Framework for Diabetes in Canada
A national strategy to improve access to diabetes prevention and treatment to ensure better health outcomes for Canadians.
Supporting Efforts to Address Diabetes Across Canada
On October 5, 2022, the Government of Canada tabled the Framework for Diabetes in Canada (Framework). The Framework aims to support prevention and treatment for all types of diabetes, and provide a common policy direction to address diabetes in Canada.
The Framework will identify gaps in current approaches, avoid duplication of effort, and provide the federal government an opportunity to monitor and report on progress. In doing so, it will lay the foundation for collaboration across sectors to reduce the impact of diabetes.
There are six components of the Framework where focus can be given to ensure better health outcomes for Canadians impacted by diabetes.
- management, treatment and care
- surveillance and data collection
- learning and knowledge sharing
- access to diabetes devices, medicines and financial supports
In guiding efforts to address components of the Framework, cross-cutting principles were identified as keys to success.
- addressing health equity
- applying a person-centred approach
- differentiating between types of diabetes
- supporting innovation
- promoting leadership, collaboration and information exchange
In recent years, momentum has been building in Canada for type 2 diabetes prevention and management for all types of diabetes. With testimonies heard from organizations including JDRF Canada, the Standing Committee on Health tabled A Diabetes Strategy for Canada in April 2019 and re-tabled in April 2021.
On February 27, 2020, Member of Parliament Sonia Sidhu introduced Bill C-237, which required the Minister of Health to develop a framework designed to support improved access to diabetes prevention and treatment to ensure better health outcomes for Canadians. Unanimously passed in June 2021, the National Framework for Diabetes Act allowed for the creation of the Framework.
Through Budget 2021, 100 years after the discovery of insulin, the Government announced investments to address diabetes. As part this funding, through the Canadian Institutes of Health Research, the federal government recommitted to the JDRF Canada and CIHR Partnership to Defeat Diabetes (established in 2017), by investing up to $15 million matched by JDRF Canada and its donors for T1D research. In particular, $25 million was invested towards research, surveillance, and prevention, and to developing the Framework.
The Framework was developed in consultation with provincial and territorial governments, Indigenous communities, people living with diabetes, academics, researchers, and other stakeholders.
Diabetes in Canada
Diabetes represents one of the most significant health-care crisis of our time. With no dedicated support or action to tackle the diabetes epidemic, it means that, every 24 hours:
- More than 20 Canadians die of diabetes-related complications
- 480 more Canadians are diagnosed with this devastating disease
- 14 Canadians have a lower limb amputation
- And our health care system spends $75 million treating diabetes
Diabetes prevalence in Canada is not only skyrocketing, but is already among the worst of OECD countries (Organization for Economic Co-operation and Development), according to the International Diabetes Federation. In Canada today, one in three people lives with prediabetes or diabetes – 11 million Canadians. Since 2000, the number of Canadians with diabetes has doubled. A 20-year-old in Canada now has a 50 per cent chance of developing the disease and this grows to 80 per cent within some Indigenous populations. The global rate of type 1 diabetes (T1D) is climbing by 3% every year – with Canada’s rate growing higher at 5% – and we don’t know why. Beyond the immeasurable impact on human life, if prevalence grows by 40 per cent in the next decade as projected, the direct costs associated with treating diabetes in Canada will top $39 billion by 2028.
For T1D, prevention means an increased investment in autoimmunity research to understand and prevent the response that triggers the body’s destruction of its insulin-producing cells.
Delayed diagnosis of T1D is a leading factor in incidence of life-threatening but avoidable diabetic ketoacidosis (DKA) in both children and adults with an estimated 5-10K Canadians hospitalized annually due to DKA. An alarming number are infants in toddlers. Nearly 4 in 10 children under age 3 present with DKA at the time of first diagnosis. Of these, 38% had visited a physician within the previous week. Interventions are needed to help Health Care Providers diagnose T1D earlier, including increased use of finger-prick blood glucose testing in clinical settings and testing of family members of those with T1D.
Appropriate interventions for T1D aimed at reducing complications include those promoting adherence to recommended treatment guidelines (eye and foot checks, for example) as well as those that increase access to beneficial diabetes technologies such as insulin pumps, flash glucose monitoring, continuous glucose monitoring and hybrid-closed loop systems.
Improving outcomes with respect to T1D means moving beyond HbA1C to look at other metrics such as time spent in target range, and reduced incidences of hypo- and hyperglycemia.
To advance the goals of the Framework, JDRF has formally submitted its recommendations for the upcoming federal budget as part of the government’s engagement process.
The Government of Canada should invest $30M over 5 years with JDRF Canada (with a minimum of $5M in financial or in-kind match funding from other funders of trials) to support a type 1 diabetes (T1D) Clinical Trial Network to enable up to 7 high-impact trials, infrastructure to accelerate the planning and launch of new trials and trial sites, and training of multiple new clinician-researchers. Funding will also support expansion of a key enabler of the T1D Trial Network, a platform co-designed by patients to engage the T1D community in research, accelerate trial recruitment and collect and report on national T1D data.
One of the key components of the National Diabetes Framework is to continue to invest and advance research activities which are inclusive of persons with diabetes. Canadian T1D researchers have an exceptional record of leading and participating in high-impact clinical studies and trials and are at the forefront of international research.
However, the limited number of clinician researchers in this field, lack of long-term funding, and fragmentation of resources continue to hinder efficient planning and execution of multi-centre trials and translation of research outcomes to the clinic.
JDRF’s global research strategy is focused on driving development and commercialization of therapies to cure T1D or prevent it in people at high risk of the disease. To leverage Canada’s strengths, build Canadian research capacity, and accelerate development of new therapies, we intend to revolutionize a Canadian T1D Trial Network that will drive globally impactful T1D research, and to provide funding to support this network for up to five years.
Additionally, this funding will support up to 7 transformational T1D trials selected based on their potential to improve care and advance curative therapies through rigorously reviewed competitive funding opportunities.
The Government of Canada should invest $5M over 3 years into implementation research on interventions that addressing mental health challenges in people with T1D.
The Framework states that diabetes prevention, management, treatment and care are most effective when approached holistically, taking into consideration people’s physical, social, emotional, mental, spiritual and cultural well-being. This person-centered approach is integral to the Framework’s implementation.
Although mental health disorders are associated with worse health outcomes and even early death in people with T1D, they typically receive less attention than better-known diabetes complications. As we emerge from the COVID-19 global pandemic when mental health is more fragile than ever, there is no better time to tackle this issue by increasing knowledge about interventions that can prevent and treat mental health disorders in people with 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.
$5M of new funding for research on mental health and T1D will enable up to 3 large-scale clinical studies focused on testing approaches to prevent or treat mental health disorders in vulnerable people with T1D.
As a policy guidance document, all sectors and levels of government are invited to make use of the Framework to address diabetes within their respective mandates.
Moving forward, the Government of Canada plans for further engagement with stakeholders to encourage collaboration and multi-sectoral partnerships, and build upon the components of the Framework.
In 2027, on the fifth anniversary of the Framework, a progress report will be delivered by the Minister of Health to identify not only the efforts undertaken by the federal government to address diabetes, but also the collaborative efforts between different levels of government and diabetes stakeholders, and the current state of diabetes prevention and treatment in Canada.
For more information and to read the Framework in full, please visit the Government of Canada’s website here: canada.ca/en/public-health/services/publications/diseases-conditions/framework-diabetes-canada