Framework for Diabetes in Canada

Supporting efforts to address diabetes across Canada

On October 5, 2022, the Government of Canada tabled the Framework for Diabetes in Canada (Framework). The Framework aims to support prevention and treatment for all types of diabetes, and provide a common policy direction to address diabetes in Canada.

The Framework will identify gaps in current approaches, avoid duplication of effort, and provide the federal government an opportunity to monitor and report on progress. In doing so, it will lay the foundation for collaboration across sectors to reduce the impact of diabetes.

There are six components of the Framework where focus can be given to ensure better health outcomes for Canadians impacted by diabetes.

Framework components:

• prevention
• management, treatment and care
• research
• surveillance and data collection
• learning and knowledge sharing
• access to diabetes devices, medicines and financial supports

In guiding efforts to address components of the Framework, cross-cutting principles were identified as keys to success.

Cross-cutting principles:

• addressing health equity
• applying a person-centred approach
• differentiating between types of diabetes
• supporting innovation
• promoting leadership, collaboration and information exchange

Background

In recent years, momentum has been building in Canada for type 2 diabetes prevention and management for all types of diabetes. With testimonies heard from organizations including Breakthrough T1D Canada (then JDRF), the Standing Committee on Health tabled A Diabetes Strategy for Canada in April 2019 and re-tabled in April 2021.

On February 27, 2020, Member of Parliament Sonia Sidhu introduced Bill C-237, which required the Minister of Health to develop a framework designed to support improved access to diabetes prevention and treatment to ensure better health outcomes for Canadians. Unanimously passed in June 2021, the National Framework for Diabetes Act allowed for the creation of the Framework.

Through Budget 2021, 100 years after the discovery of insulin, the Government announced investments to address diabetes. As part this funding, through the Canadian Institutes of Health Research, the federal government recommitted to the Breakthrough T1D and CIHR Partnership to Defeat Diabetes (established in 2017, then known as the JDRF-CIHR Partnership to Defeat Diabetes), by investing up to $15 million matched by Breakthrough T1D Canada and its donors for T1D research. In particular, $25 million was invested towards research, surveillance, and prevention, and to developing the Framework.

The Framework was developed in consultation with provincial and territorial governments, Indigenous communities, people living with diabetes, academics, researchers, and other stakeholders.

Diabetes in Canada

Diabetes represents one of the most significant health-care crisis of our time. With no dedicated support or action to tackle the diabetes epidemic, it means that, every 24 hours:

• More than 20 Canadians die of diabetes-related complications
• 480 more Canadians are diagnosed with this devastating disease
• 14 Canadians have a lower limb amputation
• And our health care system spends $75 million treating diabetes

Diabetes prevalence in Canada is not only skyrocketing, but is already among the worst of OECD countries (Organization for Economic Co-operation and Development), according to the International Diabetes Federation. In Canada today, one in three people lives with prediabetes or diabetes – 11 million Canadians. Since 2000, the number of Canadians with diabetes has doubled. A 20-year-old in Canada now has a 50 per cent chance of developing the disease and this grows to 80 per cent within some Indigenous populations. The global rate of type 1 diabetes (T1D) is climbing by 3% every year – with Canada’s rate growing higher at 5% – and we don’t know why. Beyond the immeasurable impact on human life, if prevalence grows by 40 per cent in the next decade as projected, the direct costs associated with treating diabetes in Canada will top $39 billion by 2028.

For T1D, prevention means an increased investment in autoimmunity research to understand and prevent the response that triggers the body’s destruction of its insulin-producing cells.

Delayed diagnosis of T1D is a leading factor in incidence of life-threatening but avoidable diabetic ketoacidosis (DKA) in both children and adults with an estimated 5-10K Canadians hospitalized annually due to DKA. An alarming number are infants in toddlers. Nearly 4 in 10 children under age 3 present with DKA at the time of first diagnosis. Of these, 38% had visited a physician within the previous week. Interventions are needed to help Health Care Providers diagnose T1D earlier, including increased use of finger-prick blood glucose testing in clinical settings and testing of family members of those with T1D.

Appropriate interventions for T1D aimed at reducing complications include those promoting adherence to recommended treatment guidelines (eye and foot checks, for example) as well as those that increase access to beneficial diabetes technologies such as insulin pumps, flash glucose monitoring, continuous glucose monitoring and hybrid-closed loop systems.

Improving outcomes with respect to T1D means moving beyond HbA1C to look at other metrics such as time spent in target range, and reduced incidences of hypo- and hyperglycemia.

Next steps

As a policy guidance document, all sectors and levels of government are invited to make use of the Framework to address diabetes within their respective mandates.

Moving forward, the Government of Canada plans for further engagement with stakeholders to encourage collaboration and multi-sectoral partnerships, and build upon the components of the Framework.

In 2027, on the fifth anniversary of the Framework, a progress report will be delivered by the Minister of Health to identify not only the efforts undertaken by the federal government to address diabetes, but also the collaborative efforts between different levels of government and diabetes stakeholders, and the current state of diabetes prevention and treatment in Canada.

For more information and to read the Framework in full, please visit the Government of Canada’s website here: canada.ca/en/public-health/services/publications/diseases-conditions/framework-diabetes-canada