Projects

Diabetes Action Canada will enhance patient-oriented research and contribute to improved patient outcomes by fostering alliances across and between research, policy, and practice by translating promising research findings into real-world demonstrable impacts.

Co-Scientific Leads: Gary Lewis, Jean-Pierre Després


OBJECTIVES OF THE NETWORK:

The main objectives of Diabetes Action Canada are to address the questions repeatedly articulated by Canadians living with diabetes: “what is my individual risk of developing blindness, kidney failure, lower limb amputation or heart failure?” and “what are the most effective ways to mitigate these risks?”
Keeping the end results in focus, our multi-disciplinary teams will bridge three major knowledge translation type 1 (KT1) gaps aligned with patients’ and healthcare providers’ priorities.

  • Understand the accuracy of predictive rules about which individuals with Type 1 (T1D) or Type 2 (T2D) diabetes are at the highest risk for onset and progression of retinopathy (eye damage), neuropathy (nerve damage), nephropathy (kidney damage) and cardiovascular disease.
  • Develop and apply user-friendly, customized diagnostic tools designed for both patients and healthcare providers to diagnose the risk of complications as early as possible based on sex, genomics, epigenetics, metabolomics, and by implementing new biological marker and organ imaging screening methods. Equally important are specific health determinants that modify the trajectory of diabetes complications including gender, lifestyle (diet and exercise) and co-morbidities (e.g., arthritis), and culturally appropriate care paths for those who are most vulnerable and at greatest risk.
  • Evaluate new interventions based on technology and biomedical innovation, including lifestyle modifications targeted at preventing and reducing organ damage, new and repurposed drugs to reduce the onset and prevent progression of diabetes complications, and novel automated glycemic control devices, such as artificial pancreas and dual hormone insulin pumps. This KT1 gap will be bridged by conducting Phase 1 and 2 clinical trials ( the main focus of our Network), the results of which will inform the scale-up of larger, multi-centre Phase 3 and 4 clinical trials (KT2) and policy (KT3) necessary to ultimately transform healthcare.

INTEGRATING THEMES

1.0 PATIENT ENGAGEMENT

2.0 SEX & GENDER

3.0  HEALTH POLICY


MAIN ACTIVITIES – DIABETES ACTION CANADA GOAL GROUPS


1. Patient, Practice, and Populations Diabetes Risk Management System
LeadFrank Sullivan, Michelle Greiver

Co-Investigators: Babak Aliarzadeh, Onil Bhattacharyya, Rick Birtwhistle, Gillian Booth, Neil Drummond, Serge Dumont, Jean-Francois Ethier, Julie Gilmour,  Ilana Halperin, Noah Ivers, Lisa Jaakkimainen, Peter Juni, Tara Kiran, Lorraine Lipscombe, Donna Manca, Geetha Mukerji, Andrew Paterson, Baiju Shah, Karen Tu, Xiaolin Wei, Rose Yeung 

The objectives and activities are to:

  1. Develop a platform for a national data management system to evaluate access to and implementation of effective methods for diagnosing and preventing diabetes complications for all Canadians;
  2. Design a mobile and web-based app that will assess risk for diabetes complications for individuals with T1D and T2D – the “Risk Calculator”; and,
  3. Design a novel framework for collecting reported data through mobile (bant) or web-based apps that connect with clinical data and analytics to capture population-level health data previously limited to small research studies and trials. Design a user-friendly Clinician Dashboard for researchers to manage their engagement in research.

2. Knowledge Translation (KT)
Lead: France Légaré
Co-Lead: Sophie Desroches

Co-Investigators: 
 Joyce Dogba, Monika Kastner, Helene Lee-Goselin, Lori McCallum, Monica Parry, Mary-Claude Tremblay, Holly Witteman, Catherine Yu,

The objectives and activities are to:

  1. Develop and implement evidence-informed value congruent and equity-responsive KT products (e.g., tools, practices, policies, training programs);
  2. Address patient-driven research priorities and develop an inter-disciplinary nation wide agenda of outcomes-oriented research that matter to patients;
  3. Foster an inter-professional approach to shared decision-making in the context of diabetes care and prevention of complications;
  4. Adapt existing KT products to an inter-professional team approach to shared decision-making to provide patient-centered care for diabetes;
  5. Accelerate translation of existing and new knowledge generated by basic biomedical, clinical and population health research into clinical practice and policy applications;
  6. Strengthen the capacity to conduct patient-oriented KT research focused on effective chronic disease management;
  7. Evaluate the KT strategy for Diabetes Action Canada; and,
  8. Evaluate the patient engagement strategy and its implementation.

3.  Diabetic Retinopathy Screening – National Tele-Ophthalmology
Leads: Michael Brent, David Maberley 

Co-Investigators:  Alan Cruess, Bernard Hurley, Chris Rudnisky, David Wong, Jason Noble, Mahyar Etminan, Marie Carole Boucher, Matthew Tennant, Melanie Campbell, Sherif El Defrawy,  Stephen Kosar, Tom Sheidow, Valeria Rac, Varun Chaudhary

The objectives and activities are to:

  1. Develop a national diabetic retinopathy assessment program and registry – accessible to all Canadians with diabetes;
  2. Engage patients in understanding the key health determinants for diabetic retinopathy and customizing care based on risk;
  3. Design a mobile and web-based app for patient-centered engagement and better access to diabetic retinopathy screening; and,
  4. Develop new human subjects protocols for population-based studies and clinical trials for diabetic retinopathy and other diabetes complications.

4.  Clinical Trials and New Therapies
Lead:  Bruce Perkins

Co-Investigators: David Cherney, Ahmed Haidar, Benoit Lamarche, Remi Rabasa-Lhoret   

The objectives and activities are:

  1. In adults with T1D, to determine if the use of adjunct-to-insulin sodium glucose-linked transporter 2 inhibition improves artificial pancreas system efficacy;
  2. To fund patient-oriented research projects in diabetes cardiovascular complications at the University of Toronto;
  3. To determine whether DPP-4 inhibition using sitagliptin prevents progression of diabetic nephropathy in T2D;
  4. In adults and children with T1D, to compare dual-hormone artificial pancreas (AP), single-hormone AP, and standard sensor-augmented pump therapy in outpatient settings;
  5. In individuals with T1D, to determine the effect of vigorous intensity physical activity intervals to standard care moderate intensity exercise to reduce the risk of post-exercise hypoglycemia;
  6. In individuals with T1D and mild to moderate neuropathy, to determine the role of topical pirenzepine in preventing and or reversing progressive neuropathy;
  7. Based on the hypothesis that insulin may act on the central nervous system to inhibit intestinal and/or hepatic lipoprotein production, to determine the effects of insulin on lipoprotein production in non-diabetic healthy subjects;
  8. To develop proteomic-based biomarkers for beta cell and adipose tissue dysfunction in T2D; and,
  9. To develop and evaluate dietary and physical activity web-based tools to monitor risk and facilitate intervention to prevent onset and progression of diabetes complications.

5. Training and Mentoring – Developing Capacity in Patient-Oriented Research
Leads: André Carpentier, Mathieu Bélanger

Co-Investigators: Caroline Jose, Aurel Schofield,Neeru Gupta

The objectives and activities are:

  1. To develop a shared vision among Diabetes Action Canada stakeholders (patients, researchers, healthcare providers, NGOs, and institutions) about overcoming barriers to effective patient-oriented research training and mentoring;
  2. To develop and implement a comprehensive integrated patient-oriented training and mentoring program for Diabetes Action Canada with emphasis on creating opportunities for research career paths for women and visible minorities;
  3. To develop and launch a mentoring program with experts in patient-oriented research supporting trainee skill development and career choices; and,
  4. In collaboration with the Canadian Diabetes Association, provide funding for postdoctoral fellows and graduate students engaged in patient-oriented research

6. Patient Engagement
Leads: Joyce Dogba 
Co-Lead: Holly Witteman 

The objectives and activities are:

Research (lead: Joyce Dogba)

  1. Identify research priorities of people and families living with diabetes in Canada, and communities in Canada disproportionately affected by diabetes;
  2. Evaluate the patient engagement strategy and its implementation;
  3. Conduct patient-oriented research into topics of interest to people living with diabetes;
  4. Conduct a literature review of patient-oriented research models in research organizations;
  5. Conduct realistic reviews and guidelines on the implications of vulnerable and marginalized people in patient-oriented research.
  6. Study how to best conduct patient-oriented research in diabetes.

Service (lead: Holly Witteman)

  1. Organize patient advisory councils;
  2. Organize and support patient partnership in diabetes research projects within the network;
  3. Facilitate patient input into diabetes research studies–from study design and execution, through analysis, interpretation, and dissemination.

7. Indigenous Peoples Health
Co-Leads: Alex Otsehtokon McComber (Kanien’kehá:ka), Jon McGavock

Co-Investigators: Caroline Chartrand, Barry Lavallee, Nancy Young, Mary Jo Wabano, Marie-Claude Tremblay

Patient Council: The Indigenous Patient Advisory Circle meets approximately 4 times per year. Members are Indigenous people from nations across Turtle Island who live with diabetes personally (any type) or they are current or previous caregivers to a person with diabetes. Members also bring expertise from other roles they hold in their lives.

The Indigenous Goal Group will engage community leaders, knowledge users, and youth from across Canada to support and evaluate research that centres on resilience, strengths-based models of wellness. We predict that will reduce these inequities and improve the health and lives of Indigenous people and their caregivers living with or at risk for diabetes across the country. Over the next 3 years we will accomplish the following aims:

Objectives:

  1. Support the expansion of the current network of a resilience-informed peer-led intervention for the prevention of type 2 diabetes among Indigenous youth. This network currently consists of 30 scientists, youth, stakeholders, elders and community leaders across 12 communities in 5 Canadian provinces. Our goal is to expand to 30 additional Indigenous communities across Canada by 2020. We will also expand regional centres of excellence supporting the work in these communities from 3 to 6 by 2020. These centres will house program content, training, expertise and other necessary support. Regional centres will be led by Indigenous communities/group and linked to DAC investigators through relationships with local academic centres.
  1. Train physicians and trainees in an established/successful model trauma informed diabetes care. The Diabetes Integration Project is a mobile screening and care program initiated in Manitoba in 2005. It consists of 11 mobile diabetes health care service delivery teams consisting exclusively of Indigenous health care providers. Over the past decade, this team has refined a model “trauma informed care” that has led to dramatic increases in patient engagement and improvements in diabetes complications risk. We will support extensive training of physicians and trainees across the network in this culturally-informed model of care.
  1. Create holistic, strengths-based population-level platforms to perform strengths-based epidemiology for First Nations people. Conventional models of population studies rely almost exclusively on individual-level data without recognizing contextual factors (family, community, historical factors) relevant to Indigenous people. We will use population-level data linkage to study determinants of wellness among First Nations peoples living with diabetes in Canada.
  1. Create Patient-Guided Models of Wellness for Indigenous persons living with diabetes. We have launched a national Indigenous Peoples’ patient advisory committee to guide us in the creation of wellness-based holistic interventions, guided by Indigenous teachings to improve the lives of Indigenous people living with diabetes.
  1. Support Community Engagement and Knowledge Translation for Research focused on reducing Inequities in Pediatric Type 2 Diabetes among Youth. The Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) research theme collaboration with Indigenous community-based stakeholders and health care providers, addresses bench-to-beside research focused on type 2 diabetes in youth. The three key research pillars for DREAM target: (1) Interventions to treat and prevent Type 2 Diabetes, (2) High burden of diabetes-related complications in youth with type 2 diabetes and (3) Developmental origins of type 2 diabetes in youth.

8. Sex & Gender
Lead: Paula Rochon

Co-Investigators: Paula Harvey, Robin Mason

The objectives and activities are:

  1. Enhance capacity of research team members’ ability to integrate sex and gender in their research by addressing the
    a) importance of sex and gender in health research, and
    b) development of research team members’ abilities to integrate a sex and gender lens through all phases of a research study;
  2. Document, measure and evaluate activities related to the integration of sex and gender across Diabetes Action Canada;
  3. Lead, collaborate and contribute to Diabetes Action Canada’s academic products to ensure or enhance the visibility of sex and gender considerations;
  4. Share opportunities and resources related to sex and gender that may be of benefit;
  5. Provide tailored, specific assistance upon request (e.g. literature reviews, review of data collection tools, etc.)

Diabetes Action Canada Presentations:


 

Diabetes Action Canada Annual Workshop Reports

 

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