Month: September 2022

T1D Index

This blog contains content relating to early mortality due to Type 1 Diabetes, which may be confronting and distressing to some readers. Please exercise caution and care when engaging with this content. 

How many people live with type 1 diabetes (T1D) around the globe? 
How does T1D affect life expectancy? 
How many lives could be saved with universal access to diabetes supplies and devices?  

Until now, there have been wide gaps in the data about the incidence, prevalence and impact of T1D, limiting opportunities to take actions to reduce the burden of T1D on individuals, families, and populations. That is about to change. JDRF, in collaboration with key partners and experts* around the world, have just released version 1.0 of the Type 1 Diabetes Index (T1D Index), a tool that can estimate the burden of T1D in every country in the world. A first-of-its-kind data simulation tool, the Index measures and maps the human and public health impact of T1D. The Index simulation is informed by over 400 publications from around the globe as well as a global survey of more than 500 endocrinologists. The T1D Index and its data can be accessed through a publicly available online dashboard, and the basis of the Index has been recently published in the leading diabetes and endocrinology medical journal, The Lancet Diabetes & Endocrinology. 

T1D has a profound human, emotional and financial burden for those who live with it – and prevalence is rising rapidly. New data from the Index has revealed that: 

Globally: 
  • Since 2000, T1D prevalence has increased at 4x the rate of global population growth 
  • As of 2022 there are 8.7 million people living with T1D globally 
  • The expected number of people living with T1D in 2040 will be 17.4 million 
In Canada: 
  • There are 285,324 people living with T1D in 2022 
  • 36,264 people should still be alive today (if they had not died early due to complications from the condition) 
  • Today, 1-in-21 families are impacted; in 1990 it was 1-in-47; in 2040 could be 1-in-16
  • In Canada, T1D is growing at 4.4% each year compared with 4.6% for type 2 diabetes Canada is among the top 10 countries in the world in terms of incidence (new cases each year relative to population size). 
  • The estimated years of life expectancy lost for a Canadian diagnosed with T1D at age 10 is 10.6 years 
  • The average Canadian enjoys 84 healthy years of life. If a person develops T1D at age 10, on average they will lose 22 healthy years.**

This projected growth in the number of people living with T1D, globally and in Canada, will place significant burden on individuals, caregivers, governments and healthcare systems. Yet too little is being done to reduce the burden and stem the increase in prevalence. The T1D Index was created to help shine a light on the challenges we face today and in the future, and give us a chance to act now.  
 
Leveraging data and insights from the T1D Index can help change the lives of people living with T1D by identifying attainable country-by-country interventions including, access to optimum care, supplies and devices; funding new research that could lead to prevention and cures; and enabling timely and accurate diagnosis in low-income countries where T1D is still frequently not diagnosed, leading to death soon after onset. 

The Index provides us with valuable information that will help further our advocacy and research work in Canada. For example, if everyone in Canada with T1D had access to insulin, test strips and good self-management we could restore 2 years of healthy life per person. Additionally, if everyone in Canada had access to devices (pumps and CGMs), we could restore another 6 healthy life years to the average person with T1D.  

Being able to measure and map the human, public health and economic impact of T1D will ultimately allow us to improve the lives of people living with T1D around the world and move closer to cures. 

Appendix 
* The Index was developed collaboratively by JDRF, Life for a Child, International Society for Pediatric and Adolescent Diabetes (ISPAD), International Diabetes Foundation (IDF), and Beyond Type 1.   

** “Healthy years lost to T1D” is an estimate of time lost to ill-health, disability, or early death from living with T1D, presenting complete picture of the burden of living with T1D. 

Honouring Peter Oliver’s life and legacy

September 23, 2022 
 
JDRF is deeply saddened by the loss of an incredible individual who made an unparalleled impact at JDRF, Peter Oliver.  
 
“Peter possessed a multitude of qualities that defined him as a leader – visionary, credible, trustworthy, respectful, influential, and empowering are just a few of these traits,” said Dave Prowten, President and CEO of JDRF Canada. “His contributions to JDRF are immeasurable and will have a profound impact on the type 1 diabetes (T1D) community for years to come. On a personal level, he was a dear friend and confidante to many of us, and he will be deeply missed.”  
 
After immigrating to Canada from Cape Town, South Africa and achieving success as an entrepreneur co-founding Oliver & Bonacini restaurants, Peter focused his attention on giving back to his communities. The T1D community was at the top of his list. For over 35 years, Peter gave generously to JDRF as a volunteer and donor while helping raise more than $200 million to find a cure for T1D.  
 
The day Peter’s daughter Vanessa was diagnosed with T1D was a day that changed the family’s lives forever. It was also the day Peter vowed to do everything in his power to help change the course of this 24/7 disease. Shortly after he began volunteering at JDRF, he founded the JDRF Ride to Defeat Diabetes in 1986, an event that has raised over $70 million and continues to engage thousands of volunteers across the country. He went on to serve on JDRF’s National Board of Directors from 2004-2008 and co-chair the In Our Lifetime Campaign in 2015 — JDRF’s first major gift campaign, which raised $55 million, as well as JDRF’s ongoing $100M Campaign to Accelerate.  
 
Over the last two years, Peter was a driving force as co-chair of the $100M Campaign to Accelerate. He was instrumental in raising nearly 69% of our $100 million goal in just two years, inspiring the two largest gifts to the campaign to date. He hoped to see the campaign through to completion and spent day and night strategizing new ways to raise the remaining amount. He wanted nothing more than a cure for his daughter and the millions of people around the world living with T1D –  so much so the only regret he expressed before passing was that he was not able to finish the $100 million campaign fundraising efforts – a testament to his belief in the power of this campaign’s impact.  
 
Recently, Peter came full circle on a labour of love he began 32 years ago when he lived atop a flagpole in Toronto’s Mel Lastman Square to sell raffle tickets for JDRF. Peter was passionate about bringing back his flagpole challenge during the 100th anniversary of the discovery of insulin. In the spring of 2022, he rallied hundreds of people around the country to support five Leaders in History, including his daughter Vanessa, as they lived atop flagpoles for 100 hours, raising millions for type 1 diabetes research. Nearly 100 families nationwide joined the challenge and camped out in solidarity.  

“Peter was a force to be reckoned with and always asked, we need to think bigger. The impact he has had on the T1D community cannot be expressed in words. Because Peter touched everyone he met. He had a unique ability to bring people together and always think bigger. He has had a transformational impact at JDRF and we will forever be grateful, for his leadership, tenacity and friendship.”

– Jessica Diniz, Chief Development Officer

Peter lit up every room he entered with his energy and passion. With a presence larger than life, he made everyone around him feel special. Peter always wanted to make a difference, and his dedication continues to inspire JDRF donors, volunteers, and staff alike. He was relentless on his mission to find a cure, saying: 

“When there is a cure for diabetes – and there will be – it will go down as one of the greatest achievements in the history of mankind. We will not stop until there is a cure.”

– Peter Oliver

The JDRF team, galvanized by Peter’s legacy, will continue to raise funds and accelerate research at full speed to achieve the vision they share with Peter of a world without diabetes.

Not all sugars are the same: Using glucose to treat hypoglycemia

The following is sponsored content developed in partnership with AMG Medical

Low blood glucose—also known as hypoglycemia—can be one of the most challenging, stressful, and often scary parts of living with diabetes. Learning how to treat hypoglycemia is very important.

If you live with type 1 diabetes (T1D), you know that being prepared for low blood glucose emergencies with at least 15 grams of fast-acting carbohydrates is the goal, but there can be times when we find ourselves low and must use other foods.

There are many reasons why doctors and pharmacies might recommend glucose tabs over a bowl of ice cream when it comes to treating certain kinds of low blood glucose. While the fat and protein in the ice cream slow down the digestion of the sugar, the type of sugar in any carbohydrate source affects absorption too.

If you’ve ever wondered why a bowl of raspberries has a lower impact on blood glucose than the same amount of carbohydrates from a bowl of grapes, it’s all about the amount of glucose vs. fructose vs. sucrose.

Let’s look at these sugars and how they work:

GLUCOSE / DEXTROSE

Glucose—also known as dextrose— immediately raises blood glucose levels because it is already in the form of sugar your brain and cells recognize and require for energy, making it the most rapidly absorbed source of carbohydrates if experiencing hypoglycemia.

Some sources of 100% glucose include glucose tabs such as Dex4 tabs, glucose gel, and liquiblast.

FRUCTOSE

Fructose, or fruit sugar, is a simple sugar found naturally in many plants, where it is often bonded to glucose to form sucrose.

Some sources of fructose include fruit, fruit juice, honey, pasta, bread, veggies, and many processed foods and drinks such as sugary sodas.

Fructose on its own does not break down into glucose to raise your blood glucose levels. Instead, the liver metabolizes fructose, raising cholesterol and lipid levels.  If you use an apple to treat low blood glucose, only a percentage of the carbohydrates in that apple will raise your blood glucose levels. Your body must also break down the fibrous apple for the sucrose and glucose it contains to reach your bloodstream.

SUCROSE

Sucrose is known as a “double sugar” or “disaccharide” because it’s made of equal parts of glucose and fructose.

Some sources of sucrose include white/brown sugar, maple syrup, jellybeans, gummy candies, and more processed candies/snacks.

This means half of the carbohydrates in a packet of white sugar will raise your blood sugar quickly and the other half will be metabolized by your liver.

THE BOTTOM LINE

Low blood glucose is a real part of living with diabetes—especially if you take insulin. Being prepared for low blood glucose levels comes down to having fast-acting carbohydrates in all the right places.

Keeping dried fruit or other snacks on hand is a smart idea, but having a more direct glucose source like concentrated gels or Dex4 tabs is a good option because they work quickly and are easy to store in your car, purse, nightstand, gym bag, desk, and winter coat – and they don’t freeze, melt or rot.

HOW TO USE GLUCOSE TABLETS

When your blood glucose drops below a target range (for most people, less than 4 mmol/L), it is considered low. Most glucose tablets contain 4 grams of carbs each and it’s typically recommended that you eat 4 tablets (16 carbs) while experiencing a low. Tabs can relieve hypoglycemia symptoms within 10 minutes, so you should check your blood glucose10-15 minutes after ingestion to ensure your levels are rising and you are back to a safe range.

NOTE: Tabs and gels are great for everyday safety for people with type 1 diabetes (T1D), but they should not be used if you or your loved one are having a severe reaction to low blood glucose or are losing consciousness. Carry emergency glucagon and always tell someone if you feel you might pass out.

Disclaimer: This post was prepared in partnership with AMG Medical – a Montreal-based distributor of quality Medical Supplies & Home Health Care products and a generous supporter of the Sun Life Walk to Cure Diabetes for JDRF over the last 20 years. Learn more about Dex4 fast-acting glucose.

There’s a lot to remember when you live with T1D. JDRF is here to support you, visit our website for more information on daily management and other resources breakthrought1d.ca/daily-management/ and connect with the T1D community as part of our new Facebook Group.  facebook.com/groups/jdrft1dsupport

JDRF commissions cost effectiveness study to demonstrate real quality of life value of diabetes technologies

JDRF’s #AccessForAll advocacy campaign aims to make type 1 diabetes (T1D) technology affordable and accessible for all Canadians living with the disease. With support from the T1D community, JDRF seeks to increase public and private coverage technologies such as continuous glucose monitors (CGM) and flash glucose monitors (Flash GM). The goal is to reduce the out-of-pocket costs for these technologies and improve access for Canadians with T1D. 

To support our advocacy for expanded public coverage, JDRF commissioned a study to examine glucose monitoring systems (flash glucose monitoring, continuous glucose monitoring and self-monitoring of blood glucose) and their population level impact on diabetes related complications, mortality, and cost effectiveness of each of techniques in adults with type 1 diabetes (T1D) in Canada.

An estimated 300,000 people in Canada live with T1D. Living with T1D means managing the disease through frequent checking of blood glucose levels, regular infusions of insulin, either by injection or through an insulin pump, and carefully adjusting each dose to balance against carbohydrate consumption and activity levels.

For years, the only way to measure blood glucose was through frequent and often painful finger-prick tests, and insulin needed to be administered through multiple daily injections. More recently, however, diabetes devices like advanced glucose monitors, like CGMs and Flash GM along with insulin pumps have offered more options for managing diabetes and more accurate readings.

Recently, JDRF commissioned a study to examine the population level impact on diabetes related complications, mortality and cost effectiveness of each of these three glucose monitoring techniques in adults with T1D in Canada. The study used a Markov cost-effectiveness model (a probability-based model that models the probability or chance of transitioning between states and their associated costs) and Canadian epidemiologic and economic data for adults aged 18-64 years with T1D.

The study found the following: 

Self-Monitoring of Blood Glucose (SMBG) is an approach whereby an individual pricks their finger, measuring their blood glucose manually using a glucose meter.

Average annual per person costs: $2,019

After 20 years, if all 180,000 Canadians aged 18-64 living with T1D use the traditional finger-prick method, an estimated 11,200 people would remain free of complications and there would be an estimated 89,400 deaths, at a total cost of $12.2 Billion.

A continuous glucose monitor (CGM) works through a tiny sensor inserted under the skin. The sensor measures the glucose level and provides a continuous reading.

Average annual per person costs: $3,930

Universal coverage of CGM would increase the number of people living free of complications by an estimated 7,400 and decrease mortality by an estimated 11,500.

A Flash glucose monitor (Flash GM) measures the glucose level through sensors and provides a blood glucose reading when the user scans the device over the sensor.

Average annual per person costs: $2,540

Universal coverage of Flash GM would allow an estimated 3,400 more people to live without chronic complications of T1D and prevent approximately 4,600 deaths.

Universal use of CGM and/or Flash GM in Canada for the T1D population would reduce complications and death at a cost-effectiveness threshold of $50,000/ Quality adjusted life-years (QALY). QALY is a generic measure of disease burden, including both the quality and the quantity of life lived. It is commonly used in health economic evaluations to measure the cost-effectiveness of medical interventions and is the standard measure of quality of life in cost-effectiveness models.  A value of 1 corresponds to one person living one year in perfect health; and a value of 0 is assigned when a person has died.

Quality Adjusted Life-Years (QALY):

Use of CGM and/or Flash GM over SMBG for the T1D population:
  • Leads to fewer complications such as:
Severe Hypoglycemia
Diabetic Ketoacidosis
Micro- or Macrovascular complications
  • Reduces long-term costs associated with hospitalization
  • Leads to improved mortality rates
  • Are at a much lower cost-effectiveness threshold than the acceptable threshold of $50,000/QALY ($35,017 QALY and $17,488 QALY respectively)

The study demonstrates that universal adoption of CGM and Flash devices would be anticipated to lead to a significant reduction in risk of developing severe hypoglycemia (a severe event where a person often loses consciousness due to low blood glucose), diabetic ketoacidosis (a severe event where a person has high levels of blood glucose and ketones in their blood.  These often require hospitalization) and micro- or macrovascular complications (chronic complications that affect the smaller blood vessels such as retinopathy, nephropathy, and neuropathy.  They can also lead to other severe complications like kidney disease, blindness, etc.) Macrovascular complications affect more major blood vessels which includes heart attack, coronary artery disease, etc.

Therefore, funding these devices is more cost-effective compared to traditional finger-prick methods, and while the cost of funding CGM and Flash GMs are higher in the near-term, they generate significant long-term cost savings due to lower costs of complications, potential hospitalization, and additional medical interventions.

Moreover, access to these devices brings users greater peace of mind and provides more accurate blood glucose measurements. T1D self-management is facilitated by these technologies through real-time readings that help to improve overall blood glucose (HbA1C) and time in target range (TIR). Better self-management and glucose control also help to relieve some of the anxiety that surrounds the disease. It allows people with T1D to better plan exercise, meals, and rest and greatly improves overall quality of life.

CGM and Flash GM devices are extremely cost-effective compared to traditional finger-prick methods. To learn more about Access for All and how to advocate in your community, please visit https://breakthrought1d.ca/advocacy/access-for-all/