A National Framework for Diabetes in Canada

Work is underway to establish a national framework for diabetes in Canada in order to address the growing number of diabetes cases that disproportionately affect Indigenous peoples, Canadians of African and South Asian descent (in the case of type 2 diabetes), and people with low incomes and low levels of education. 

This initiative follows the assent of Bill C-237, which was adopted by the Senate in 2021, the year that marked the 100th anniversary of the discovery of insulin. This legislation aims to establish the first national strategy to reduce the risk of diabetes onset and improve its management in Canada.

Why a national framework?

The primary goal of the framework is to improve access to diabetes prevention and treatment in order to improve the health of people at risk for or living with diabetes in Canada. It also aims to identify the training needs of health professionals involved in diabetes prevention and treatment, and to promote research.

A framework based on a survey 

With the help of provinces and territories, Diabetes Canada, Diabetes Quebec, JDRF, Indigenous organizations and other stakeholders, a survey was conducted from January to May 2022 to determine key diabetes-related needs in Canada.

People living with diabetes (type 1, type 2 and rarer forms), healthcare professionals and other stakeholders were involved and participated in interviews, discussions and online surveys.

What are the main diabetes-related needs in Canada?

The results of this survey, released in September 2022, provided insight into the considerations on the minds of people living with or connected to diabetes in Canada. Some of the key themes highlighted in the survey include:

• Connections between inequity and diabetes. Although the pandemic has paved the way for virtual healthcare and improved access to care in Canada, inequity between provinces and territories in terms of access to care, medications (e.g., different types of insulin), medical devices (e.g., insulin pump, continuous glucose monitor), financial assistance and diabetes education were highlighted in the survey. The need to improve anti-racism training for healthcare professionals and the healthcare system to fight inequity was also highlighted.

• Distinguishing between types of diabetes. Survey respondents, particularly those with type 1 diabetes (T1D), emphasized the need to distinguish between the different types of diabetes, and to recognize that the medical, social, financial and psychological implications vary depending on the type of diabetes. Access to treatments and technologies should take these differences into account. People living with T1D mentioned the importance of having access to the device of their choice and emphasized the impact this would have on their overall quality of life. 

• Moving from stigma and shame to support. The issue of stigma associated with diabetes was widely reported in the survey. People with T1D spoke about the sense of shame they often feel when discussing their diabetes “control” and outcomes with their healthcare team. Participants emphasized the vicious circle of shame and guilt they may feel due to this stigma, which is detrimental to managing their illness. This means that in the future, the care system will need to demonstrate more humanity, flexibility, inclusion, consultation and understanding to reduce judgment and stigma.

• Accessible and appropriate healthcare. Survey participants also criticized the healthcare system’s “unit costs only” approach and called for a comprehensive view of costs and benefits (e.g., long-term reduction of the risk of complications, improved quality of life) in covering various diabetes-related treatments and technologies.
• Research, surveillance and data. Participants noted that people living with diabetes should keep being included in research, but that they should also be allowed to provide guidance, so that their needs are considered and addressed. In an effort to follow this model, patient partners are involved in most stages of the BETTER project. 

One point that was regularly mentioned by people living with T1D in the survey was inequality of access to the tax credit. This access has already been improved since the survey, because since June 2022, all people with T1D in Canada can get the tax credit (DTC) without exception.

Let’s hope that this national framework and survey, which provide a baseline for diabetes-related needs and issues, will lead to improvements in the lives of people with diabetes in Canada.

References :

• National Framework for Diabetes Act, Government of Canada, consulté le 21 septembre 2022, https://laws.justice.gc.ca/fra/lois/N-9.1/page-1.html
• Informing a Framework for Diabetes in Canada: Stakeholder Engagement Summary, Government of Canada, consulté le 21 septembre 2022, https://www.canada.ca/en/public-health/services/publications/diseases-conditions/informing-framework-diabetes-canada-stakeholder-engagement-summary.html