Bill C-237 (Historical)

National Framework for Diabetes Act

An Act to establish a national framework for diabetes

This enactment provides for the development of a national framework designed to support improved access for Canadians to diabetes prevention and treatment.

[Kimberley Hanson]

Yes, thank you, Monsieur Thériault.

I think there's no difference between a national framework and a national strategy. When we were drafting diabetes 360°, we debated strongly which words to use to describe what we were trying to accomplish. It is Diabetes Canada's fervent hope that when Bill C-237 passes into law, the framework that it requires to be tabled before Parliament will be heavily inspired by or informed by the diabetes 360° strategic framework.

I can't speak to why we find ourselves in the position that we do in 2021, but I can say that we've seen in the case of other illnesses or disease groups—such as cancer—that when we take a coordinated approach, when we help facilitate information sharing and the sharing of best practices across jurisdictions, we can materially improve the health care of Canadians and really make a difference in reducing the impact of these diseases. I would definitely agree that it's past time that we acted, but the only time we have is now, so let's act now to embrace this bill and move forward.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Van Bynen. It's a great question. Thank you for your support all the way.

You're right. We need to consult with the indigenous stakeholders as well because, as you know, on reserve and in indigenous populations there are higher rates than with any others. We need to consult with indigenous stakeholders, provinces and territories. The government needs to consult with the stakeholders such as Diabetes Canada and JDRF and listen to the proposals.

Ms. Hanson mentioned diabetes 360°, which we all supported in the HESA committee. It has very good aspects and I hope it can address many indigenous concerns as well.

There have been consultations on subjects that help those with diabetes. For other aspects, like Canada's food guide, there has not been a national holistic consultation called for, and that is why my bill calls for that. It would bring together both levels of government, indigenous partners and other stakeholders with the common goal of creating a national diabetes strategy, which I'm asking for in my bill, Bill C-237.

It's also to address Canadians of all different ages and demographics, and will be sensitive to cultures and socio-economic backgrounds, too.

[Juliette Benoît, Volunteer, JDRF Canada]

Thank you, Mr. Prowten.

Good afternoon, everyone.

My name is Juliette Benoît. I'm 17 years old, and I'm from L'Assomption, Quebec. I've lived with type 1 diabetes for almost five and a half years.

My life changed when I was 11 years old. I was diagnosed shortly after Hallowe'en. It is quite unusual for a child to ask to stop trick-or-treating to go to the bathroom.

I was thirsty and hungry, but the more I ate, the more weight I lost. I had also lost my energy and zest for life. As my family really started to worry, my parents took me to the hospital. I remember the cold walls and the staff trying to reassure me, but I was rather annoyed by all the questions I was being asked. Finally, they put three words and a number to my symptoms: “type 1 diabetes”.

After that, I took all kinds of training to tame the monster that was inside me. I thought it was rather strange to see my mother, father, step-mother and step-father sitting around the same table trying to make jokes to lighten the situation.

Before I knew it, I was at home, 11 years old, giving myself injections and trying to survive it all. The child I was was being asked to be an adult, to be strong and to hold it together. The diabetes diagnosis was really what I thought was the worst for a child. I was told I had to give myself shots several times a day and stop eating candy. That's really how I saw my disease.

Fortunately, thanks to research, I now have an insulin pump that allows me to administer insulin without injection and a continuous blood glucose reader that allows me to know my sugar levels faster and without injections, in addition to allowing me to adjust my insulin doses more easily.

That said, it's not a cure. These devices make my daily life easier, but I still spend many hours a day caring for my diabetes. Imagine, before and after eating anything, before, during and after physical activity, when I'm not feeling well and at many other times, I have to check my sugar level, calculate the carbohydrates of what I eat and adjust accordingly.

That's why Bill C-237 is so important to me. The research needs to continue in order to find ways to achieve a genuine cure. Canadians with diabetes need support from the federal and provincial governments to make insulin pumps and continuous blood glucose monitoring systems affordable. Diabetes is a very expensive and difficult disease to live with.

We need help managing the stress and mental burden of the illness, and we also need it to reduce the stigma. It's very important that people stop asking me if I have diabetes because I ate too much sugar, for example. This is an annoying remark that all type 1 diabetics hear on a daily basis.

At 11 years of age, I became a mini-adult, but more importantly, a warrior. I have become a symbol of strength for all type 1 diabetics. Now we just have to hope that the bill to create a national diabetes framework will pass so that real action can be taken.

Thank you for your attention.

[Dave Prowten, President and Chief Executive Officer, JDRF Canada]

Thank you, Mr. Chair, and members of the committee.

I'm joined today by Juliette Benoît, a JDRF youth advocate who joins us from L'Assomption, Quebec, and will speak to the lived experience of type 1 diabetes. Just as background, Juliette was one of our two youth co-chairs during our Kids for a Cure this past November and would have met some of you during those sessions.

We're pleased to speak today in support of Bill C-237, the national framework for diabetes act. JDRF is grateful to Ms. Sidhu for her leadership in introducing this bill, as we are to those MPs and other diabetes organizations like Diabetes Canada that worked hard to develop a diabetes strategy for Canada.

Our mission is to accelerate life-changing breakthroughs to cure, prevent and treat type 1 diabetes and its complications. Type 1 diabetes causes the body's immune system to attack and destroy insulin-producing cells in the pancreas, making children and adults dependent on daily injections or infusions of insulin for life. As other have noted, 2021 marks the 100th anniversary of the life-changing discovery of insulin, rightly celebrated as Canada's gift to the world. As Banting himself said, “insulin is not a cure”.

The incidence rate for type 1 diabetes is growing at over 5% a year in Canada, which is higher than the global average. The incidence rate for type 2 diabetes is growing even faster, as is the proportion of annual health budgets taken up by diabetes.

Therefore, JDRF would like to encourage passage of this bill. It will be critical that all levels of government work together to make this diabetes strategy impactful by fostering conditions that prevent diabetes and take actions to keep diabetics healthy, such as finding ways to make diabetes technologies more affordable and accessible as their price is out of reach for many working families.

For type 2 diabetes, prevention means lifestyle interventions. For type 1, prevention means investment in new research into the autoimmune response that causes it.

I'd like to take a moment here to acknowledge the JDRF-CIHR partnership to defeat diabetes. It's a remarkable collaboration between JDRF and the Government of Canada, which is up for renewal this year. Launched in 2017 with $15 million of funding through the CIHR and matched with $15 million from JDRF, this partnership is funding critical research to prevent diabetes complications and investigate groundbreaking immune therapies and stem cell-based cures.

It's important, too, that we focus our resources on psychosocial supports, as Kim Hanson just mentioned. Because we can't change what we don't measure, a robust strategy needs to track outcomes for both types of diabetes through a registry, repository or both.

I'd like to turn it over to Juliette to talk about the urgency for a national diabetes strategy.

[Kimberley Hanson, Executive Director, Federal Affairs, Diabetes Canada]

Good afternoon, committee members. I'm grateful to be living and working on the traditional lands of the Haudenosaunee, Anishinabe and Algonquin peoples.

I would like to begin by thanking you for the opportunity to appear before you today on this important bill, but more importantly for your ongoing work to improve and protect the health of all Canadians.

Never have I been prouder to be a Canadian than during the last year. Witnessing our elected officials work together in challenging and ever-changing circumstances to help Canadians weather the COVID-19 pandemic has been inspiring.

My proudest Canadian moment, though, might be when, earlier this month, members of Parliament from all parties unanimously voted in support of MP Sidhu's Bill C-237. As someone who has lived with diabetes and several of its complications for 25 years now, and who has lost many loved ones to its consequences, it was powerful to see every MP acknowledge that diabetes is a serious problem in Canada, and one we must take bold and urgent action to address.

In 2019 this committee studied diabetes strategies in Canada, as MP Sidhu mentioned, and recommended the following:

That the Government of Canada, in partnership with the provinces and territories, and in collaboration with stakeholders such as Diabetes Canada, plan and implement an approach to the prevention and management of diabetes in Canada through a national diabetes strategy, as outlined in Diabetes Canada’s Diabetes 360°: A Framework for a Diabetes Strategy for Canada. The partnership should facilitate the creation of Indigenous-specific strategic approaches led and owned by any Indigenous groups wishing to embrace this framework.

Those were your words, committee. You recommended this because you recognized that countries with a national framework or strategy to address diabetes do better.

Diabetes is less prevalent and people living with it experience fewer complications, which is why the World Health Organization recommends that each country develop a national diabetes strategy.

Still, Canada does not currently have such a strategy, and in the eight years since Canada last had a national diabetes strategy in place, nearly two million Canadians have received a diagnosis of diabetes. That is why Diabetes Canada, our colleagues at JDRF who are here today, and the community we represent feel such a strong sense of urgency that Canada act to reduce the burden of this disease on Canadians. With someone new diagnosed every three minutes in Canada, at least 12 preventable lower-limb amputations occurring every day, as well as 20 more deaths, we don't have a moment to waste in embracing Bill C-237 and implementing a nationwide approach to preventing type 2 diabetes and all diabetes complications.

The COVID-19 pandemic only heightens that sense of urgency. People who have diabetes have been shown to be at least three times more likely to die of COVID-19 than someone who does not have diabetes. Emerging research suggests that COVID-19 infection may be triggering new cases of diabetes, and the economic insecurity and physical inactivity triggered by the pandemic has put many of us at greater risk for type 2 diabetes and its complications.

People living with diabetes are significantly more likely to struggle with mental health challenges, including depression and anxiety. COVID-19 has also exacerbated that risk. I have barely left our home in more than a year now because of the risk if I catch COVID-19, and I know that many of my friends and colleagues living with diabetes are in the same situation. The sense of isolation and worry that all Canadians are experiencing during these times is powerful, and it adds to the mental and emotional burden of living with diabetes.

During COVID-19, many people are delaying accessing health care, and that appears to be increasing the risk of diabetes complications such as blindness and lower-limb amputation. As Dr. Karen Cross said at the most recent meeting of the all-party diabetes caucus, if diabetes before COVID-19 was the earthquake, COVID-19 is the ensuing tsunami. We must act now to minimize the impact of the tsunami of diabetes and diabetes complications that we are facing.

Bill C-237 will improve diabetes prevention and treatment, promote essential diabetes research, improve data collection and address health inequalities. It requires the Minister of Health to table a national diabetes framework in the House of Commons within one year.

Bill C-237 is strongly aligned with Diabetes Canada's diabetes 360° strategic framework, which was developed in collaboration with more than 120 stakeholders and has strong support not only from the entire diabetes community but also from other key health stakeholders, including the Canadian Cancer Society and the Heart and Stroke Foundation. Diabetes Canada encourages that, when Bill C-237 becomes law, the minister refer closely to the diabetes 360° strategy in preparing Canada's new national diabetes framework.

When Bill C-237 becomes law, Diabetes Canada will be pleased to collaborate with the government to define the national diabetes framework and to implement governance and evaluation mechanisms and supports for intergovernmental collaboration, to ensure that it quickly benefits the maximum number of Canadians possible. That is why Diabetes Canada strongly supports Bill C-237 and congratulates MP Sonia Sidhu for her leadership in tabling it and for her commitment to our cause.

We urge Parliament to pass this legislation quickly so that we can begin implementation as soon as possible, which is what Canadians want. In an Ipsos poll conducted in November 2020, 86% of total respondents and 91% of BIPOC respondents urged the federal government to embrace a national diabetes strategy urgently.

This year, Canada and the world are celebrating the 100th anniversary of the discovery of insulin by scientists at the University of Toronto. This momentous discovery saved the lives of millions of people around the world and is rightly recognized by most Canadians as one of our proudest achievements. By passing Bill C-237 now, the federal government can make a fitting recognition of the significance of this anniversary and begin to reap the human and financial rewards of a nationwide approach right away.

Thank you for your attention.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair, and colleagues.

It's my pleasure to speak today on my private member's bill, Bill C-237, an act to establish a national framework for diabetes.

Before I begin, I want to thank all members immensely for your support of this initiative at second reading. I'm glad to know we share the goal of fighting diabetes.

This year we commemorate the 100th anniversary of the discovery of insulin by Sir Frederick Banting and his partners at the University of Toronto. It was also at U of T that stem cells were discovered in the 1960s. These have led to promising research that may lead to a cure.

Since Canada has been home to these great inventions in the fight against diabetes, we should also have a comprehensive strategy to help those living with this disease.

We have 11 million Canadians living with diabetes or prediabetes. The number of diagnoses doubled in the last 20 years, and every three minutes, another Canadian is added to this list. In my own community of Brampton, almost every sixth resident lives with diabetes or prediabetes.

In my 18-year career as a health care professional, I saw patients with cardiovascular disease, kidney disease, amputations or high blood pressure and diabetes was frequently an underlying and complicating condition. That is why a strategy is so important. By effectively fighting or preventing one disease, we will make an impact on many others.

When you consider the expense to the public health care system and to individuals living with diabetes, it represents a massive financial burden. Every dollar spent fighting and preventing diabetes means greater savings down the line.

It is one of the most common chronic illnesses in Canada and the rate is only growing. Some Canadians are at increased risk of diabetes, such as South Asians, Black and indigenous Canadians. We also know that diabetes disproportionately affects Canadians with low income and education. Diabetes rates are three to four times higher among first nations than among the general Canadian population. Furthermore, indigenous individuals are diagnosed with type 2 diabetes at a younger age than other individuals.

The COVID-19 pandemic has disproportionately affected Canadians with chronic diseases, including diabetes.

For all these reasons, we need a cohesive national plan to respond to diabetes, one that coordinates funding for awareness, prevention, research and treatment, and that ensures equal access to treatment across Canada.

Mr. Chair, we can learn from Canada's past diabetes plans and programs, and we can make sure that the framework called for in Bill C-237 is data-driven, accountable and engaged with stakeholders such as Diabetes Canada, JDRF and others.

A national framework for diabetes would provide a common direction for all stakeholders to address diabetes, and by extension, other chronic diseases with the same risk factors. It would enhance coordinated efforts across federal, provincial and territorial jurisdictions and provide a mechanism for tracking and reporting on progress.

The framework would allow for the identification of gaps in present approaches, strengthen action to address health inequities in diabetes and decrease the duplication of efforts by coordinating across jurisdictions.

The bill calls for promoting research, data collection and treatment. It would offer an opportunity for indigenous people and organizations to engage in federal, provincial and territorial strategies using a distinctions-based approach.

It would make a difference in the lives of millions of Canadians. Back in April 2019, this committee conducted a study and released a report on this very issue.

Mr. Chair and Mr. Davies, you were both part of the committee at that time. The comprehensive report already outlines the steps the government should take in the fight against diabetes.

The number one recommendation in this report was that the Government of Canada, in partnership with the provinces and territories and in collaboration with stakeholders, plan and implement an approach for the prevention and management of diabetes in Canada through a national diabetes strategy. Bill C-237 mandates the minister to do just this.

The HESA report made 10 other recommendations. Among them were that the government explore options to reduce diabetes-related stigma and improve public awareness and education on diabetes; provide funding through the Canadian Institutes of Health Research for research into preventing and treating diabetes; hold discussions with the provinces and territories to explore possible approaches to providing uniform coverage for diabetes-related medication, supplies and equipment across Canada; work with the provinces and territories to explore possible approaches to improving access to health care for individuals living with diabetes in rural, remote and northern communities and address the difficulties faced by many Canadians in accessing a family physician; and work with the provincial regulatory bodies to ensure that health care professionals receive comprehensive education and training to properly identify and manage diabetes and diabetes-related complications in their patients.

I believe that with more coordination among all levels of government and stakeholders, we will be a better position to win the fight against diabetes. I know that the government will give full consideration to the HESA report and the dozens of witnesses who shared their expertise and experiences to help shape the recommendations. For example, I personally think the Diabetes Canada 360° proposal is an excellent one.

This past November I went to Banting House in London, Ontario, where the Flame of Hope, a perpetually burning torch that serves to honour all who have been affected by diabetes, is located. It is a reminder that we must still work for a real cure. It will only be extinguished when one is discovered.

The discovery of insulin is remembered as one of the greatest medical achievements of the 20th century. It was the first time the Nobel Prize for medicine went to someone outside Europe. It went to Canada. The best thing we can do as a country to honour this discovery is to recommit to helping everyone battling this chronic disease, whether they are patients, doctors, researchers or loved ones.

Mr. Chair and fellow committee members, Canadians have always been leaders in the fight against diabetes. I want to thank you all again for the support you have shown for this bill, which I hope will eventually lead to the day when we can extinguish that torch at Banting House. Canada gave insulin to the world. Why can we not lead the way?

Thank you, Mr. Chair.

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order. Welcome, everybody, to meeting number 26 of the House of Commons Standing Committee on Health.

The committee is meeting today to study Bill C-237, an act to establish a national framework for diabetes and then proceed to the clause-by-clause consideration. After that, we will discuss the first report of the subcommittee on agenda and procedure.

I want to thank the witnesses for appearing today.

First up, we have Ms. Sonia Sidhu, MP for Brampton South, whose private member's bill this is. From Diabetes Canada, we have Ms. Kimberley Hanson, executive director, federal affairs. From JDRF Canada, we have Dave Prowten, president and chief executive officer, and Ms. Juliette Benoît, volunteer.

Ms. Sidhu, please go ahead with your statement.

National Framework for Diabetes Act

[The Speaker, Anthony Rota]

Pursuant to order made on Monday, January 25, the House will now proceed to the taking of the deferred recorded division on the motion at second reading stage of Bill C-237, under Private Members' Business.

The House resumed from March 8 consideration of the motion that Bill C-237, An Act to establish a national framework for diabetes, be read the second time and referred to a committee.

[Sonia Sidhu, Liberal, Brampton South, ON]

Madam Speaker, I would like to thank all the members who spoke to this bill: the members for South Okanagan—West Kootenay, Winnipeg North, Calgary Shepard, Abitibi—Témiscamingue, Windsor West, Oakville North—Burlington and Provencher, and the members who spoke during the first hour of debate. The member for West Nova, whom I serve with on the health committee, spoke about his son's diagnosis. The member for Shefford told us about her relative's diagnosis. My friend from Brampton North told us about her grandmother and her childhood friend who would later pass from complications related to diabetes. There are too many heartbreaking stories like these.

Almost 11 million Canadians live with diabetes or prediabetes. The number of diagnoses has doubled in the past 20 years, and every three minutes another Canadian is added to the list. In my city of Brampton, every sixth Bramptonian lives with this disease.

For 18 years, working in health care, I saw how diabetes impacts Canadians. Often I would see patients with cardiovascular disease, kidney disease, amputation or high blood pressure, and diabetes was often an underlying and complicating condition. Diabetes also disproportionately impacts Canada's indigenous and racialized communities because of socio-economic factors.

In the last term, I met with Canadians through my cross-country consultation and with world-leading experts through international conferences. If we rededicate our efforts in reducing the number of cases and improving treatment and care for those living with this disease, we make progress in the battle against diabetes.

I would like to take a moment to thank the individuals who have supported this bill and helped it come together. I want to thank the mayor of the city of Brampton, Mayor Brown; city council members, including Councillor Medeiros; the Peel medical officer of health, Dr. Lawrence Loh; great advocates like Laura Syron, Russell Williams and Kim Hanson at Diabetes Canada; organizations like JDRF, CNIB and the Canadian Nurses Association; and of course my colleagues in the all-party diabetes caucus and the JDRF caucus, as well as many others.

As someone who has served on the Standing Committee on Health since 2016, I was proud when we brought forward a report calling for a strategy, such as Diabetes 360°, to fight diabetes. It was concluded that diabetes would cost Canadians almost $40 billion a year by 2028. We need to work with the provinces and territories, indigenous groups, medical professionals and community organizations so that we can best serve patients living with diabetes and advance the research that will end it.

Bill C-237 calls on the government to do that and create a national framework for diabetes. As parliamentarians, let us recommit to helping everyone battling this chronic disease, whether they are patients, doctors, researchers or loved ones, and continue fighting it so that more Canadians can lead a healthy life.

This year we commemorate the 100th anniversary of the discovery of insulin by Frederick Banting, which is recognized as one of the most important medical discoveries of the 20th century. Since then, we have continued to lead the way with stem cell research, which could one day lead to a cure.

Canada gave insulin to the world. Why can we not lead the way in defeating diabetes? I hope all members will join me in supporting my bill, Bill C-237.

[Ted Falk, Conservative, Provencher, MB]

Madam Speaker, Mitch Beauchemin was a lifelong resident of Ile des Chênes, Manitoba, in my riding of Provencher. His family and friends described him as a quiet, gentle and generous individual, always ready to lend a helping hand, yet never needing recognition.

I am going to give him a little recognition this morning. Mitch was a member of the Ile des Chênes Knights of Columbus Council and an advocate for Diabetes Manitoba. He was passionate about supporting those living with diabetes, and he actively lobbied the government on behalf of those with the disease.

Mitch was not just an advocate; he lived with type 1 diabetes for 40 years. Then, early last year, Mitch was able to receive a kidney and pancreas transplant, effectively closing the chapter on decades of managing his diabetes.

Sadly, he passed away this past September, but not without leaving his mark. In 2016, I was invited to be one of several guest speakers at a fundraiser Mitch organized called “Let's Get Pumped”, with proceeds going to the Canadian Diabetes Association. It had all the trappings: a luncheon, live music, speakers and a silent auction, and a 50/50 draw. He was quoted in the Niverville Citizen at the time, saying that he wanted to do this event, not only because of his own experience but also for all diabetics in the province.

Beyond this event, my office heard from Mitch from time to time, always making sure that diabetes was top of mind for decision-makers. Though I know many, including his wife Cathy, are missing him dearly, his memory lives on.

It is a pleasure to have this opportunity to speak to Bill C-237, the national framework for diabetes bill. I would like to think that Mitch would be pleased to see this conversation taking place today in this House, in Parliament. I want to thank my colleague, the member for Brampton South, for bringing forward this legislation. Her advocacy has been generating general awareness about diabetes for several years now.

As Diabetes Canada so succinctly puts it, “Diabetes is a disease in which your body either can't produce insulin or can't properly use the insulin it produces.”

Some 11 million Canadians are living with diabetes or prediabetes. If we consider an average 24-hour period, about 20 Canadians will die as a result of diabetes complications, 620 will receive a diabetes diagnosis, and 14 of them will have their lower limbs amputated. These numbers represent real people, family members, friends and neighbours whose lives have been lost or dramatically changed as a result of this disease.

The national framework for diabetes bill seeks to develop a national framework designed to support improved access to diabetes prevention and treatment to ensure better health.

It looks to include measures to explain what diabetes and prediabetes are, identify the training and education needs of health care professionals related to the prevention and treatment of diabetes, promote research and improve data collection.

Bill C-237 would also require the Minister of Health to hold at least one conference with relevant stakeholders to develop this framework, and within one year from when this act comes into force, the minister would have to report to the House on this framework. This is an important accountability mechanism that would ensure that the minister would do the work necessary to build this framework, although we must also be wary that there is no guarantee that the minister would meaningfully address issues that diabetics face here in Canada.

Canadians should have stable and reasonable access to the health care and the treatments they need. By working with stakeholders like Diabetes Canada, we can take concrete steps forward to develop a plan for the prevention and management of diabetes in Canada through a national strategy.

When the health committee studied this subject in 2019, it made important recommendations that bear mentioning. The first one was that the Government of Canada, in partnership with provinces and territories, and in collaboration with stakeholders such as Diabetes Canada, plan and implement an approach to the prevention and management of diabetes in Canada through a national diabetes strategy.

Second, as part of a national diabetes strategy, the Government of Canada, in partnership with the provinces and territories, and in collaboration with stakeholders such as Diabetes Canada, should explore options for establishing a national diabetes registry for people living with both type 1 and type 2 diabetes; explore options to reduce diabetes-related stigma; and, finally, explore options to improve public health awareness and education on diabetes, particularly through community programming, including public awareness of the relationship between nutrition and diabetes.

The bill serves to answer the call of these 2019 recommendations, but it is worth noting that programming already exists to address common risk factors of diabetes within the integrated strategy on healthy living and chronic disease. In going forward with the bill, there must be clarity about how the national strategy would tie in with existing programming.

A number of previous governments have taken important steps forward on diabetes as well. In 1999, the federal government created the Canadian diabetes strategy to further the prevention, early detection and self-management of diabetes and its complications, and national surveillance. It committed $115 million over five years for that strategy. In 2005, the Canadian diabetes strategy became part of the integral strategy on healthy living and chronic disease. Funding for the Canadian diabetes strategy was renewed in 2005, and $18 million a year was introduced for the Public Health Agency of Canada's diabetes programming. Funding for diabetes research is also disbursed through the Canadian Institutes of Health Research. In 2010-11, under the previous Conservative government, the Canadian Institutes of Health Research funded approximately $44 million in diabetes research.

As I reviewed this history, I was struck by the gap between the previous Conservative government's funding and where we find ourselves today. When the health committee's recommendations that I highlighted earlier were laid out, the committee had a Liberal majority, which was supported by Conservative members of the health committee, and it was understood that the government needed to act. Unfortunately, we have not seen much action by the current Liberal government in recent years. As a government, it could have introduced a government bill, but no such bill was introduced—not when the Liberals had a majority and not now in the current Parliament. Had they chosen to introduce a government bill, Parliament could already have had work under way to develop this framework. Bill C-237 is important, but Canadians with diabetes also know that it is late.

It is also troubling that the Liberal government's most memorable connection to diabetes was when it oversaw a Canada Revenue Agency crackdown on access to the disability tax credit, which is a non-refundable tax credit that helps persons with diabetes reduce the amount of income tax they might have to pay. In 2017, the CRA began restricting access to this disability tax credit, which affected hundreds of Canadians living with diabetes and other rare diseases. This happened because officials changed the interpretation of the rules around life-sustaining therapy and associated requirements for those diseases. Our Conservative opposition sounded the alarm and stood with organizations demanding that Canadians continue to receive the benefits they ought to have access to. Given this history, I think there would be value in including an amendment to ensure that the Canada Revenue Agency is administering the disability tax credit fairly and that the disability tax credit is designed to help as many persons with diabetes as possible. This is something that the committee can look at when the bill is referred to it. I think we can all see how this would give greater certainty to those folks who rely on the disability tax credit.

It is my duty as an opposition member to constructively critique the proposal. I have highlighted where I think it could be better, but I do not want to dwell on that. I appreciate that the member for Brampton South is stepping up in the absence of action from her government. She is using the opportunity that she has been afforded through the private members' bill lottery to move the dial forward on this issue, and I commend her for that. At a time when so much attention has been dedicated to COVID-19, it can be easy to forget that the daily challenges faced by individuals with diabetes have continued without their receiving much media attention and without widely publicized diagnosis.

The final word is this: There is merit to committed and coordinated federal leadership to tackle diabetes in Canada. We have an opportunity to move the ball forward and a strategy that could help support those living with diabetes and help prevent millions of potential cases. As I said before, we are talking about real people, and this could better the lives of millions today and in the future. I encourage all members to move the bill forward to committee so that we can take a long-overdue step.

[Pam Damoff, Liberal, Parliamentary Secretary to the Minister of Indigenous Services]

Madam Speaker, I would like to begin by acknowledging that I am speaking today on the traditional territory of the Mississaugas of the Credit First Nation. As someone who lives and works on the traditional territories of indigenous peoples, I recognize my responsibility to acknowledge and listen to their perspectives and interests.

I am thankful as well for the opportunity to speak in favour of the member for Brampton South’s private member’s bill to establish a framework for diabetes. I also want to commend her. Since she was elected in 2015, she has been tireless in raising awareness about diabetes and in advocating, as the chair of the diabetes caucus, to ensure the issue receives the attention it deserves. On this International Women's Day, I am so proud to serve in this Parliament with her.

Diabetes is an important public health issue that affects millions of Canadians from coast to coast to coast. Diabetes happens when the body loses its ability to produce or properly use insulin, a hormone that controls blood glucose levels. When diabetes goes undetected or if action is not taken to keep it in check, serious complications can develop, and in some cases, premature death can occur.

As we know, there are three types of diabetes. Type 1 diabetes is an autoimmune disease in which the body is unable to produce enough insulin. It is usually diagnosed in children and young adults and is not preventable. My cousin Adam Fraser and my friend Dave Millar live with type 1 diabetes, and I have seen the challenges they face to manage their disease.

Type 2 diabetes generally develops in adulthood and accounts for 90% of all individuals living with diabetes. It is caused by several factors, including obesity, ethnic background, a family history of type 2 diabetes and other environmental factors.

Gestational diabetes is diabetes that is first diagnosed during pregnancy and usually disappears after delivery.

Many Canadians live with the impacts of this disease. Diabetes or prediabetes affects one in three Canadians. One in two young adults will develop the disease in their remaining lifetime.

Research has shown that some indigenous peoples and Canadians are more susceptible to diabetes than others in the general population. First nations and Métis people, Black Canadians and South Asian Canadians have significantly higher rates of type 2 diabetes than other Canadians. The increased risk for type 2 diabetes in these groups is often a result of inequities in social determinants of health related to income, education and the social and physical environment. These inequities can limit the ability of individuals to access nutritious foods and be physically active, and can increase the risk of obesity, diabetes and other major chronic health conditions.

Higher rates of diabetes among first nations and Métis people reflect the long-standing effects of colonization that disrupted the transmission of culture across generations and resulted in physical changes to the environments of their communities. Among other negative impacts, these factors limit the availability of and access to important sources of nutritious foods as well as the ability to engage in traditional active lifestyles.

The COVID-19 pandemic has exacerbated and unmasked the challenges faced by people living with diabetes. We now know that people living with diabetes are at increased risk of developing severe symptoms and dying from this infectious disease. We also know that people living with diabetes can face significant challenges to participating fully in the economic and social life of Canada. This debilitating disease exacts a significant toll on our nation’s economy and health care system.

I have had the privilege to work with Kimberley Hanson from Diabetes Canada and Mike Swartz from my riding to advance their Diabetes 360° initiative. Both Kim and Mike live with diabetes and have advocated that our government needs to do more. I agree. I sincerely hope our government provides funding to implement Diabetes 360° in our next budget.

A recent study estimated that new cases of diabetes between 2011 and 2021 account for $15.36 billion in health care costs. Beyond the immeasurable human costs of this disease, if prevalence grows by 40% in the next decade, as projected, the health care costs associated with treating people with diabetes in Canada will top $39 billion by 2028.

To reduce the risk of developing type 2 diabetes, the most common and preventable form of the disease, it is important to help Canadians in every way to develop healthier lifestyles. Canadians of all backgrounds and in all regions must have the opportunity to find ways to sit less, move more, eat more healthily and stop smoking.

During the pandemic, at a time when we encourage people to stay home, we can find ways to be active safely, such as going skating, skiing or snowshoeing or bundling up for a hike. Being active and promoting healthier weight are fundamental in helping to prevent type 2 diabetes.

Canada was the first country to develop 24-hour movement guidelines for the early years, children and youth. Through additional guidelines released last year, Canada now has a complete set of recommendations for physical activity, sedentary behaviour and sleep across all age groups.

These guidelines are important in helping Canadians integrate healthy behaviours into their everyday lives, and reduce their risk of major chronic diseases, including type 2 diabetes. Healthy eating is also a key factor in preventing diabetes.

The Government of Canada is taking action to help Canadians eat better and access nutritious foods. Through our healthy eating strategy led by Health Canada, we have strengthened nutrition labelling on food products, eliminated industrially produced trans fats in foods, and are working toward restrictions on the marketing of unhealthy foods to children.

In 2019, we updated and published a new Canada food guide, based on the best evidence available to promote healthy eating. Further, to help Canadians consume less sodium, last fall we released revised sodium targets for processed foods. The Government of Canada is also working with its partners to promote healthy living and prevent chronic diseases, such as diabetes.

Being aware of one’s risk for diabetes is also key to helping people take action to prevent the disease. The Public Health Agency of Canada, in collaboration with its partners, developed and promotes a diabetes risk questionnaire called CANRISK to help Canadians understand their level of risk for developing prediabetes and type 2 diabetes.

The Government of Canada is also investing in innovative community-based programming and public education to test and scale up projects that help to prevent chronic diseases, such as diabetes, and encourage healthy living choices. The government is providing extensive support for diabetes research. From 2014 to 2019, the Government of Canada, through the Canadian Institutes of Health Research, invested approximately $229 million in diabetes research.

This year marks the 100th anniversary of the discovery of insulin. I grew up in London, Ontario, the home of Sir Frederick Banting. One of my high school’s rivals was Sir Frederick Banting Secondary School. Canadians should indeed be proud of the work that Banting and Best did with their discovery of insulin.

The Government of Canada is working with partners to commemorate this monumental Canadian innovation that has saved millions of lives worldwide. However, while this milestone is indeed worthy of celebration and a source of pride, we have more to do. Diabetes Canada has stated:

When the world looks to Canada in 2021 to see how we are faring at treating diabetes 100 years later, Canadians will have less to feel proud of. Double the number of Canadians lives with diabetes than did 15 years ago, and Canada is in the worst third of developed countries for both prevalence and costs of treating the disease. The problem of diabetes is very bad, and rapidly getting worse. We need to do something bold to address this problem and mark this important anniversary in 2021.

Eleven million Canadians are living with diabetes or prediabetes. Chances are that the disease affects someone or someone we know.

I am pleased to support Bill C-237 as the government continues to undertake meaningful efforts toward preventing and reducing the impact of diabetes and other chronic diseases on Canadians. This bill reminds us that we need to increase our efforts and work together, alongside individuals living with diabetes, to reduce the burden of this devastating disease and improve health outcomes for Canadians and indigenous peoples.

Finally, I would like to again thank the member for Brampton South for bringing this bill before the House of Commons and for her tireless advocacy.

[Brian Masse, NDP, Windsor West, ON]

Madam Speaker, that is very gracious of you. I appreciate it, because it is a special day. I want to thank Terry for 24 years of putting up with this. I will take these glasses off because they will fog up as I talk in the debate today.

It is a great debate. It is something that I think the House will support, but it is also something that I am hoping, after my 18 years here in the chamber, will actually get some action. How many times do we have to talk about diabetes and issues like it and not have any real action. Why are we waiting? What will change between now and 10 years from now? Nothing. We know diabetes has a significant consequence on our population. We know it has a significant consequence on our economy and a significant consequence on what we do every single day, yet we still do not have a national strategy. We have not supported it through either a provincial or a federal plan.

I do not see this as a jurisdictional issue, whether it be Quebec, British Columbia, Ontario, Saskatchewan or Newfoundland. I see it as an issue that kind of brought me to politics. As an employment specialist for persons with disabilities and as a PSW, I met people with diabetes who had extra complications in their lives. Why we would not provide the support for medications and proactive engagement in their treatment is beyond me as a legislator in this House and in this chamber. Having discussions and spending time on this issue is kind of incomprehensible in many respects. We know that if we actually do the right things, we can support people. The modest things that are necessary would give them extra life, extra employment, inclusion and, most importantly, the sense of fulfillment that we all enjoy.

We know that the percentage of our population who have diabetes is rising and we know that there are solutions for that, yet here we are today, debating a bill, which is fine, but we are not acting. That is where I have an issue with this situation right now. It is that we need to move forward.

We all have a unified vision that this is a serious issue for all Canadians, and the House and the chamber acknowledge that, but we are still going through a process that is very draconian with regard to getting results for people who are suffering from diabetes. I am really happy to discuss this because it still raises this issue and brings us another step forward, but I hope we can actually go farther than that.

When we look at the issue of diabetes, we see it is one of those things that is affected by the consumer element and the products and foods being pushed onto people. At the same time, we expect people to manage their disease with medication, but some people do not have any choice. Some of us can drive to a grocery store or elsewhere to get food and other supplements that are better choices, rather than having go to stores in their own neighbourhoods, but other people cannot, because they have to take a bus or rely on other people or do not have the support or experience to look at all the ingredients on the labels of the products they need.

The situation is that diabetes is different for those privileged to have an income that allows them to deal with it through a logical plan and provides supports to do those things and make those choices. Then there are other people who have to deal with it but cannot get out of their apartment. They are stuck with limited choices. They do not have the choices that other people have to help themselves. They know that, so they have to do the things necessary just to manage the situation.

I am hoping this motion will propel the government to do something. We can have lots of slogans, different motions, committee studies, all of those different things, but we know diabetes affects people right now, as I am speaking. There are solutions for it, like insulin, which is a pride of our country in terms of its development and use in society, but it is not without cost or effect on populations.

Young people with juvenile diabetes organize and spend their time and their youth fighting for political change by us here, which is a sad thing. How wrong is that? How wrong is it that we are asking young people to spend their time and their youth advocating a public policy we know is true and just? That is what gives me difficulty in this whole situation and what is going on here when we have all of those tools.

We have seen the things that were impossible before COVID-19 and now are possible. We have bailed out banks. A good example is Bell. With $112 million of government assistance, Bell laid off people and made $5 billion in profit, but at the same time we cannot afford strategies for diabetes. Those are good examples of what was impossible before COVID-19 and are possible now.

I am hoping we will see the light with regard to diabetes through the legislation before us, Bill C-237, and other bills that come before the House. I am hoping we will actually start to act. It is important, because none of the debate here really matters, in the sense that it does not affect an individual at the end of the day unless it reaches the goal line. Hopefully, the discussion today will translate to real results.

The Liberal administration had a supermajority in the past Parliament but now has a minority, so we can push things like this forward. I am hoping the government will do that. I do not think we need a five-year study to tell us the effects of diabetes. We do not need more research and development to understand its connection to human bodies and how it affects us as citizens in our communities. We need action.

The discussion here today should be about whether we are going to act or not. That should be the benchmark. The benchmark should be whether we are going to act.

And we should act on this now, not in five years but in five weeks. There should be an initiative to support what needs to be done. The research is there and the population is there, and we can certainly see the inequity in the demographics and research, which shows that people can deal with this issue better if they have money versus not having money, which puts a greater onus on us from the expectations of the population.

It is of even greater importance than ever before for us to act now. Because of COVID-19, we know what we can do to prevent health issues. We can do that with pharmacare, dental care and a series of things, but if we do not act, it does not mean anything. That is the reality. Why do we need another study to understand diabetes? I do not understand that. I will support this bill and the NDP will support it. We will be behind it, pushing really hard for real results, but action is necessary now. It will save us money and give us the opportunity to save lives. I am thankful that this bill has come forward.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Madam Speaker, it is important for me to speak to this issue this morning. I thank the member for Brampton South for giving us the opportunity to do so.

Unfortunately, despite the many efforts that have been made to combat diabetes in Quebec and Canada, this chronic disease continues to progress. The percentage of people with diabetes continues to grow. Nearly 8% of Canadians have either type 1 or type 2 diabetes. More than 888,000 Quebeckers and 4 million Canadians have diabetes.

Today, the treatment and management of this disease and its impacts impose a financial burden estimated at $3 billion a year in direct and indirect costs. Diabetics require a range of health care services, mainly to treat and manage the disease but also to diagnose and treat related complications.

The direct costs are those associated with the health care services covered by public or private health insurance or by the individuals and their families. The indirect costs are those that are not related to health care and have an impact on the economy and individuals when a loss of productivity arises as a result of the disease, a disability or premature death.

Canada has a long history of fighting diabetes. In 1999, 4% of the population had diabetes, and that number has doubled in the past 20 years. Grabbing the bull by the horns, the authorities created Canada's first diabetes strategies, which involved collecting and sharing information and mobilizing stakeholders. Ten years later, in 2009, efforts to fight diabetes were augmented by funding for research and public awareness. Since 2019, organizations have been calling on the Government of Canada to set up a strategic framework and fund a national strategy. That brings us to today. Bill C-237 would create a Canadian national framework for diabetes.

What is a national framework? Its goal would be to improve access to diabetes prevention and treatment. That is a good thing. We have to act fast, because the incidence of diabetes is rising at an alarming rate. I would point out that the purpose of Bill C-237 is to have Canada's Parliament recognize the need to be proactive in the fight against diabetes and to have the Government of Canada develop and implement a national diabetes framework.

The bill provides for the strategy to be designed in consultation with the provincial governments and Quebec. Organizations, provincial governments and the federal government must work together to develop this national framework and determine the broad themes to be included, such as education about diabetes, identification of needs, promotion of research, promotion of knowledge sharing and analyses of what is already being done to achieve health care equality.

The bill gives the government one year to develop the strategic framework and five years to report on its effectiveness. This is all well and good. The Bloc Québécois supports Bill C-237 as long as the Canadian national framework does not infringe on Quebec's jurisdiction over health care. Before the bill can move forward, the Bloc Québécois must ensure that the Canadian national framework reflects the demands of Quebec and respects its jurisdiction. As far as Quebec is concerned, the federal government should only be involved in the areas of prevention and research.

I want to acknowledge the efforts of the hon. member for Brampton South. I would like to highlight what our colleague has done in the fight against diabetes. She worked in the health sector for 15 years and devoted part of her career to the cause of diabetes, since it is very important to her. She took part in the Diabetes Canada 2018 forum. She has also moved three motions on diabetes to raise public awareness. She wrote a report entitled “Defeating Diabetes”. It presented a cross-section of the various stakeholders that are likely to make an impact on the issue. We at the Bloc Québécois believe that her desire to contribute to the cause is sincere and that, at the very least, she knows what she is talking about.

More than ever, we must fund research. The way we beat diabetes is by ensuring better prevention and making discoveries that will lead to a cure. We must give more funding to research so we can contribute to the global effort on diabetes research. This research is making progress on many fronts. The latest advances include improved methods for insulin delivery and control of blood sugar, as well as better insulin pumps. The most significant breakthrough in all this is the transplantation of insulin-producing cells.

A number of researchers are working on transforming stem cells into healthy beta cells that can be transplanted into patients. We can now manage insulin-producing cells that act like the beta cells we have in the pancreas.

These are promising advances, but we cannot overlook any aspects of diabetes. Research is needed so that we can learn more about the mechanism of diabetes and expand our knowledge in such areas as pharmaceutical research, diabetes screening, food, weight issues and physical activity programs tailored to people with diabetes.

Let us talk about the close relationship between obesity and diabetes. The governments of Quebec and Canada have developed strategies to promote healthy lifestyles among Quebeckers and Canadians. Governments must continue to promote awareness, which is not easy to do, since big multinationals bombard us with advertising and sell us high-calorie foods that can cause obesity and, as a result, diabetes.

Governments must continue promoting physical activity through awareness campaigns and also through enhanced tax credits for sports. The rise of type 2 diabetes among young children is alarming, so we need to get kids moving. Governments also have to continue promoting healthy eating and a healthy weight. They must also provide financial support to organizations like Diabète Québec and Diabetes Canada.

I would be remiss if I did not remind the federal government that it needs to provide more help for Quebeckers and Canadians, and in particular indigenous communities, which have much higher rates of diabetes than the general population.

I want to throw out a question about COVID-19 vaccinations for us to think about. Should people with chronic diseases like diabetes get priority for the COVID-19 vaccine?

For all of these reasons, the Bloc Québécois is in favour of developing a strategy, provided that it respects the provinces' demands and the division of powers.

I would also like to point out the work being done by local and regional stakeholders. I especially want to acknowledge the work of my friend Anne-Marie Trépanier, who has had type 1 diabetes since forever. Many people are battling diabetes and must develop a different lifestyle. We must be there for them because, from what I have understood by talking with my friend, they require a significant amount of psychological and physical support. Associations play a fundamental role in these areas. In terms of awareness of this disease, we must also think of local associations, which offer essential services.

I will conclude by mentioning that this disease can strike anyone at any time. There is a strong link between cardiovascular disease and diabetes. My father passed away 10 years ago, and in his final days we suspected that diabetes was involved. Diabetes probably accelerated his failing health and contributed to his heart attack.

It is important to invest in research, especially in diabetes management, which could have given my father better health in his final days and extended his life so that he might have been able to enjoy his grandchildren for a few more years.

[Tom Kmiec, Conservative, Calgary Shepard, AB]

Madam Speaker, I am pleased to continue debate on Bill C-237, which was brought forward by the member for Brampton South, and to listen to the previous member. I agree with him. I do not see much to disagree with in this private member's bill. It was in the format of a motion in the previous Parliament, and I know the member for Brampton South is well-meaning in the work she is attempting to have the House pass to committee to study this issue.

The contents create more reports to Parliament and parliamentarians in which we would get further information, hopefully from government sources, that will track and provide very specific timetables and details in the content of this report, which I am all for.

Generally speaking, we find that in government legislation there is simply an ask for a report to be made to Parliament, but often it does not ask for much detail. This one does. It has five points that would be in the report, including an explanation of diabetes and prediabetes. It also asks for things like data on the promotion of research, prevention and treatment. There are a lot of good things this bill is attempting to do.

It could have also asked the Canada Revenue Agency to provide more information on the disability tax credit, which we know many diabetics would like to use. In 2017 or 2018 the Liberal government made changes, and thousands with type 2 diabetes were no longer able to obtain the DTC.

We also know that the DTC and the registered disability savings plan are two very important programs that a lot of people with serious disabilities make use of, and the DTC maximum payable tax benefit in 2019 was $8,416. This is a substantial amount of money to help people with a disability. For constituents with type 1 and type 2 diabetes, it is a very serious disability.

A mom came to one of my town halls, and at a later point to an annual general meeting in my local association, and she explained how difficult it is to live with a daughter who has diabetes. It involves waking up in the middle of the night because an alarm would go off on the diabetic pump. It is trying to ensure that they have enough insulin, especially after eating.

It is a serious condition, but I do not think many Canadians really understand the depth of how bad it can go. The member for Winnipeg North spoke to how serious this condition can be because of the complications that arise from being a diabetic, and of one of his friends having had a leg amputated.

I have a friend who was diagnosed later in life, and he had half of his foot amputated because of diabetes, so we know it is a very serious condition. Diabetes Canada and JDRF have done extensive, profound work to try to sensitize Canadians and governments across Canada to how serious this condition is, but also to the weight it places on our health care systems. It is one of the fastest-rising chronic conditions in our health care system, and it is a big driver of Canadian health care costs.

If we look at Diabetes 360°, I think Diabetes Canada has put forward an excellent plan on it. This framework could be used to further those types of private sector projects that are trying to gather more support, both from government and from private sources, to ensure that we deal with the rising tide of diabetes diagnoses across our country.

There is a Yiddish proverb that says, “Spare us what we can learn to endure.” Diabetes is a difficult condition to endure. I have kids who have a chronic kidney condition, so I have an inkling of what goes into trying to manage a condition like this. A framework to Parliament is a simple ask by the member from the back benches in this Parliament for the government to build information and report it back to Parliament so we can have good, solid evidence for decisions to be made in the future.

The disability tax credit is one of the key tools being used by those with a disability across Canada. Members will know I proposed Bill C-399 in the last Parliament. It never came to a vote because I drew too high a ballot count. It would have made changes to the DTC specific to diabetics. This is where it ties in with the national framework that the member is asking the House to pass to committee.

Making it easier to access the disability tax credit, or any type of disability program that the federal government could run, should be addressed directly in the framework. I would hope that the reports provided to Parliament in the future would specifically address the disability tax credit, how it functions, and how it addresses issues and conditions such as diabetes.

An important piece of evidence to be tracked is the cost per person, across all of Canada's health care systems, of a diabetic's condition as it worsens in later years. Its annual cost to the health care system would lead to better decision-making at the front end when considering different types of insulin and technology, and whether there is a government role or support that could be provided to bridge the gap for those who cannot afford it.

One of the recommendations in the pre-budget report from the finance committee in this Parliament was to make the disability tax credit refundable. Because tax credits are administered by the Canada Revenue Agency, those types of decisions would be easier to make if a national framework, and a report from a national framework specifically on diabetes, provided information and evidence from the DTC program on the top 10 doctors in Canada who are approving the six-page form for the DTC, and if they are approving them specifically for diabetes. That would offer an excellent opportunity for parliamentarians to reach out to those doctors and ask them to describe their experience filling out these applications, how serious the condition is, what the downside is and what it can lead to. That would be an interesting data point, and we cannot easily get that information without having something like a national framework that produces evidence.

As I said, I would like to see the Canada Revenue Agency compelled, through a report tabled in Parliament through this national framework, to provide such information. I would also like to see which provinces are applying the most for this one condition, specifically diabetes. JDRF, Diabetes Canada and other stakeholder groups have all asked in the past for more information to be provided to us so that we could make better decisions.

Often, I find that the Canada Revenue Agency is a black box: It does not like to reveal any type of information. A few years ago, the Auditor General reported on the DTC and the program's performance and administration. It was not very good. It was not what we parliamentarians would expect to see in the administration of such an important tax credit for Canadians.

A report like this is important. It is beneficial. I applaud the member for bringing it forward. I have no doubt that we will be able to pass it to committee, and I am hoping at that stage there would be further consideration given to perhaps including a specific mention of the disability tax credit and other federal government programs specific to diabetics, and that we could address the specific lack of information in the framework. When the bill returns to the House and we have our final say before it heads to the Senate, we could add that important piece of information. The changes that were made a few years ago by the Canada Revenue Agency, as directed by the government, really hurt the case for thousands of diabetics across the country who were removed from the disability tax credit. It would be good for us all to have that type of information available.

I will be voting for this private member's bill. It is a good bill. It provides the foundations for better work to be done at committee to add the disability tax credit angle. Again, spare us not what we can endure to learn. Diabetes is a very serious chronic medical condition, and it is about time we had a framework in this country to deal with it.