1D, feelings of anxiety, stress and depression are often amplified, which can negatively affect physical health. With a clear indication of the mental health strain this disease has on people living with T1D and the obvious gaps in care, it’s time to take action and that’s why we are raising $2M and launching our first mental health strategy.”

Dr. Sarah Linklater, Chief Scientific Officer of JDRF Canada

Our plans to address the need 

“Mental health needs to be a larger part of care, especially for teens with diabetes. There is so much pressure socially, academically and hormonally and it’s hard to find anyone who understands the difficulty of managing diabetes on top of all of that.”

Jenna, JDRF Youth Ambassador, diagnosed with T1D at age 12

The vision of JDRF Canada’s Mental Health Strategy is to expand and create new avenues for children, youth, and adults with diabetes to access psychosocial health support and mental health services, ultimately improving quality of life and health outcomes.

The Strategy will involve multiple initiatives that focus in three main areas: funding research on mental health and T1D, informing and educating health care providers, and developing new programs to support the T1D community. Several initiatives, including research funding opportunities and development of a new virtual training program about diabetes for registered Canadian mental health providers, are already in progress.

“I started providing psychological services to those living with diabetes in 1985. At that time, I was amongst only a few Canadian mental health providers with an expertise in diabetes. Thirty-five years later almost nothing has changed. Most people living with diabetes experience psychosocial challenges that negatively impact their health and quality of life. Psychosocial issues are amongst the biggest care gap in diabetes management.”

Dr. Michael Vallis, registered psychologist and Associate Professor, Family Medicine, Dalhousie University, Halifax, NS

With the help of donors and our initial partners including Brain Canada, BD, iA Financial Group, Canucks for Kids and The Leona M. and Harry B. Helmsley Charitable Trust, JDRF is well-positioned to take the lead to address gaps in care and tackle one of the most significant health issues facing Canadians with diabetes.

With further support from donors and partners, JDRF can help to provide a unified approach to helping families across Canada overcome challenges and cope with T1D.

Facts and figures

People living with T1D are more likely to experience mental health disorders compared with their peers without T1D:

  • The prevalence of depression is 3 times higher in people with T1D than people without diabetes, with women experiencing higher rates than men.1
  • Teenage girls with T1D are 2.4 times more likely to develop an eating disorder, and over 30% of women with T1D have been reported to restrict insulin to control weight.2,3
  • One in five youth with T1D experience anxiety.4
  • Half of adults with T1D experience “diabetes distress”, a clinical term to describe the powerlessness, stress, guilt, relentless worry and denial that comes with living with diabetes and the burden of self-management.5
  • Mental health issues in people with diabetes are correlated with worse outcomes, including worse glycemic control,6-9 more frequent and severe hypoglycemia,10 and more frequent diabetic ketoacidosis (DKA),6 increased frequency of diabetes complications.11

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To learn more about partnering with JDRF Canada and get more details about our Mental Health Strategy, or to share your story about the impact of T1D on your psychosocial health and emotional wellbeing, please contact us at mentalhealthstrategy@jdrf.ca

References

1) Roy T and Lloyd CE. Epidemiology of depression and diabetes: a systematic review. Journal of Affective Disorders. 2012. 142 Suppl: S8-21.

2) Goebel-Fabbri, A. Diabetes and Eating Disorders. J Diabetes Sci Technol. 2008. May; 2: 530–532.

3) Hanlan ME et al. Eating Disorders and Disordered Eating in Type 1 Diabetes: Prevalence, Screening, and Treatment Options. Curr Diab Rep. 2013. Sep 12:10.1007/s11892-013-0418-4.

4) Herzer M and Hood KK. Anxiety Symptoms in Adolescents with Type 1 Diabetes: Association with Blood Glucose Monitoring and Glycemic Control. J Pediatric Psychol. 2010. May; 35: 415–425.

5) Vallis M et al. Diabetes Attitudes, Wishes and Needs Second Study (DAWN2): Understanding Diabetes-Related Psychosocial Outcomes for Canadians with Diabetes. Can J Diabetes. 2016. Jun; 40:bv234-41.

6) Plener PL et al. Depression, metabolic control, and antidepressant medication in young patients with type 1 diabetes. Pediatric Diabetes 2015; 16: 58–66.

7) Corathers SD et al. Improving depression screening for adolescents with type 1 diabetes. Pediatrics. 2013. 132:e1395-402.

8) Lustman PJ et al. Depression and poor glycemic control: a meta-analytic review of the literature. Diabetes Care 2000. 23:934–942.

9) Strandberg RB et al. Longitudinal relationship between diabetes-specific emotional distress and follow-up HbA1c in adults with Type 1 diabetes mellitus. Diabetic Medicine. 2015. 32: 1304-10.

10) Katon WJ et al. Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes. Annals of Family Medicine. 2013. 11: 245-50.

11) de Groot M et al. Association of depression and diabetes complications: a meta-analysis. Psychosomatic Medicine 2001. 63: 619–630.

Back to School and Hypoglycemia

Starting a new grade, new school or beginning university can be very stressful even without having diabetes, particularly during the COVID pandemic.  Many students went to school virtually last year so this autumn may be the first time going to school in person in over a year. 

No matter the grade, getting back into the school routine requires a lot of preparation and planning.  It is always good to have a plan that includes emergency numbers along with insulin plan info, and how to treat low and high blood sugar levels. 

In a perfect world, all school teachers and staff would understand how to manage T1D. Since this isn’t always the case, communication is key.  It is important to educate teachers on T1D before school begins.  Providing information to the school and classmates on T1D management, especially recognizing the signs of hypoglycemia, will help kids feel comfortable returning to school and importantly will keep them safe and healthy, no matter what the school day brings.

Here’s some information on causes and signs of hypoglycemia.

Low blood sugar can be caused by1:

  • Changes to eating patterns such as skipping or delaying meals
  • More exercise or activity than usual, or exercising for a long time without eating a snack or adjusting insulin before exercise
  • Too much insulin or a change in the time taking insulin
  • Stress (presentations, tests, exams, etc.)
What are the symptoms chart


It is important always to BE PREPARED!

In case blood sugar levels fall below 4 mmol/L, school staff should be provided in advance with fast-acting glucose (e.g. Dex4 tablets, gels, and liquids).  If teachers notice a difference in behaviour related to the signs of low blood sugar or children feel warning signs of hypoglycemia, blood glucose should be checked immediately and treat low blood sugar promptly if needed. If a blood glucose meter is not available but low blood sugar is suspected, treat right away.

Treatment options include1:

Afterwards, wait 15 minutes, then check blood sugar again. If blood sugar cannot be tested, monitor the child closely to ensure symptoms of hypoglycemia improve. 

As low blood sugar can happen at anytime, it is important to be prepared.  Dex4 Glucose products help raise glucose levels FAST. 

Dex4 Glucose products are:

  • Fast-acting
  • Pre-measured so you know exactly how much glucose you are consuming
  • Fat-Free
  • Caffeine, gluten, cholesterol free
  • Great-tasting flavours

Additional Resources:

The Diabetes Hope Foundation supports mentorship programs for youth.  Buddy systems are available, for more information visit www.diabeteshopefoundation.com/mentor-biographies

1 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212.

Disclaimer:

Information in this article is provided for informational purposes only and is not a substitute for professional medical advice.

UBC team works to uncover new cell therapies that may one day lead to a cure for type 1 diabetes

UBC

JDRF Canada renews grant for UBC team identifying potential cell therapies for islet cell regeneration

JDRF is the leading charitable funder of research into type 1 diabetes in Canada, with a focus on research that will help improve lives today, and lead to disease prevention and cures

Verchere

JDRF Canada is pleased to announce continued support for University of British Columbia Researcher Dr. Bruce Verchere, the head of the Diabetes Research Program at the Child & Family Research Institute. Verchere and his team are exploring ways to regenerate the pancreatic insulin-producing beta cells that are subject to immune attack in type 1 diabetes (T1D).

Verchere’s lab investigates how certain types of white blood cells known as macrophages might be involved in activating the immune system. Macrophages are often called the ‘garbage eaters’ of the body, as they eat dead cells and bacteria in order to remove them safely. Research has also shown that these macrophages are involved in tissue repair and wound healing. By drawing on this knowledge, Verchere plans to see whether macrophages can produce proteins that will stimulate the production of new beta cells or even improve the function of existing beta cells. 

JDRF’s support will allow Verchere and his team to study how the islet macrophages respond to the death of neighboring insulin-producing beta cells. When faced with stressful situations, macrophages have the potential to release proteins that can regenerate beta cells. The team will closely examine the genes and proteins that are produced in response to the stress of the beta-cell death. By understanding the new genes and proteins made by islet macrophages under these conditions the team hopes to identify new therapeutic pathways to stimulate beta cell regeneration – and uncover new avenues to cure T1D.

The team will stress human islets in the lab and identify the genes that are subsequently expressed in islet macrophages. The goal of this simulated stress will be to see which of the produced proteins can stimulate new beta cell formation or enhance beta cell function.  Think of the initial beta-cell death as a trigger. This trigger then activates the neighboring islet macrophage to express, or turn on, specific genes. The macrophage machinery then produces, or pumps out, new proteins that can stimulate the production of new beta cells.

The 2-year $300,000 USD JDRF grant will support the team as they aim to identify a list of genes that can potentially stimulate human beta-cell regeneration. The team will also test out some of the lead candidate proteins that are produced by these genes. Ultimately the researchers plan to identify a list of proteins that can one day be used to develop new beta-cell therapies in T1D.

Thank you to our donors for supporting JDRF Canada. It is because of your generosity that JDRF can fund this exciting work and help us get closer to our goal of turning type one into type none.

Can we eliminate carb counting for people with type 1 diabetes?

Carb Counting

Research is exploring whether an insulin + pramlintide closed-loop system eliminate carbohydrate counting for people living with T1D.

JDRF is the leading charitable funder of research into type 1 diabetes in Canada, with a focus on research that will help improve lives today, and lead to disease prevention and cures.

Haider

JDRF Canada is pleased to continue supporting research led by McGill scientist Dr. Ahmad Haidar. Haidar and his team are looking at ways to improve the quality of life of people living with type 1 diabetes (T1D) using a novel insulin-plus-pramlintide artificial pancreas that may alleviate the need for carbohydrate counting.

Carbohydrate counting is the process of counting the number of carbohydrates in a meal – something that people living with T1D need to do every time they eat in order to be able to calculate the appropriate and safe amount of insulin needed for blood sugar control. Carbohydrate counting can however become burdensome as it requires an extensive knowledge base and detailed calculations, made multiple times a day. Haidar and his team aim to develop an automated insulin delivery system that can minimize this burden for people living with the disease.

A closed-loop system, or “artificial pancreas”, automates the delivery of insulin based on the blood sugar levels obtained from continuous glucose monitors. Evidence shows that individuals using a closed-loop system are often less burdened by the decision-making process of daily insulin management and can benefit from improved glucose control, fewer hypoglycemic episodes, and a better quality of life.

Haidar and his research team plan to study a closed-loop system that delivers both insulin and pramlintide. Pramlintide is a medication that resembles a natural hormone produced by healthy beta cells called amylin, which slows the movement of food through the stomach. This hormone can blunt the extent to which sugars are broken down, allowing for a meal to less severely elevate blood sugar levels. The team’s previous work showed that such a system was safe and effective in people with T1D. Now, they want to explore whether a combination of a fast-acting insulin and pramlintide can eliminate the need for carbohydrate counting without compromising glycemic control.

Haidar will examine how this closed-loop system will affect target blood sugar levels in adults and adolescents, as well as these individuals’ quality of life, in a randomized controlled trial. The study will be two weeks long, will take place outside of a clinic setting, and will compare a system that delivers both insulin and pramlintide versus a system that delivers insulin on its own. The study will also compare traditional carbohydrate counting techniques against a simple meal announcement notification.

JDRF is pleased to support two more years of Haidar’s ongoing work with a $760,000 USD grant in this important area of diabetes management, and thanks its donors for their continued support in T1D research.

Skin cells may be the key to unlocking better treatment for people with type 1 diabetes

Researcher

JDRF renews grant support for study examining stem cell transplants for diabetes

JDRF is the leading charitable funder of research into type 1 diabetes in Canada, with a focus on research that will help improve lives today, and lead to disease prevention and cures.

As part of this commitment, JDRF is renewing its support of an important study led by the University of Toronto’s Medicine by Design bioengineering department. Executive director Dr. Michael Sefton is being awarded almost $430,000 USD to study how skin cells may play a key role in establishing an environment that is suitable for successful stem cell transplants for people living with type 1 diabetes (T1D).

Sefton and his team are exploring new ways for insulin-producing cells to be transplanted into people living with T1D. Their research examines ways to engineer tissues so that transplanted insulin-producing cells are not rejected by the immune response. In clinical islet transplantation, insulin-producing cells are transplanted into the liver of people living with T1D. In this scenario, though, the immune system often acts up and makes the liver a hostile environment for the transplanted cells.

Even with the use of immunosuppressive drugs, the transplanted insulin-producing cells can stop working, and the people need to return to insulin therapy. The success of the transplant can therefore be short lived.

Sefton’s lab is exploring ways to use the skin, instead of the liver, as a transplant site. By using a more accessible site the hope is that the transplanted cells can receive nutrients from blood vessels, and ultimately survive and produce insulin when blood sugar levels are elevated. In addition, the team is investigating ways to prevent rejection of the transplanted cells that will not require use of conventional immunosuppressive drugs, which can have serious side effects.

The JDRF grant to Dr. Sefton will be pivotal in supporting his team as they continue to explore ways to create an environment that supports transplantation of insulin-producing cells. This renewed funding will support the team as they seek to answer the following important questions:

  1. Can blood vessels be created so that the skin has a better supply of nutrients for the transplanted cells to survive? Insulin producing cells that have access to blood vessels after transplant can be healthier and better able to produce insulin for longer periods of time. Having previously studied a material containing methacrylic acid (MAA) that can stimulate creation of new blood vessels, Sefton’s lab will continue to understand how MAA can support the insulin-producing cells’ transplant.
  2. Are there ways for the immune system of the person with T1D to not to reject the new transplanted cells? The team will explore whether they can minimize the immune response by delivering special immune cells found in the skin, known as dendritic cells, so that the transplanted cells are recognized by the immune system and not targeted as being foreign, and rejected. Using the natural ability of the immune system to protect, rather than reject, the transplanted cells will be pivotal in helping the transplanted therapy have potential clinical impact.

Medicine by Design, where Dr. Sefton’s lab is located, was founded in 2015, thanks in part to a $114-million grant from the Canada First Research Excellence Fund. Focused on regenerative medicine, Medicine by Design-funded researchers use engineering, mathematics, medicine and physical and life sciences to develop new therapies for diseases such as stroke, heart failure, and diabetes.

JDRF is excited to once again fund this innovative work and we look forward to sharing research updates as they become available. Thank you to our donors for supporting this important work.