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Knowledge Mobilization Consultation Service

The Knowledge Mobilization (KM) Consultation Service is a program to support DAC research teams with their KM needs at any stage of the research process.

DAC researchers who would like to use this service can fill in a needs assessment survey by clicking the link or scanning the QR code below.

Julie Makarski (Research Manager and Implementation Support Practitioner, DAC KM Program)will follow-up to schedule a meeting to co-create your KM plan.
 
Through the DAC 2.0 KM Program, we aim to increase knowledge and capacity in knowledge mobilization across the DAC Network and to support DAC members in their knowledge mobilization goals and activities.

How the Patient voice is Transforming Database Research

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How do we know the number of people living with diabetes in a province? Is that number going up or down? Are people living with type 2 diabetes more or less likely to have a heart attack after they turn 50? Does a person with type 1 diabetes using an insulin pump have fewer diabetes related complications compared to those without an insulin pump?

These are all questions researchers are able to answer when they have access to data about people living with diabetes. It’s one of the core reasons Diabetes Action Canada has developed the National Diabetes Repository (NDR). The NDR is a tool researchers can use to better analyze information about people living with diabetes across Canada in order to support improved health outcomes and prevent complications. Oversight of the use of the data is through dedicated Patient Partners working alongside researchers, healthcare providers and experts in privacy and law. It is still uncommon for a research organization to incorporate patients into the governance of a project like this and, as highlighted in a recent article in the April 2019 edition of the British Medical Journal, this collaborative approach has been extremely successful.

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Opening Letter from Gary and Jean-Pierre

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Each year we see amazing strides in patient engagement within our research activities.   This year, some of these successes in patient engagement were highlighted at the 2019 Diabetes Canada Professional Conference during a 90 minute symposium. Dr. Ruth Ndjaboue, one of trainees, presents her perspectives on patient engagement and the pre-conference trainee day in this newsletter.

Over the past year, Diabetes Action Canada has engaged in performance assessment to better understand the impact of our activities in fulfilling our mission of improving health outcomes for persons living with diabetes. An in-depth Network Evaluation prepared by the research teams of Drs. Val Rac and Mathieu Ouimet has revealed the importance of our growing inter-disciplinary collaborations that evolve around the experiential knowledge and perspectives of our Patient Partners. Internal communication among our members has emerged as an area for improvement. We have not engaged a Communications Consultant, Krista Lamb, who is assisting us in improving the readability and accessibility of the information generated by our Network including through social media.  The Network Evaluation Report has been shared internally with our Operations and Management Committee as well as externally with CIHR and the external review committee. The content will be shared more broadly, once the peer-reviewed publications are in press in the near future.

The External Scientific Review of Diabetes Action Canada, which concluded at the end of November, was recommended by our leadership and Steering Council (although not required  by CIHR).  The panel of four external reviewers with expertise spanning all aspects of our SPOR Network activities, conducted interviews with Patient Partners, Researchers, Steering Council and Staff members to gather information and insight about our research and organizational structure.   Although a detail report is still pending we heard preliminary positive and constructive feedback from the panel and we look forward to acting on their recommendations. We want to thank all of those members of our Network who took the time to attend the external review in person, particularly those who travelled from across the country.

We hope you enjoy the stories in this newsletter as we strive to make the content more interesting to read.  We feature interviews with both Dr. Charles de Mestral on his recent media appearance and publication on diabetes-related lower limb amputations in Ontario and with our National Diabetes Repository team and how the repository is being used in research projects.  Finally, we share the recent press release for Research Canada, highlighting our patient-oriented research for diabetes awareness month. Finally, we wish to congratulate the recipients of our Knowledge Translation scholarship awards who are listed in this publication.

Wishing you all a happy a restful holiday season.

 

Diabetes Action Canada is building a Digital Patient Engagement Network

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Our Patient Partners, who live with T1D, have made it very clear that they feel disconnected from current clinical trials, researchers and research outcomes. In parallel, researchers struggle to connect with this diverse and geographically dispersed population. This disconnect is an impediment to recruitment to clinical trials and research, thereby hindering scientific advances that could greatly inform treatment pathways and improve health outcomes.

To bridge this gap, the Diabetes Action Canada iT1D Program is developing an opt-in digital platform for the purpose of recruiting, contacting and regularly engaging persons interested in contributing to clinical research to accelerating scientific advances that could greatly inform treatment pathways and improve health outcomes in T1D.  At time of registration those living with T1D will be asked to complete a very short questionnaire to determine their demographics, location and research interests as well as provide consent to be contacted for clinical research opportunities. Once enrolled, those living with T1D can explore clinical research opportunities and provide their opinion to help set targeted research priorities that address their specific needs.  Conversely, researchers will be able to directly engage members of the T1D Community in clinical research opportunities and in determining research questions for patient-oriented research projects.   To makes this platform truly patient-centred we have undergone an extensive co-design process with members of the T1D Community, which included large workshops with the T1D ThinkTank and Diabetes Action Canada Patient Partners, smaller working groups and one-on-one interviews.  This rigorous co-design has led us to a product that will present clinical research information in an easy to understand dashboard that presents information in a way that is easy to interpret and easy to determine if a clinical research study is a good match for the user.  The design of this digital patient engagement network, soon to be renamed, is nearly complete with an expected launch date in Q1 of 2020

Type 1 Diabetes TrialNet: A Type-1 Diabetes Research Network Screening Relatives of people with T1D and Innovative Clinical Studies

In our June 2019 newsletter we featured the ground-breaking news that the anti-CD3 antibody, Teplizumab, originally intended to protect new organs after kidney transplantation, could deactivate T cells that are targeting insulin producing beta cells.  This in turn could delay the onset of type-1 diabetes for those with close family members living with the condition.  What we didn’t mention was that those who participated in this study were recruited through the international research network called TrailNet.  TrialNet, funded by the National Institute for Health, offers risk screening for relatives of people living with type-1 diabetes and conducts innovative clinical studies to preserve insulin production.  The TrialNet Network includes 25 Clinical Centres and over 200 affiliated sites across North America, Europe, UK and Australia.  In Canada, the coordinating site operates out of the Hospital for Sick Children in Toronto and has 10 affiliated sites in Vancouver, Edmonton, Calgary, Winnipeg, London, Saskatchewan, Hamilton, Ottawa, Halifax and St. John’s.   Together these sites offer free Pathway to Prevention screening to evaluate the personal risk of developing T1D for relative of those living with the disease.   This minimally invasive blood test can detect autoantibodies that are predictive of developing T1D and those with these autoantibodies will have an opportunity to be monitored to ensure that if disease progression were to occur, that acute DKA and other complications are avoided.  Furthermore, those at risk of developing T1D can participate in prevention and insulin preservation trials to contribute to ground-breaking research, like the Teplizumab trial.  We are excited to be working collaboratively with TrialNet as Diabetes Action Canada develops our digital patient and researcher platform to connect those living with T1D with clinical research opportunities.  For more information on TrialNet you can visit their site here.

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Revolutionize How we Use Health Data

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National Diabetes Repository

Diabetes Action Canada has successfully launched the first National Diabetes Repository in Canada.  This novel, secure analytics platform designed and implemented by Dr. Michelle Greiver (University of Toronto) and colleagues now contains information from over 110,000 individuals with diabetes in Alberta, Manitoba, Ontario, Newfoundland and Quebec, along with the same number of age-matched non-diabetic controls.  The National Diabetes Repository was created through collaboration with the Canadian Primary Care Sentinel Surveillance Network https://cpcssn.ca , using de-identified and encrypted primary care electronic medical records (EMRs) data that can be accessed by approved Diabetes Action Canada investigators for population-based and observational studies.  The repository has since evolved to accept patient reported outcomes and experience measures directly from patients using digital tablets that are directly connected to EMRs.  Data from provincial administrative data sources can be linked to individuals in each province to provide social determinants of health and outcomes data.  To facilitate data integration, data sharing agreements are anticipated with the provincial organization members of the SPOR National Data Platform research program.

In collaboration with the Fields Institute Centre for Quantitative Analysis and Modelling (Fields-CQAM), and the Vector Institute for Artificial Intelligence and investigators from the Dalla Lana School of Public Health from the University of Toronto, we held a two-day data workshop June 17th and 18th 2019.  Trainees and established researchers applied advanced analytics to the de-identified dataset within our National Diabetes Repository. The exercise provided much needed insights into the feasibility of using advanced mathematic modelling and artificial intelligence learning models on Canadian EMR data in a secure high-performance computing environment.  Using two testing environments, the results of this workshop showed that our data can be used for: 1) machine learning to predict patient responses to SGLT2 Inhibitors with high accuracy based on their health records; and, 2) artificial intelligence to identify the characteristics of sub-group patients, including their medication history, that are associated with different HbA1c trajectories.  Taken together, we were able to demonstrate that artificial intelligence and advanced analytics could be applied to our dataset to provide useful information for both patients and physicians in selecting treatment options to manage their condition.

Révolutionner la façon dont nous utilisons les données sur la santé

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Répertoire national sur le diabète

Action diabète Canada a lancé avec succès le premier Répertoire national sur le diabète au Canada. Cette plateforme analytique sécurisée innovante a été conçue par la Dre Michelle Greiver (Université de Toronto) et des collègues. Elle contient maintenant des données sur plus de 110 000 personnes vivant avec le diabète en Alberta, au Manitoba, en Ontario, à Terre‑Neuve‑et‑Labrador et au Québec, ainsi que des données sur le même nombre de témoins non diabétiques appariés suivant l’âge. Le Répertoire national sur le diabète a été créé en collaboration avec le Réseau canadien de surveillance sentinelle en soins primaires (http://rcsssp.ca/) à partir de données anonymisées et chiffrées provenant de dossiers médicaux électroniques documentant des soins de base, auxquelles les chercheurs accrédités par Action diabète Canada peuvent accéder afin de réaliser des études fondées sur des populations et des observations. Le Répertoire a depuis évolué pour intégrer les résultats des soins de santé et des expériences des patients fournis directement par ces derniers à partir de tablettes numériques directement reliées aux dossiers de santé électroniques. Des données administratives provenant de sources provinciales peuvent être associées aux personnes dans chaque province pour fournir des déterminants sociaux liés à la santé et des données sur les résultats des soins. Dans le but de faciliter l’intégration des données, on prévoit conclure des ententes de partage des données avec les organismes provinciaux membres du programme de recherche sur la plateforme nationale de données SRAP.

En collaboration avec le Fields Institute Centre for Quantitative Analysis and Modelling (Fields-CQAM), l’Institut Vecteur pour l’intelligence artificielle et des chercheurs de la Dalla Lana School of Public Health de l’Université de Toronto, nous avons organisé un atelier de deux jours sur les données les 17 et 18 juin 2019. Des stagiaires et des chercheurs titulaires ont appliqué des méthodes avancées d’analyse à des jeux de données anonymisées tirées du Répertoire national sur le diabète. Cette analyse a fourni des pistes précieuses quant à la faisabilité de l’application de méthodes évoluées de modélisation mathématique et de modèles d’apprentissage par intelligence artificielle sur des données provenant de dossiers de santé électroniques canadiens, dans un environnement informatique haute performance sécurisé. À l’aide de deux environnements d’essai, les résultats de cet atelier ont montré que nos données peuvent être utilisées pour : 1) permettre l’apprentissage machine afin de prédire avec une grande précision la réaction des patients aux inhibiteurs de SGLT2 à partir de leurs dossiers de santé; 2) permettre l’utilisation de l’intelligence artificielle afin de déterminer des caractéristiques de sous-groupes de patients, y compris leur historique de médication, associées à différentes trajectoires HbA1c. Globalement, nous avons été en mesure de montrer que l’intelligence artificielle et l’analytique avancée peuvent être appliquées à notre base de données dans le but de fournir des renseignements utiles aux patients et aux médecins, en vue de la sélection d’options de traitement pour gérer l’état de santé des patients.

Scientific Ambassadors’ Report From the Joint Annual Meeting of SQLNM, CMDO Network, and Colossus Congress is now Available!

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This seventh joint annual symposium of SQLNM, CMDO Network and COLosSUS congress, aimed at maintaining the efforts to improve the health of the Quebec population with respect to diabetes, dyslipidemia and cardiometabolic and vascular disorders, took place at the Hôtel Chéribourg, Magog-Orford on February 6-8, 2019.  Diabetes Action Canada sent four Patient Partners as Scientific Ambassadors to this event which also highlights the Francophone Quebec week dedicated to education on cardiometabolic health, diabetes and obesity in February each year.

For two days, the scientific ambassadors took part in four symposia which covered several themes related to cardiometabolic health, diabetes and obesity and attended presentations from Dr. Bruce Perkins and Dr. Pedro Geraldes, winner of the 2017 CMDO Network Young Investigator Award. In the report below, we will give a brief overview of the topics covered and present the various points of view expressed by the ambassadors about their experience.

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The Innovations in T1D Research Program has Started a New Research Trial

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Researchers in Toronto (Bruce Perkins MD) and Montreal (Ahmad Haidar PhD) and their teams have started the “Closed Loop ASSessment 17 (CLASS17)” study investigating how a pill used for the management of type 2 diabetes can help a hybrid closed loop insulin pump system work better to achieve time-in-target blood sugar levels for those with type 1 diabetes. The pill is a type of Sodium-Glucose Linked Transporter (SGLT) inhibitor that lowers blood sugar by increasing the urinary excretion of sugar. The hybrid closed loop system uses a Dexcom sensor, a Tandem insulin pump, and the McGill Artificial Pancreas algorithm run on an Android phone.

For more information about the study, see https://clinicaltrials.gov/ct2/show/NCT03979352?term=CLASS17&rank=1 or e-mail Class17@lunenfeld.ca

Tidepool working with diabetes device manufacturers to empower the diabetes community with their health data

If you attended the American Diabetes Association (ADA) 2019 Scientific Sessions, you might have heard first-hand the news that Tidepool is working with diabetes device manufacturers Metronic, Dexcom, and Omnipod to help create an interoperable automated insulin pump system – Tidepool Loop.  Tidepool is a non-profit data hub for patients and clinicians to combine and view data for insulin pumps, CGMs and blood glucose and make it easy to understand and interpret.   Medtronic manufactures the only commercial available hybrid closed-loop system (aka artificial pancreas) and its components CGM and insulin pump.  Dexcom manufactures the G6 interoperable continuous glucose monitoring system (iCGM), and the Omnipod System that is a wearable three day insulin delivery system.   Together these manufacturers plan to work with Tidepool on the regulatory and software processes necessary to develop Tidepool Loop as an FDA–regulated version of Loop.

This is big news to those using or wishing to use a hybrid closed loop system as these developments open the door to interoperability of devices that will empower people with diabetes in their health care decision-making.  Although this technology is planned to be launched in the USA, Diabetes Action Canada currently has two funded clinical studies testing an artificial pancreas algorithm.  The first study led by Dr. Bruce Perkins will identify the feasibility and efficacy of combined SGLT2 inhibition therapy and artificial pancreas treatment using quantitative outcome measures and questionnaires in subjects with type 1 diabetes.  The second led by Dr. Remi Rhabasa-Lhoret, examines an insulin pump technology that includes two configurations, one that infuses insulin (single-hormone) alone and another that infuses insulin and the counter-regulatory hormone glucagon (dual-hormone).  We are also working with Tidepool to integrate the system into our digital assets. We expect that this technology will soon be available to Canadians and informed by Canadians and our health system.

News release on Medtronic and Tidepool collaboration can be found here

News release on Dexcom and Tidepool collaboration can be found here

News release on Omnipod and Tidepool collaboration can be found here

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