Author: Linxi Mytkolli

ACHRU researchers are examining the effectiveness of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month nurse-led program that promotes self-management for older adults with diabetes and other chronic conditions.

This article in Trials, presents a protocol for the two-armed, multisite, pragmatic, mixed-methods randomized controlled trial (RCT). This study will provide evidence of the success of the community-based self-management program and ultimately reduce the research-to-practice gap.

Markle-Reid M, Ploeg J, Fraser K, Fisher K, Akhtar-Danesh N, Bartholomew A, Gafni A, Gruneir A, Hirst S, Kaasalainen S, Kelly Stradiotto C, Miklavcic J, Rojas-Fernandez C, Sadowski C, Thabane L, Triscott J, Upshur R. (2017) The ACHRU-CPP versus usual care for older adults with type 2 diabetes and multiple chronic conditions and their family caregivers: study protocol for a randomized controlled trial. Trials. 18:55. DOI: 10.1186/s13063-017-1795-9 

Click here to read the article 

Diabetes Action Canada is now completing its first year of intensive planning and implementing the first stage of our patient-oriented research endeavours. Using our patients’ first lens our investigators are identifying major gaps in health care across Canada for individuals living with diabetes. Our core activities focus on establishing the most effective ways to identify those at risk and prevent blindness, amputations, cardiovascular and kidney disease. For individuals living with Type 1 diabetes (T1D), the most successful methods of improving glucose control is through technology-assisted glucose sensing and insulin delivery. This requires shared-decision making between the patient and a medical expert, generally located in tertiary referral clinical sites. For individuals living with Type 2 diabetes (T2D), who also suffer from multiple chronic conditions, community-based support is required from a professional team who can provide customized interventions to holistically address  all health determinants. These approaches are supported by a high level of evidence in keeping with the Canadian and American diabetes guidelines.

As the first step in establishing these proven interventions to prevent diabetes complications, we must first identify individuals who are at risk. To this end, our Health Informatics group is now working on establishing a diabetes repository in which individuals with diabetes can be registered for the purpose of connecting with their provincial health systems. Frank Sullivan and Michelle Greiver, the group leads, describe this approach and the potential impact on identifying individuals with diabetes and their current health status. Concurrently, Diabetes Action Canada will be launching specific projects to improve interventions for individuals with both T1D and T2D.  We feature one of our patient representatives, Doug Mumford, who has lived with T1D for 49 years and attests to the successful use of technology-assisted insulin treatment.

The second step is to increase the capacity of our patient-oriented research workforce in Canada to enable a continual learning environment where improvements in care for individuals living with diabetes is supported by best evidence. Our Training and Mentoring Group, under the leadership of Mathieu Bélanger and André Carpentier, has established a comprehensive program for graduate students, health professional students and post-doctoral students engaged in diabetes research. We are most grateful to Diabetes Canada (formerly the Canadian Diabetes Association) for their generous support in partnering with Diabetes Action Canada to establish new joint postdoctoral fellowships in patient-oriented research commencing in 2017.

We look forward to accelerating all of our endeavours in 2017-18 that will be kicked off at our Annual Workshop in May where all of our patient representatives, investigators and stakeholder representatives will meet to evaluate progress to date and commit to next year’s strategic goals.

Our Diabetes Action Canada Scientific Leads, Principal Investigators, Co-Investigators,
patient representatives and key stakeholder representatives will convene in Toronto at our annual workshop on May 26, 27.

The purpose of this face-to-face meeting is to evaluate our progress to date and advance strategic planning for the next year and beyond. This networking experience is critically important for the development of new opportunities to build collaborative relationships. We aim to better understand how our major projects can be integrated for optimal outcomes including translation of knowledge into practical solutions for individuals living with diabetes.  After a year of start-up and much progress, our workshop will highlight all of our projects in Patient-Engagement, Indigenous Health, Retinopathy Screening, Health Informatics, Clinical Trials, Teaching and Mentoring, Knowledge Translation, Sex&Gender – focused on impact. In advance of the two day workshop, our Patient Councils will meet and prepare to advise our deliberations during the visioning and strategic planning of our research and capacity building. As part of our proceedings, the Steering Council and the Standing Committee on Strategic Partnering and Innovations will meet and then advise us during our workshop deliberations. We look forward to this exciting opportunity to network with all those engaged in Diabetes Action Canada.

Dr. Frank Sullivan

Dr. Frank Sullivan is an academic family physician at the University of Toronto with clinical appointment at North York General Hospital and is the director of the University of Toronto’s Practice Based Research Network. Before coming to Canada, he was involved in developing the Scottish Care Information – Diabetes Collaboration (SCI-DC), which tracks real-time clinical information on all 300,000 people with Type 1 and Type 2 diabetes in Scotland. Data in this system are used for research and quality improvement as well as clinical care. Some of the lessons learnt over fifteen years developing the Scottish system may be applicable in Canada. Many of the new and exciting approaches being developed in Canada may be beneficial to people in Scotland with diabetes.

Dr. Michelle Greiver 

Dr. Michelle Greiver is an academic family physician at the University of Toronto with clinical appointment at North York General Hospital. She has been involved with the inception and development of Canadian Primary Care Sentinel Surveillance system. She is also involved in studying Electronic Medical Record implementation and its effect on preventive services. Dr. Greiver believes that the lack of data standards and problematic data quality in EMRs are holding back quality improvement efforts in a range of long-term health problems, including diabetes. She is involved in studies looking at improving EMR data quality and is the deputy director of the University of Toronto’s Practice Based Research Network.

Doug Mumford

Doug Mumford has had diabetes since 1968.  Initially with only urine testing and animal insulins, control was difficult to achieve and Doug feels lucky and grateful that he is still around and healthy forty-nine years later!

In 2009 he volunteered in a clinical trial to determine whether a Sensor Augmented Insulin Pump could enable patients to lower their A1C.  A measurement and control engineer, Doug took to Continuous Glucose Monitoring (CGM) like a duck to water, seeing it as a tool to finally enable control of blood glucose (BG) levels.  As Doug says, “If you cannot measure something, you cannot hope to control it”.  His A1C fell from 8.5% to 6.5% during the trial and has remained below that, and more importantly Doug now lives life as he chooses.  That freedom was impossible before.

Dr. Bruce Perkins was the research clinician for that trial and Doug switched to him for ongoing care.  Believing he could help others with diabetes, Doug became a volunteer and has been active in that role ever since.  He has been instrumental in developing a Diabetes Patient Portal website which will soon go live.  With a nurse colleague, he also developed software to show graphically how insulin pump complex boluses actually affect BG over their duration.  Patients have found this tool very helpful.Dr. Perkins suggested that Doug get involved in the SPOR initiative and after reading everything he could find on-line, Doug volunteered and was selected as a member of the General Patient Council.  Within days they realized Doug was a good fit for the Diabetes Action Canada Health Informatics project and drafted him to its Technical Committee where he has contributed both by representing the patient viewpoint and as someone knowledgeable in data and systems.

The Steering Council of Diabetes Action Canada, is our highest level of governance and provides the Network with the necessary guidance and oversight on all aspects of our Network activities.

We are delighted to announce our new Steering Council Chair is Malcolm King. Malcolm led the CIHR Institute of Aboriginal Peoples’ Health as its Scientific Director for the past 8 years, and has devoted many years to improving wellness and achieving health equity for Indigenous Peoples through his tireless efforts in promoting meaningful research and strategic collaboration.  We are privileged to be able to tap Malcolm’s invaluable leadership and wealth of experience.

Provided below for your information, are links to Malcolm’s profile and the Steering Council webpage of the Diabetes Action Canada website.

– https://www.sfu.ca/fhs/people/profiles/malcolm-king.html

– http://s971398767.online-home.ca/about/

Terry Sullivan and Ross Gray have very kindly agreed to accept the invitation to be the Chairs of the Nomination/Governance and Finance/Audit Standing Committees, respectively.

As Chair of the Nomination/Governance Standing Committee, Terry leads the Committee in the recruitment of members for the Steering Council and Standing Committees, as well, organize the performance evaluation for the Steering Council and our leadership of the SPOR Network. Ross, in his capacity as Chair of the Finance/Audit Standing Committee, will lead the Committee in providing oversight of the budget plannings, financial reporting and audits for the Network.

Dr. Terrence Sullivan currently serves on a number of governance and advisory roles in health services and health policy. He is the Chair of CADTH’s Board of Directors, the Quality Committee of the Hospital for Sick Children, and the Governance Committee for Exactis Innovation (a federal Network Centre of Excellence focused on new therapeutics for cancer).

Ross Gray is currently a Patient Representative advising Diabetes Action Canada. He is a semi-retired Real Estate developer who has been a member of the Rotary Club of Bolton for over 25 years. He has held many Executive positions within several corporates and charitable organizations. Also, Mr. Gray is actively involved in major charitable endeavors (both locally and nationally) including the Banting & Best Cabinet. He has been supporting Diabetes Research for around 10 years and has been greatly involved with Dr. Gary Lewis.

Diabetes Action Canada is delighted to have members with such outstanding skills serving on our Steering Council.

New Diabetes Pharmacist Network-developed learning module for pharmacists about the need for preconception care in women with diabetes

Women with diabetes and their unborn children have a greater likelihood of developing complications during pregnancy, compared with the general population.

(Tuesday, March 28, 2017 – TORONTO) – Today, a new online interactive learning module launched that will help educate over a thousand pharmacists from across Canada on the recommendations for preconception care for women with diabetes. The project is the result of an on-going collaboration between the Diabetes Pharmacists Network based at the University of Toronto’s Banting & Best Diabetes Centre and Diabetes Action Canada.

“Pregnant women with diabetes and their unborn children have significantly higher rates of complications – compared to women in the general population,” said Dr. Lori MacCallum, Sun Life Financial Professor in Wellness and Diabetes Education and Assistant Professor, Leslie Dan Faculty of Pharmacy, University of Toronto. “Women with diabetes see a pharmacist more often than any other health care provider. By educating pharmacists on the importance of preconception care, they will be able to play a significant role in reaching women with diabetes of childbearing age and providing education.”

Women with diabetes who become pregnant are at greater risk of many potential complications, which include: malformations in the baby, preterm delivery, large for gestational age infants, caesarean delivery as well as worsening diabetes complications in the mother, such as high blood pressure and eye disease. The good news is that studies have shown that preconception care, ideally delivered in the planning stages for pregnancy, before one becomes pregnant – can significantly reduce risks, almost to the level of women without diabetes.

Unfortunately, less than 50% of women receive such care and vulnerable populations including women with a lower socioeconomic status, lower health literacy, and those with a poor relationship with their health care provider are less likely to receive such care. All women with diabetes of childbearing potential need to be aware of the need for preconception care regardless of where they are in their reproductive journey. It is vital to implement these measures prior to women becoming pregnant.

This is where pharmacists, particularly community pharmacists, can play a greater role in addressing this care gap.

The new module will educate pharmacists about the importance of preconception care, particularly in women with diabetes, and the recommendations for blood sugar control, safety of medications, folate supplementation and screening for diabetes complications. It features tools that allow pharmacists to self-assess their current knowledge, watch an expert video, apply their learning to a patient case, and discuss the topic with their peers.

“Our goal is to empower and support pharmacists in taking a greater role in the delivery of preconception care,” said Dr. MacCallum.

For more information about this exciting initiative, please visit diabetespharmacistsnetwork.ca.