Skip to main content
About Us
What is Diabetes Action Canada?
Mission and Vision
Team
Partners
Governance
Policies
Impact
Patient Engagement
Our Approach to Patient Engagement
Become a Patient Partner
Research to Action Fellowship
Patient Leadership Award
Community Hub
Recruit Patient Partners
Patient Voices Blog
Digital Health
About
Data
Apply
Success Stories
Privacy & Security
Contact Us
Knowledge Mobilization
Our Approach to Knowledge Mobilization
Consultation Service
Basics Video Series
Success Stories
Webinars
Practice Tools
Connect1d
Members
Membership
Researchers
Trainees
Community Action Partners
Research
Researchers
Trainees
Research Programs
Foot Care and Prevention
Older Adult
Indigenous Peoples Health
Mental Health
Innovations in Type 1 Diabetes
Retinopathy Screening
Resources
Podcast (Actions on Diabetes)
Webinars
Previous Newsletters
News
Donate
Join Our Network
About Us
What is Diabetes Action Canada?
Mission and Vision
Team
Partners
Governance
Policies
Impact
Patient Engagement
Our Approach to Patient Engagement
Become a Patient Partner
Research to Action Fellowship
Patient Leadership Award
Community Hub
Recruit Patient Partners
Patient Voices Blog
Digital Health
About
Data
Apply
Success Stories
Privacy & Security
Contact Us
Knowledge Mobilization
Our Approach to Knowledge Mobilization
Consultation Service
Basics Video Series
Success Stories
Webinars
Practice Tools
Connect1d
Members
Membership
Researchers
Trainees
Community Action Partners
Research
Researchers
Trainees
Research Programs
Foot Care and Prevention
Older Adult
Indigenous Peoples Health
Mental Health
Innovations in Type 1 Diabetes
Retinopathy Screening
Resources
Podcast (Actions on Diabetes)
Webinars
Previous Newsletters
News
Donate
Repository: Request Access
Study Title
Long Form Title
(Required)
Working Title
(Required)
Application Information
Title
First Name
(Required)
Last Name
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Daytime Telephone Number
(Required)
Email
(Required)
Principle Investigator (If different from applicant)
Same as above
Principle Investigator Details
Title
First Name
(Required)
Last Name
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Daytime Telephone Number
(Required)
Email
(Required)
Sponsor
Budget related to this request (with justification)
Scientific and Ethics Review
Has there been external scientific review of this protocol?
Yes, this protocol was part of a larger peer-reviewed grant. Please describe the reviewing organization.
Yes, this protocol specifically was peer-reviewed. Please describe the reviewing organization and attach reviewer’s feedback.
No
Peer Review Details
(Required)
Do you have research ethics approval for this study?
Yes – Which REBs have or will be reviewing this protocol?
In progress – Which REBs are reviewing this protocol?
Seeking REB review after DAC approval.
No – Please provide written correspondence with your REB indicating why not required.
External Review Details
(Required)
Does this study have any proprietary or commercial element to it?
No
Yes
Please Describe
(Required)
Project Details
Maximum 500 words
Background
(Required)
[Describe the underlying clinical scenario / issue.]
Research Questions/Study Aims:
(Required)
Data Fields Required
Demographic (e.g. age range, gender)
(Required)
Diseases (List all relevant diseases)
(Required)
Other
Medicines (List all relevant)
(Required)
Please describe your sampling frame
(Required)
Patient outcomes being measured
(Required)
How will this research benefit people who are living with diabetes or the general public?
(Required)
How will risks be mitigated?
(Required)
In what way(s) have patients or their families or caregivers been involved in the planning of the research?
(Required)
How are sex and gender issues being addressed in this study?
(Required)
(See CIHR guidance: http://www.cihr-irsc.gc.ca/e/50836.html)
What are your plans for data linkage?
No plans for data linkage
Yes, plans for linkage. Please describe:
Data Linkage Information
(Required)
Signature
Date
MM slash DD slash YYYY
Please attach Protocol, REB approval, scientific review feedback, and any other third-party feedback on the protocol.
File
Max. file size: 64 MB.
CAPTCHA