The Canadian Diabetes Strategy: History, Evolution, Moving Forward

Diabetes is a chronic condition that affects almost 2 and a half million Canadians. There are three main types of diabetes: Type 2, Type 1, and gestational diabetes.

• Type 2 diabetes is the most common form, accounting for 90 to 95 percent of all diabetes in Canada. Preventing Type 2 diabetes is a public health priority that relies on supporting Canadians in adopting and maintaining healthy lifestyles, particularly healthy weights. In Canada, two in three adults and one in three children are overweight or obese, and this is driving the increasing rates of type 2 diabetes across the country.
• Type 1 diabetes (also called juvenile diabetes) accounts for 5 to 10 percent of all cases of diabetes in Canada. It is not preventable and there is no cure.
• Gestational diabetes is a temporary condition affecting about 4 percent of all pregnancies, which carries an increased risk of future diabetes for both mother and child.

The First Phase of the Canadian Diabetes Strategy: 1999 to 2005

In 1999, the Government of Canada committed $115 million over five years to develop a national diabetes strategy. At that time, the Aboriginal Diabetes Initiative was included in the Canadian Diabetes Strategy (CDS), which focused on increasing awareness of diabetes among First Nations, Inuit and Metis in order to reduce the prevalence and incidence of diabetes in these high-risk communities.

During the first phase of the CDS, stakeholders worked together to build a framework that would guide priorities - Building a national diabetes strategy: a strategic framework - PDF document.

This phase also saw the development of the National Diabetes Surveillance System, which became the basis for the Chronic Disease Surveillance System (CDSS). The CDSS now provides provincial, territorial, and national data on trends in diabetes.

In 2005, the CDS became part of a new federal Integrated Strategy on Healthy Living and Chronic Disease. The Aboriginal Diabetes Initiative was subsequently funded separately from the CDS, but the two strategies remained complementary in their approaches.

The Integrated Strategy focuses on three areas:

• Promoting health for all Canadians;
• Preventing chronic disease by reducing risks for Canadians who are at high risk; and
• Supporting early detection and management of chronic diseases for those Canadians who are living with chronic diseases.

Building on the Foundation: 2006 to 2013

Since 2006, the landscape for chronic disease prevention has evolved based on new research evidence, the public health dialogue in Canada and around the world, and the recognition of the need for new and different types of partnerships in order to make a difference in chronic disease prevention.

The key elements of the Canadian Diabetes Strategy - surveillance, public education, and community-based programs - remain; however, we are working differently and, in particular, are focusing on common risk factors for major chronic diseases, including diabetes.

Program Accomplishments:

Self-management prevents diabetes complications

Through partnerships, we are providing tools to Canadians for self-management of diabetes. Complications of diabetes are severe and can result in lower limb amputation, vision loss and blindness, kidney disease, and cardiovascular disease.

The Canadian Diabetes Strategy supports a range of community-based programs through federal grants and contributions. For example:

• Canadian Diabetes Association: Transforming Materials for People with Diabetes
• Diabetes, Healthy Feet and You
• Eye Connect: Diabetic Retinopathy (PDF document)
• Hypertension Canada “Getting to the Heart of the Matter” Cardiovascular Screening Initiative
• Kidney Foundation of Canada National Screening and Targeted Education Program

Putting evidence into action: The Canadian Best Practices Portal

The Canadian Best Practices Portal provides access to evaluated community and population health interventions related to chronic disease prevention and health promotion. It is designed to help Canadian public health practitioners and decision-makers identify appropriate interventions that they can adapt and replicate to meet their needs.

The federal Diabetes Partnership

In 2009, the Public Health Agency of Canada, Health Canada and the Canadian Institutes of Health Research formed a partnership with the Canadian Diabetes Association, Diabète Quebec and the Juvenile Diabetes Research Foundation. The Diabetes Partnership’s objective is to facilitate joint work on common priorities to advance diabetes prevention and management, along with the research needed to support these areas.

Bringing more data to our stakeholders

Diabetes surveillance is a cornerstone of our program. It provides the information needed to design policies and programs and to evaluate their impacts. The Agency releases diabetes surveillance highlights and, periodically, more in-depth analyses are provided to better understand trends and surveillance findings.

For the latest in-depth national diabetes report, please see: Diabetes in Canada: Facts and figures from a public health perspective

We now provide direct access to diabetes surveillance data through the Public Health Infobase. The Infobase was developed to allow users to create their own tables and graphs using interactive databases. For example, data from the Survey on Living with Chronic Diseases in Canada (2011) includes a subsection on Living with Diabetes.

Type 1 diabetes: Research is a priority

The Canadian Institutes of Health Research (CIHR), funds researchers in universities, research institutes and teaching hospitals across the country who are working to understand prevention, find better treatments and ultimately a cure for type 1 or juvenile diabetes. Over the last 6 years, CIHR has invested $210 million in diabetes-related research.

Launched in 2011, the Clinical Trial Network for Diabetes Research is a partnership between the Government of Canada, through the federal Economic Development Agency of Southern Ontario, and the Juvenile Diabetes Research Foundation. The federal investment of $20 million over two years combined with JDRF’s $13.9 million investment brings together Canada’s top physicians, scientists, researchers and innovators to evaluate new treatments and technologies for type 1 diabetes and its complications.

Healthy Weights: A priority for type 2 diabetes prevention and for managing all forms of diabetes

National and international focus on chronic disease prevention has grown. Chronic diseases are the most common, costly and preventable of all health challenges we face. The four major chronic diseases - cancer, diabetes, cardiovascular disease and respiratory disease - share common risk factors: unhealthy eating, physical inactivity, unhealthy weights, smoking and harmful use of alcohol. Reducing these risks will prevent chronic diseases or delay their onset.

In Canada, governments are working together to put a priority on prevention. In 2010, Canada’s Declaration on Prevention and Promotion was endorsed by federal, provincial and territorial health ministers. Soon after, health ministers endorsed Curbing Childhood Obesity: A Federal, Provincial, and Territorial Framework for Action to Promote Healthy Weights. These initiatives are essential to diabetes prevention and management because overweight and obesity are the main drivers of Type 2 diabetes.

The establishment of these priorities in prevention set the stage for a new federal approach to partnerships that seeks to engage sectors beyond health.

Early detection of diabetes and pre-diabetes: CANRISK

The Agency has also invested in the development of CANRISK, a diabetes risk questionnaire which helps Canadians identify their risk of having pre-diabetes or diabetes - the first step toward taking appropriate measures to avert or delay the onset of the disease.

Partnerships with pharmacies, provincial governments and local public health units have allowed this resource to be used in a wide variety of settings. By expanding access of a risk assessment tool such as CANRISK to pharmacies and other "non-traditional" public health venues across the country, Canadians are more aware of type 2 diabetes and its risk factors, and pharmacists and other health professionals have increased knowledge of and capacity to support diabetes prevention.

Your Guide to Diabetes provides a diabetes prevention checklist and information on living with diabetes. The importance of maintaining a healthy weight is highlighted.

In order to meet the needs of Canadians who are at higher risk for diabetes and the health professionals who serve them, CANRISK and Your Guide to Diabetes have been translated into 11 alternate languages:

• Chinese simplified
• Chinese Traditional
• Vietnamese
• Korean
• Punjabi
• Tagalog
• Tamil
• Urdu
• Guajarati
• Spanish
• Persian

To receive electronic copies of these translations, please email the Partnerships and Strategies Division and indicate which language(s) you wish to receive.

Opportunities for future work include expanding access to CANRISK among high-risk groups, promoting the CANRISK mobile application, and exploring how to improve linkages to community-based diabetes prevention programs for populations identified with pre-diabetes.

Where we are going from here

Our Centre for Chronic Disease Prevention: Strategic Plan 2016–2019 is the roadmap we will follow to build on what has been done to date. It reinforces our core businesses of surveillance, building the evidence on what works in chronic disease prevention, and, working with our partners to put what works into practice and to develop and test innovations that address complex health issues.

Funding

• Multi-sectoral Partnerships
• CDS Funded Projects