June 25, 2019 How to address the diabetes epidemic in Canada

[00:01] I’m really excited to be sharing with you about our Diabetes 360 strategy and how you might help us advocate for it and how it might benefit you or those you care about who are living with or at risk for diabetes.

[00:19] I wanted to introduce myself. My name is Kimberly Hanson and I’m the executive director for Federal Affairs for Diabetes Canada. I’m responsible for our advocacy with the federal government and on national issues, and I’ve also been leading the Diabetes 360 project for almost the last two years. And it’s really a passion project of mine. I have been with the organization for just about two years and I’ve been living with type 1 diabetes for 25 years so I’m really very committed and very honoured to work everyday in support of people living with all forms of diabetes. I’m really excited to share this strategy with you tonight because I really believe it can help make a difference in preventing a number of cases of diabetes where that’s possible, but also in helping those of us with the disease live better and healthier longer lives.

[1:18] So, what I’d like to do tonight, if this works for you guys, is a quick walkthrough of what Diabetes 360 is. And I know that some of you on the line may have had some exposure to it. Some of you may be coming new to this project. And so, I’m going to kind of try and talk to it as though I were in front of, say, my member of parliament, wanting to let them know for the first time what this is and why our government should support this. And so, if you’re thinking about advocating or speaking out on behalf of Diabetes 360, whether it’s through sending emails or through meetings, this is kind of the way that I would suggest speaking to it. And then after that I’ll share some tips and some requests for you in terms of how I would love it if you could help us advocate for this strategy, which I believe would help so many.

[2:21] Diving in, what is Diabetes 360? Well, it’s a nationwide strategy to address the diabetes epidemic. Even though diabetes is growing in Canada at a rate of almost 40%/decade now, and even though Canada is in the worst third of developed countries in terms of the prevalence of diabetes and the cost of treating it, we have had no coordinated plan, no national strategy, no action plan in place since at least 2013. And that one was judged by the auditor general as not having worked very well. So, there’s a real gap and the problem is getting worse by any measure. It’s really time for coordinated action so that’s what Diabetes 360 is about.

[3:15] Let’s focus a minute on why we need this strategy. And I’ll direct your attention to the upper left-hand side of the infographic, the section entitled Every 24 Hours. And so, what you can see here is that it is true today in Canada, every single 24 hours more than 20 Canadians die from the complications of diabetes. And that’s actually a number we consider to be probably significantly underreported. 620 people receive a diagnosis of type 2 diabetes every day in Canada. 14 have lower limb amputations, most of which could have been avoided with better care and earlier detection. And our healthcare system spends $79M treating diabetes. In total this year, our healthcare systems will spend $29B in direct health costs associated with treating diabetes, which is clearly unsustainable. So, from a human cost perspective, from an economic cost perspective, and from the perspective of the burden on our healthcare system this situation cannot continue. We have to do something bold and we have to do something urgently. So, we’re saying that is a coordinated framework.

[4:42] That framework is Diabetes 360. And so now I’m going to refer to the bottom of the infographic. Diabetes 360 was a strategy that was developed by 120 stakeholders from all across Canada: there were academics, patients, people living with diabetes, healthcare providers, researchers, companies that provide services, devices or supplies to people with diabetes, all bringing their expertise and diverse perspective on diabetes in Canada to the table. We followed a model that has been used very successfully in HIV/AIDS, that was called in their case, the 90-90-90-target. That target was set by the UN AIDS organization in 2014 and amazingly every country in the world was able to choose whether to sign up or not and how to implement that target in a way that was relevant and meaningful to that country. But many countries around the world have done so and largely because of that effort. Recently HIV was listed as no longer having epidemic status in the world, people are able to live very full very healthy lives even with the HIV virus, so it’s really been a tremendous success in the case of that disease and so we sought advice from some of the architects of that target for the HIV/AIDS community and borrowed from their lessons learned and what really worked for them, and what didn’t work for them as well, and sought to replicate it for the case of diabetes in Canada.

[6:36] And really what that meant is we took a multi-sectoral or multi-stakeholder approach to developing it as I mentioned a few minutes ago. And everything in Diabetes 360 is designed to drive towards improved patient health outcomes and everything is designed to be able to be measured as doing so. And so, if any programs are not delivering benefits in terms of patient health outcomes, than they should be adjusted so that they do or perhaps sunset if they can’t. So, with that in mind, this group of 120 stakeholders worked together over the course of 2018 to develop the Diabetes 360 framework and a whole host of recommendations for how these targets ought to be achieved.

[7:33] Diabetes 360 consists of four targets: prevention, screening, treatment and outcomes. We started out, as I said, trying to emulate a 90-90-90 target, which was around screening, treatment and outcomes in the case of HIV/AIDS, and we really quickly realized that because of the nature of diabetes and because of how many complex risk factors there are in everyone’s day to day environment, that contribute to either type 2 diabetes or its complications, we really had to add what we call a fourth 90 on prevention – primary prevention. Helping people avoid the disease in the first place. And so four 90’s is 360 and the circle motif was nicely in line with the international symbol for diabetes so Diabetes 360 was born.

[8:35] When we have implemented Diabetes 360, we will have 90% of Canadians living in an environment that prevents the development of diabetes, an environment that’s conducive to wellness, where they’re able to eat healthy diets, get regular physical activity, people are not living with poverty and food insecurity, where healthy living is taught from an early age. Then, 90% of Canadians will be aware of their diabetes status – whether they have diabetes or are at risk of developing it, living with prediabetes or at risk of developing it. Right now we know that a million people in Canada are living with diabetes and don’t know it, and another six million have prediabetes, many of whom don’t know that. So, there’s really a large group of people who are unaware of their diabetes status. And we know if we make them aware as quickly as possible, we can help prevent as many as 60% of people with prediabetes from developing type 2 diabetes for up to 20 years. So, it’s really worth doing. The third target is that 90% of Canadians with diabetes are engaged in appropriate intervention to support their health. Those interventions are a combination of getting access to the right healthcare from the right provider at the right time. It’s also getting access to the right medications, devices and supplies that we need to manage our diabetes well. And it’s having the right kind of community and social supports to enable us to kind of do the difficult work of living day after day after day with a chronic disease. There are many recommendations supporting that target, as you might imagine, and really important gains to be made there in terms of improving the care that people with diabetes are able to access and are able to provide themselves. All three of those targets drive toward the fourth, which is that 90% of all Canadians with diabetes are achieving improved health outcomes. Those might be that they have lower average blood sugar readings, better cholesterol profiles or better blood pressure readings. It will be at a population level that we’ll have fewer complications like kidney failure or blindness or amputation. And it will also be, importantly, that people will have a better sense of well being living with diabetes. So, it’s not enough that my lab work is coming back better, I have to be feeling good living with this disease as much as is possible. That’s an important measure of health outcome as well.

[11:49] So, as I mentioned, there are about 36 specific recommendations that will drive towards us achieving those four targets. I won’t get into the depths of those tonight on this call, but if you’re interested in learning more about them, I would refer you on our website to the full report which is the full 43 page document that outlines the strategy and all of the research the supports our recommendations. If you’d like the Coles Notes version that can be found in the Executive Summary document and it will list all the recommendations we have in support of these targets.

[12:30] We’ve done some digging and we found that we strongly believe that if we implement this strategy, we can generate $20B in savings in just seven years. So, why did I pick seven years, as opposed to ten or say, a nice round number? Well, in order to implement that Diabetes 360 strategy, we suggest that the federal government needs to create a taskforce, that’s a kind of centre of expertise, that needs to work with each of the provinces and territories to support them in identifying what a Diabetes 360 strategy might best look like for their province. One province might have a real need in the area of screening, where another one has a strong need to enhance the drugs listed on their formulary, for example. So, it won’t look the same the way it’s implemented across the country and that’s by design. Just the same as with HIV, each country approached meeting that target in a way that was meaningful to them and it helped the whole world achieve the target.

[13:48] So, this taskforce or nerve centre needs to be created for a period of about seven years. We think that’s the time it would need to make its recommendations, to work with the provinces and territories, help them implement the measurement of patient outcomes, the sort of data foundation that would be needed to help them institute a process of continuous improvement so that all of their patient care programs can continuously renew, based on how they’re improving patient health outcomes, and then that taskforce would work its way out of a job. It would be designed to imbue all of its expertise within the health and social infrastructure in many of the provinces and territories and then work itself out of a job. We think that that would work and would take seven years and would cost $150M that we’re asking the federal government to dedicate.

[14:55] The work over seven years could result in $20B in savings. And the way we calculate that, I will acknowledge upfront that these are rough estimates because we don’t have a good foundation of data in Canada right now to tell us even exactly how many people there are with type 1 versus type 2 diabetes, let alone what’s the total burden of diabetes and which programs are working well in support of it. But there’s research that’s peer reviewed that supports all of the assertions that I’m about to make and if you’re curious about the science behind the numbers, I would point you to the document of that name on our website that provides the explanation for how we come up with all of these numbers and cites the research the proves all of these assertions. So, these are only blunt numbers but not only are they not inflated, they are significantly underreported.

[15:59] So, in seven years, with Diabetes 360 being implemented, we would have 770,000 fewer cases of type 2 diabetes being diagnosed, 110,000 fewer every year. We would therefore have 240,000 fewer hospitalizations across the country and 34,000 fewer lower limb amputations, which is, I get goosebumps every time I think about that figure. Each of those things costs a lot of money, as you might imagine, and so there would be significant, about $11B of reduced costs for the healthcare system in terms of these hospitalizations and amputations as a result of cases of diabetes. So, that’s a pretty big gain. Then there’s an additional $9B that would accrue to employers and to Canadians themselves who are able to be more engaged productively in the workforce who aren’t needing to take sick leave or have absences from work, who aren’t needing to draw on health benefits quite so much. I’ve heard it said by a number of parliamentarians I’ve talked to, and I’m glad to hear them say it because I really agree, implementing this strategy is absolutely a no brainer. It’s completely unacceptable to leave the epidemic where it is right now, we must take focused concerted action and this strategy is supported by the entire diabetes community in Canada and will make huge returns on investment really quickly.

[17:54] So, how are we advocating for that $150M of federal funding? Well, we’ve been working really hard and with many of the people who have been involved with the strategy right beside us, some of whom I’d imagine are on the line tonight. We’ve been reaching out to parliamentarians and bureaucrats advocating that Diabetes 360 receive funding. We were gunning really hard for Budget 2019, we really wanted to get the money as quickly as possible so that we could start to bend the growth curve of this disease and also so that we could have something to all be really proud about in 2021, when we’ll celebrate the 100^th anniversary of the discovery of insulin in Canada. We did not get funding in Budget 2019 and so we sought a bunch of feedback about why not. And we head from people in the Minister of Health’s office and the Prime Minister’s office that there’s lots of support for our strategy and it just wasn’t our turn yet and there’s lots of reason to be hopeful that we’ll receive funding in Budget 2020, while that’s all well and good but we need to make sure that we keep pushing so that we are there in 2020. We can’t let up the pressure by any means. And that’s where you guys come in.

[19:30] So, in 2019 our goal now is making diabetes and Diabetes 360 an election issue so that it will be in Budget 2020. And in order to do that, this summer our big push is getting signatures on the petition that we’ve launched. You’ll see that petition on our website diabetes.ca/strategy. If you’re looking on a mobile phone, it’ll be on the bottom. And if you’re looking on a computer, it’ll be over the right. You’ll see it’s a pretty simple petition, where we’re calling on all parties to commit to launching a strategy to prevent a million cases of diabetes and avoid hundreds of thousands of hospitalizations of diabetes-related conditions in the next ten years. Basically, what we’re saying is that we want every federal political party to commit to launching a diabetes strategy in their platform. I’ve been working night and day to try to influence them to have a strategy in their platform but I need you guys to speak up or networks and communities speaking up in support of it to make sure politicians know that this is critically important.

[20:51] The signatures on the petition will demonstrate to politicians that there is strong support for Diabetes 360 and so we really need as many signatures as possible and that’s where you come in. We’re hoping that you can consider, obviously, signing the petition yourself. That you will consider engaging your personal and professional networks to get people to sign and that you will consider meeting with either your provincial elected official or your candidate for federal office once they all come door-knocking, which should be anytime now, and ask them to sign our petition. They should be able to, it’s nothing a politician couldn’t sign, in terms of the way its worded, and asking them if their party supports Diabetes 360.

[21:46] At the same time, while this petition is out and you are hopefully getting signatures from your communities, Diabetes Canada will continue to keep working to influence federal politicians and political parties to put the strategy in their platform and we’re also going to be working at the provincial level with a few provinces that more inclined or closer to developing a Diabetes 360 strategy of their own, which as I mentioned a few minutes ago, exactly as this is intended to work. So, we’re setting up for round tables in Ontario, British Columbia and New Brunswick in early September to try and shape how a Diabetes 360 strategy might look in those provinces. And so, we’re trying to apply pressure if you will from the top, the federal level, and the bottom, the sort of grassroots level and provincial level to make sure that we meet in the middle with the Diabetes 360 strategy implemented as soon as possible. Then in August, when the federal election starts in earnest, we’ll kick it up another notch. We’ll have a really coordinated social media campaign. We’ll be reaching out to volunteers again to get even more signatures. We’re going to be trying to get diabetes talked about in any debates by candidates during the election. We’re going to have pieces in the media, in print, websites, blogs and you can contribute to that if you like. And all of those things will encourage candidates to tweet their support for Diabetes 360. It will encourage you to tell your personal story about how diabetes affects you and help to really create that unified voice calling for this.

[23:50] So with all that said, what I was hoping that those of you on the line would consider doing was, as mentioned, sign the diabetes petition on our website if you haven’t already. And please consider encouraging your personal and professional networks to do so. Maybe put up a post of Facebook, or twitter or LinkedIn, depending on which forum you use. And think about putting a post up maybe every week or two to remind your friends and associates to sign the petition if they haven’t yet. I even had to prod my mother a couple of times who is a great supporter of this to put pen to paper and that’s because we all have busy lives and summer is coming and people will be busy but if you can encourage your networks to sign it and get them to encourage their networks, that will really make a huge difference.

[24:52] As I mentioned a few minutes ago, please give some thought about whether you’d be comfortable asking for a meeting with your MPP or federal candidate once they get started and talk to them about how diabetes affects you and how a nationwide strategy could help you life.

[25:15] And so, how might a Diabetes 360 strategy actually improve the life of a person with diabetes, I’d like to give you a couple of examples. If you are a person, for example, who is living in a semi-rural community, you might have some trouble getting to a doctor’s office regularly, or maybe your doctor’s visits are a little rushed because there are fewer care providers in your area, but you want to know whether you’re at risk for diabetes. Well, Diabetes 360 will ensure that screening clinics will be available in your local community centre or pharmacy or grocery store so you can find out if you’re living with diabetes. Say you’ve just been diagnosed with diabetes and you’re wondering what this means, how do you get advice or help, how do you learn how to cook. Well there will be a patient portal that will give you access to support groups in your community, or fitness classes or cooking classes. If you’re a person who is a newcomer to Canada and English or French aren’t your native languages that you’re fully fluent in, you’ll be able to connect through that portal to resources in your language. If you’re a person who is living with food insecurity and struggling to have as healthy a diet as you’d like to in order to reduce your risk of diabetes or its complications, Diabetes 360 will be ensuring that we partner with other agencies doing work to limit food insecurity by delivering subsidies for fruits and vegetables, through supporting food cupboards and banks, through helping hydroponic plants for fruits and vegetables to be grown in northern communities. If you’re a person who has type 1 and you really want to have continuous access to a glucose monitor or pump or a new kind of insulin that’s working really well for one of your friends but isn’t covered on your provincial formulary, Diabetes 360 will be a framework for helping to level out the medications, devices and supplies that are covered in each of the provinces and territories and it will help support building up the base of evidence for how they help to improve patient outcomes and therefore are worth government’s investing in.

[28:10] So those are just a handful of examples showing how things might be different if Diabetes 360 were implemented but there’s something in it for every person with diabetes or at risk of it and it will help people with diabetes throughout the life cycle, throughout the journey through life with the disease. So you can think about that and familiarize yourself with the recommendations and think about what these might mean to you and what you’re struggling with the most of have struggled with the most in the past in terms of Diabetes 360 to be able to speak to your community or candidate or elected official about how it could make a difference to you. Think about posting or sharing messages on social media to increase awareness about diabetes itself and Diabetes 360. You can also think about writing a blog or op-ed for a local publication. If you’re on LinkedIn you can post a blog there and share it with your network anytime you like. Some of you might have your own blogs and online or print media will take opinion pieces of up to 500 words and they love to hear from people who are in their own community. So do consider writing it up and speaking to why diabetes matters to you and why Diabetes 360 would help. And certainly, although we are by no means asking you to go out and fundraise, I would be remiss if I didn’t mention that we would certainly welcome individual donations to Diabetes Canada to support the advocacy work that we do on behalf of Diabetes 360 and all the sub-components of it, if that’s something that the people you’re talking to express and interest in.