Recently, our Knowledge Translation research group, led by Dr. Sophie Desroches, published a paper on their environmental scan of knowledge translation tools in the Canadian Journal of Diabetes.

The paper, Environmental Scan on Canadian Interactive Knowledge Translation Tools to Prevent Diabetes Complications in Patients with Diabetes, identifies existing interactive knowledge translation tools that could help patients and health care professionals prevent diabetes complications in the Canadian context. The team conducted an environmental scan in collaboration with researchers and four patient partners across Canada.

They looked at tools used to prevent diabetes complications that met the following criteria: they were used in a real-life setting; used any instructional method or material; had relevance in the Canadian context, were written in English or French; has been developed and/or published by experts in diabetes complications or by a recognized organization; were created in 2013 or after; and had accessibility online or on paper.

The results of this study inform Canadian stakeholders interested in the prevention of diabetes complications to avoid unnecessary duplication, identify gaps in knowledge and support implementation of these tools in clinical and patients’ decision-making.

Read the paper here.

By Krista Lamb

If patient involvement in designing research studies is to become an integrated part of the diabetes research process, the next generation of scientists must understand why it is necessary and how to successfully incorporate patients into their work.

To achieve this, Diabetes Action Canada’s Training and Mentorship team has been working to build resources and share knowledge in both official languages with students and trainees across the country.

Dr. André Carpentier is one of the program leads, alongside Michelle Murray, Dr. Mathieu Bélanger and Patient Partner André Gaudreau. For Carpentier, this project is essential to establishing a process for incorporating patients into research planning. He sees this as a way to further democratize research, opening it up to everyone who has a stake in the results. To do this, the team needed to ensure everyone was starting from a place of common understanding. “Because such a program did not exist before, we had to train the trainers and train all the different patient partners and the investigators at Diabetes Action Canada, then move on to expand the training base to others as well,” he says.

Gaudreau, who lives with type 2 diabetes, got involved because he wanted the opportunity to help researchers see that patients brought a very specific and needed expertise to the table. He had met investigators who did not see why a patient partner needed a role in their studies, then after attending one of his training sessions they realized the value they were missing out on. “They would come up to me and say, “Oh, André, I know why now.” After the training, they see why it’s important to start with the patient partner at the beginning, not at the end or the middle,” Gaudreau says. “Start with patient partners and ask them what the research could do for them.”

Carpentier is particularly proud of how patient partners like Gaudreau have been integrated so fully into the process—from the administrative level, to the planning and evaluations, as well as through doing the training sessions themselves. “We have incredible patients that are really engaged throughout all of the process and all the programs, and that has helped us move the needle even further than what we anticipated,” he says.

One example of this is a recent project with the Diabetes Action Canada Indigenous Peoples Health Program, in collaboration with the Can-SOLVE CDK SPOR Network. The groups hosted the inaugural Wabishki Bizhiko Skaanj (wah-bish-kih biish-ih-goo skaa-nch) learning pathway in April 2019 in Winnipeg, Manitoba.  The pathway aims to enhance researchers’ and Patient Partners’ knowledge and awareness of histories of Indigenous peoples in Canada and the impact of colonization and racial biases on Indigenous health.  It introduces culturally safe patient-oriented research practices with Indigenous communities as partners and helps foster a climate where the unique history of Indigenous peoples is recognized and respected in order to conduct research in an equitable and safe way. This process also involves developing an ongoing personal practice of critical self-reflection, and being honest about one’s own power and privilege, especially as these relate to Indigenous people.

Moving forward, Carpentier is hopeful they can secure more partnerships and involve more research institutes—bringing trainings like this to a larger and more diverse audience. He would also like to see continued investment in mentorship programs to help expand the number of young scientists who can be immersed in this work and see the tangible impacts.

Gaudreau is also very interested in expanding the reach of this knowledge sharing. In future, he would like to focus on doing more train the trainer sessions in French or other languages. While many of the current trainings take place in French, he would like to see this increase as a way to ensure that there are trained instructors available across the country who are able to reach a large and diverse population.

Overall, the group hopes to build on their successes to increase the understanding of how patient involvement in research can have a positive impact on research at all levels.

Learn more about the Diabetes Action Canada Training and Mentoring Program.

By Krista Lamb

For decades, sex and gender were often missing from the list of things considered during the research process. Unfortunately, this led to some health care interventions that were inappropriate or potentially harmful for some patients.

These days, sex and gender are recognized as important to health research—a development applauded by Diabetes Action Canada—and our research team in this area is looking to ensure that understanding of sex and gender is broadened to include considerations of intersectionality, encompassed by the term sex- and gender-based analysis plus (SGBA+).

The sex and gender research team at Women’s College Hospital in Toronto defines SGBA+ as “the process of integrating sex, gender and other demographic factors – such as race and disability – throughout the research process, from conceptualizing (e.g. research question development) through to completion (e.g. knowledge translation).”

This means that while it is important to look at the distinction, for example, between women and men, there is also a need to look at other factors in their lives and how these affect outcomes in health research.

“I think at the start, it was realizing the importance of looking at differences between women and men,” says Dr. Paula Rochon of this area of research. “We know that there are so many important differences from a sex perspective, in terms of, for example, who is predisposed to getting diabetes. Then there are many gender-related pieces, everything from how it impacts diet or body image, to the design of insulin pumps. Over time, we’ve added on all of the other intersecting factors that are so important. How does socioeconomic status play into it? How does race play into it? What are all these other pieces? It just adds so much more complexity and richness to the work.”

Dr. Robin Mason agrees. “All these elements contribute to identity, making each person’s experience in developing diabetes, learning to live with diabetes, self-management and the overall impacts of diabetes, somewhat unique,” she explains.

In other words, we can say that a woman may be more or less likely to develop diabetes based solely on the genetic variations that stem from her sex. However, there are many other variables in her life that may also play into that risk—where she lives, her race, her socioeconomic status, what she does for a living, what resources she has access to and so on—and these too must be considered in a research study in order to get a full understanding of the results.

This leads into the concept of intersectionality, which is another major tenant of this work.

“Intersectionality is a framework to understand how different demographic factors, like sex, age, race, religion and education, intersect to determine health outcomes. As such, it’s important to apply an intersectionality lens throughout the research process from the onset of the project until completion to ensure all identity factors are accounted for,” explains Jaimie Roebuck.

Looking at sex and gender exclusively, explains Mason, helped the team at Women’s College Hospital recognize the limitations of these elements when considered on their own. They also needed to look at intersecting identity-related factors.  “We recognized that we needed to do some further work in developing our understanding of how these key identity-related factors intersect with sex and gender to create individualized experience.”

To further this goal, the team has developed an article that explains the concepts of SGBT+ and intersectionality, and they are working on a number of training modules that they will roll out for Diabetes Action Canada researchers over the next few months.

For Dr. Rochon, working with the Diabetes Action Canada Network is helping to build understanding of these concepts into research in order to better serve those living with diabetes. “Through our group, we’re helping to increase capacity and advance the future of diabetes research in Canada,” she says. “If all researchers start applying an intersectionality lens to their work, we can create a body of evidence that people can use to help really improve the way we care for those with diabetes.”

Learn more about our Sex and Gender research program.

Diabetes Action Canada is excited to continue it’s webinar series in October with our research spotlight featuring our Knowledge Translation program. Please note that all presentations will occur in French

Below you will see the list of topics and presentations for this October webinar series:

Tuesday October 6^th at 1PM EST

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Personal Impact Story: Lanie Deslauriers

• ScaLing up sharEd decision makinG for pAtient-centred Care (LEGACy) in home care
  • Presented by: Karine Plourde

Canadian seniors/caregivers in home care could benefit from shared decision making and become fully engaged as partners in their care.  Although excellent tools for shared decision making have been developed the challenge is scaling these tools for wider use.  Dr. France Legare, co-lead for the Diabetes Action Canada Knowledge Translation Enabling Program discusses her CIHR Foundation Scheme Grant to scale shared decision making in home care.  

• Development of standards for a reporting guideline for studies assessing the impact of scaling up strategies – SUCCEED
  • Presented by: Amédé Gogovor

Scaling successful health interventions has no defined process, leaving many interested in scaling their intervention with little to no guidance.  Amédé Gogovor, discusses an approach to reporting scaling studies using a patient-oriented and sex and gender lens.

• Integration of notions of sex and gender in interventions aimed at promoting the adoption of shared decision-making by health professionals: secondary analysis of a Cochrane systematic review
  • Presented by: Lionel Adisso

Shared decision making has been proven favourable to patients and healthcare teams.  Integrating sex and gender considerations have also had proven benefit in treatment plan for diabetes, but how often are the two combined?  Lionel Adisso, shares his results from evaluating these two concepts together.

*Moderated by: Olivia Drescher

Wednesday October 21^th at 11AM EST

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Personal Impact Story: Nicole Ruel

• Sleeping habits among adults living with diabetes: Understanding to develop better interventions to prevent complications associated with diabetes
  • Presented by: Lydi-Anne Vézina-Im

 What is the secret to a good night’s sleep for those living with diabetes? Lydi-Anne Vezina-Im, Diabetes Action Canada Knowledge Translation Awardee, will share her findings on what people living with type 1 and type 2 diabetes believe is their secret to a successful snooze.

• Research on Patient-Oriented Scaling Up (RePOS)
  • Presented by: Ali Ben Charif

As researchers gather evidence of successful research initiative at the local scale there is increased interest in scaling these innovation to reach more region in Canada and increasing access to more people. Dr. Ali Ben Charif, discusses a multi-stakeholder approach including, Patient Partners, to create a framework for patient and public involvement in scaling-up health research innovations.

 Scaling-up Potential for Health Innovations: Status in Canada

• • Presented by: Ali Ben Charif

Canadian researchers gather evidence through countless pilot projects, but how to researchers scale their ideas to more places in the country? Dr. Ali Ben Charif, discusses the current state and process for scaling health research innovations and key success factors.

 *Moderated by: France Legare

By Krista Lamb

For older Canadians, diabetes is often one of multiple conditions they are trying to manage—all while encountering barriers that are specific to their age. This is why a research team at Diabetes Action Canada is dedicated to working together with older adults with multiple chronic conditions and their caregivers to promote optimal aging at home.

This Diabetes Community Partnership Program (CPP), developed  by the Aging, Community and Health Research Unit at the School of Nursing, McMaster University in Hamilton, ON involves a six-month self-management intervention that is designed to improve the quality of care and health outcomes in adults over 65 with diabetes and other chronic conditions who are living in the community. The Diabetes CPP is delivered through a partnership between primary care and community partner organizations and consists of care coordination, home or virtual visits, wellness sessions, and team case conferencing in addition to usual diabetes care. The Diabetes CPP is currently being evaluated in six diverse settings across three provinces (Ontario, Quebec, PEI).

For Dr. Jenny Ploeg, the need to focus on an older adult population is key. “We fully recognize the vulnerability of older adults in terms of their multiple chronic conditions,” she says. “They’re high users of the health system, their quality of life is often affected by the presence of chronic conditions. And also, they’re heavily reliant on their family caregivers for support.”

Dr. Maureen Markle-Reid agrees. “This is a population that is underserved, in that they face a lot of inequities and have difficulty, for example, accessing services, and are often difficult to reach because they have low income or they have low social support. There’s lots of factors that influence their health outside of the health care system,” she says. “And a large piece of this puzzle is the fact that they’re under studied. When we started this project, we found that a lot of the research looking at different models of community-based care had actually excluded older adults who had multiple chronic conditions.”

Older adults with diabetes and other chronic conditions often receive care from multiple providers who do not communicate directly with each other. This can mean their care is fragmented. The CPP was designed to improve communication and coordination across providers, settings and sectors so that older adults and their caregivers can feel better supported and improve health outcomes.

The team are also studying the barriers and facilitators to implementing the CPP in specific communities so that the program can be tailored appropriately. They recognize that elements like geography and individual cultural safety should be considered when implementing the program in diverse settings. For example, in a community like the suburb of Scarborough, ON, older adults may struggle to find transportation to get to the grocery store and purchase healthy groceries, or to find resources available in their native language. When considering these factors, what may work well in one population may be completely wrong for another. Being aware of this allows for a much more holistic and evidence-based approach.

For the Patient Partners involved in this project, much of the appeal of this project was in better understanding the needs of older adults from diverse backgrounds and, therefore, being able to provide programming and support that would improve their lives.

Frank Tang experienced many of the barriers the program has observed when he was caring for his aging parents, including a mother with diabetes and dementia. He had to navigate multiple doctors and specialists and translate to his parents what was needed and why. Now, as he grows older and manages his own diagnosis of type 2 diabetes, he is very aware of the need for research to focus on meeting the specific needs of communities. “I think that what I bring to this project is the lived experience, especially when language is a major factor,” says Tang. “As people get older, their hearing is not as good. And you get a specialist that talks quickly to them and they don’t have a clue what the details are. You need someone who has some good comprehension of the English language or the French language who could help them break it down in a way that they can understand.”

Patient Research Partner Ron Beleno agrees. He is also helping his parents manage diabetes and other chronic conditions. He sees clearly the challenges of having older adults from an immigrant population trying to navigate the health care system, and the need for research programs to study their needs and create programs that meet them. “This is about understanding that community piece and being willing to adapt,” he says. Researchers have been learning from the Patient Partners about the very different concerns faced by each individual and how research must meet the needs of everyone. “You have to have some flexibility based on the community.”

Moving forward, the program aims to continue to focus on collaboration with Patient Research Partners and community resources to improve on outcomes. “I’m so proud of the changes that we’ve seen as we move forward with this study,” says Markle-Reid. “We often say that we were changing practice as we study it. And we’re seeing changes in terms of how providers are caring for older adults with multimorbidity, how they’re paying attention to the social determinants of health, how they’re now working with a patient-centered lens, working collaboratively with patients and families, including family caregivers or friends, and really bringing those people in as part of their care.”

Learn more about the program on our website.

A paper from Diabetes Action Canada researchers Drs. Peter Senior, Bruce Perkins and Remi Rabasa-Lhoret, along with Patient Partner Kate Farnsworth, was recently released in the journal Springer Nature.

The paper, Assessment of Risks and Benefits of Beta Cell Replacement Versus Automated Insulin Delivery Systems for Type 1 Diabetes, looks in detail at these treatment options.

Read the paper here.

Diabetes Action Canada is thrilled to restart its highly successful webinar series this September, October and November.   Each month we will be featuring a different research programs and this September we will highlight the Training and Mentoring Program and the work of our awardees and trainees.

Below you will see the list of topics and presentations for this September seminar series:

Tuesday September 15^th at 1PM EST

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Personal Impact Story: Tom Weisz

1. Implementation of the Indigenous Youth Mentorship Program
   • Presented by: Frances Sobierajski

The Indigenous Youth Mentorship Program (IYMP) is designed in partnership with Indigenous communities to promote holistic wellness, prevent type 2 diabetes, and promote positive mental health. Frances Sobierajski, will discuss this dynamic after school program and the critical community engagement used to implement this successful program.

2. Exploring the feasibility of a mobile health application for management and follow up of women with Gestational Diabetes Mellitus
   • Presented by: Bhavadharini Balaji

Women who develop gestational diabetes have increased needs from the health system need increased monitoring by both their practitioner and self.  Learn how Dr. Bhavadha Balaji, Diabetes Action Canada, post doctoral fellowship awardee, is evaluating the feasibility of the bant app to support self-management for women with gestational diabetes in pregnancy and postpartum.

3. How knowledge exchange of primary care research can benefit diabetes individuals: a qualitative study
   • Presented by: Francesca Brundisini

Research findings in diabetes care often suggest different approaches to managing the condition, but how is this information communicated among those who would use it (i.e. both practitioner and citizen)? Francesca Brundisini, examines a patient-oriented approach to disseminating new knowledge to the general public.

*Moderated by: Tracy McQuire

Wednesday September 30^th at 11AM EST

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Personal Impact Story: Sasha Delorme

1. Keep it Going! Sustaining and spreading quality improvement interventions
   • Presented by: Celia Laur

Quality improvement programs have time and time again generated evidence for better care for those living with diabetes, but what happens when the funding stops? Dr. Celia Laur, Diabetes Action Canada Intercentre Trainee awardee, will share her findings of interviews with authors of trials with successful quality improvement initiatives to explore what happened when funding ended, and if/how the work continued.

1. How sugar affects fat in the blood and risk of heart disease
   • Presented by: Priska Stahel

Developing heart disease is a major concern for those living with type 2 diabetes.  Priska Stahel, Diabetes Action Canada post doctoral fellowship awardee discusses the role of glucose in releasing stored fats and increases the risk of developing heart disease. 

3. Quantifying type 2 diabetes risk in pregnant women
   • Presented by: Stephanie Read

Gestational diabetes is an important marker for future risk of developing type 2 diabetes in women. Dr. Stephanie Read, Diabetes Action Canada postdoctoral fellowship awardee, will discuss a digital tool to help women and physicians calculate individual risk of developing type 2 diabetes so that health care interventions aimed at reducing type 2 diabetes risk can be deployed at the right time for the right individuals.

4. Insights into impact of Tele-retina screening for diabetic retinopathy among those who identify as women of low socio-economic status (SES) Multimethod qualitative study
   • Presented by: Aleksandra Stanimirovic

Tele-retinal screening for diabetic retinopathy has proven to be a cost effective approach to preventing this much feared complication for those living with diabetes.  Dr. Aleksandra Stanimirovic, Diabetes Action Canada Mentorship awardee, discusses the particular challenges faced by women of lower socioeconomic status in participating in tele-retinopathy screening.

*Moderated by: Tracy McQuire

To explore ways in which data can remain safe while also becoming more easily accessible to researchers who examine issues of public interest, Diabetes Action Canada and the Schwartz Reisman Institute for Technology and Society at the University of Toronto teamed up in late 2019 to host a collaborative, cross-disciplinary workshop. The event helped to uncover insights about how health data could be liberated from the outdated mechanisms that ostensibly protect privacy, but instead act as obstacles to improved health outcomes for patients.

Participants, including Diabetes Action Canada Patient Partners, came from a variety of policy sectors, academic disciplines, non-profit organizations, and health care institutions to bring their diverse perspectives and backgrounds to a common goal: improving the health and autonomy of those who live with diabetes in Ontario through better access to and analysis of data stored in the health system. The group aimed not only to address diabetes-specific data challenges, but to more generally think about how data liberation could improve health and save lives. 

This report, Liberating Health Data in a Digital World, summarizes the problems for which participants tried to pinpoint root causes, the diversity of approaches that were brought to bear on those problems, and the unique perspectives and backgrounds of participants from a variety of sectors.

Read the report now! 

By Krista Lamb

Thanks to the work of Diabetes Action Canada researchers Dr. Alanna Weisman and Dr. Gillian Booth, it is now possible to distinguish type 1 diabetes from type 2 diabetes in Ontario’s electronic medical records and administrative databases.

This is an important step forward, as for years Ontario researchers had to take a ‘best guess’ approach to establishing the needs of people with type 1 diabetes in the province. “We’ll be able to learn a lot about type 1 diabetes in Canada, which we previously hadn’t been able to study,” says Weisman. “We didn’t even know basic things about type 1 diabetes, like how many people have a diagnosis of type 1 diabetes, are the rates increasing over time, decreasing over time, or are they stable?”

Having access to this type of data will allow researchers and policymakers to better understand the needs of those with type 1 and find ways to improve care.

Weisman, an endocrinologist at Mount Sinai Hospital, has focused her research on databases. She uses national and provincial sources to capture the health information of a population. Because type 1 diabetes is relatively rare compared to type 2—only about 5-10% of those with diabetes have type 1—it was challenging to find a way to extract information specific to the type 1 community.

“It’s important to understand that when we use these types of large databases that capture health information for a population, we don’t have the same level of detail available in the medical chart. We don’t actually have a simple coded variable that says what type of diabetes someone has,” Weisman explains.  “If you don’t have a simple way of distinguishing that, it’s really hard to reliably identify those people who have type 1 diabetes because they’re such a small population relative to type 2 diabetes.”

The paper, “Validation of a type 1 diabetes algorithm using electronic medical records and administrative healthcare data to study the population incidence and prevalence of type 1 diabetes in Ontario, Canada,”was published in the journal BMJ Open Diabetes Research and Care. Weisman hopes that it may help researchers in other provinces find a reliable way to distinguish type 1 diabetes in their database systems. She cautions, however, that because each province has slightly different ways of collecting data, the algorithm may need to be adjusted in every case.

Next up, Weisman and her research team are working on ways to use this newfound data to learn more about how access to insulin pumps can have an impact on outcomes for those with type 1 diabetes. Across Canada, each province has different rules for pump funding, which means that outcomes could potentially differ greatly based on access.

“One of the first questions we’re looking at, since we have this opportunity for the first time to compare between provinces within Canada, is to look at whether this affects incidence of insulin pump use, and whether it affects who is able to use an insulin pump based on what funding is available in their province,” Weisman says. “It’s disheartening to think that the same individual with type 1 diabetes has access to an insulin pump in one province and not another. I think this can be used to advocate and drive change in those provinces where people don’t have that much access.”

Her findings could also influence how coverage for technologies like continuous glucose monitors, which are currently not covered in most provinces, are supported. As wearable technology improves, it will be important to know just how much impact these devices have on the overall health of those who use them in order to better understand the need for improved access and funding. This new research offers a step forward in that work.

Read the paper.

Learn about Diabetes Action Canada’s National Diabetes Repository.