Evidence of meeting #66 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was research.
A recording is available from Parliament.
12:45 p.m.
Conservative
12:45 p.m.
Medical Doctor, Montreal Children's Hospital, McGill University, As an Individual
Actually, I am part of the trigger study and this is exactly one of the questions we are addressing.
To answer part of the question that was just asked, strangely enough, if your dad has type 1 diabetes, your child has a higher chance of developing type 1 than if your mom has type 1 diabetes. It sounds like it is counterintuitive, but that tells you that there is obviously not a direct link.
Part of the study is to explore many of these aspects, because all the kids who were selected for that prevention study had similar risk factors, but they do develop diabetes at different rates. So it's a combination of many different things.
You do sometimes have the same genetic set-up, but there are probably environmental triggers, as were briefly described by Dr. Sherman, and those may play a different role, depending on what your genetic makeup is. So it's not quite clear, but it's very complex in nature, and we are trying to unravel those complexities through that study. Perhaps we're not going to have all the answers, and it's at least five years down the road before we can conclude anything.
12:50 p.m.
Conservative
The Chair Conservative Joy Smith
Dr. Legault, I note that your clinic starts at one o'clock. We are going to have one more question, and then we'll be dismissing.... We love to have you here; it's just that you gave us this warning about your clinic and I want to be mindful of that.
Mr. Scarpaleggia.
12:50 p.m.
Liberal
Francis Scarpaleggia Liberal Lac-Saint-Louis, QC
You're looking at triggers, or the possibility of triggers, such that someone with the gene will never get type 1 and someone with it may get it at a different time in life. Are the triggers you are looking at mostly environmental? Is that what I understand from what you and Dr. Legault said?
12:50 p.m.
Scientific Director, Institute of Nutrition, Metabolism and Diabetes, Canadian Institutes of Health Research
The answer is that we don't precisely know, so we're taking a very wide-angle lens.
Environmental triggers are being looked at. There was a study, for example, published last year from China, where type 1 diabetes is occurring. Bisphenol A, the stuff in hard plastics, might be a risk factor for diabetes.
There is some evidence—actually excellent Canadian work—suggesting that it's not chemicals in the environment, but it's the composition of the microbes that colonize your intestinal tract that are a risk factor. Another one might be the kind of dietary exposures you have early in life.
So all of those things are being looked at, at the same time, and we don't yet have the answer. But it's a wide angle, because if you go too narrow you might miss something that is the real culprit.
12:50 p.m.
Liberal
Francis Scarpaleggia Liberal Lac-Saint-Louis, QC
I'm just trying to simplify the issue so that I can grasp it. Where are the gaps in research? Triggers are one area, but if you had to name three major gaps in research, what would they be? Where do you feel more resources are required? What are you concentrating on—your research priorities?
12:50 p.m.
Chief Scientific Advisor, National Office, Canadian Diabetes Association
I will start, and Phil can pick up.
Certainly there is a need for ongoing research toward a cure. That's the best way to stem this epidemic, but even if we had a cure today, there are millions of people with diabetes, or at sufficiently high risk for diabetes, and we will be treating the condition for a long time. So more effective treatments to manage diabetes and to reduce the risk of the chronic complications....
Eighty percent of the cost of managing diabetes is related to the complications, not just to controlling the blood sugar, so better treatments to prevent and manage those complications are important.
Public health approaches and the understanding of the importance of public health approaches.... We focus on diabetes as a condition where people can self-manage and really take control of their health, but if we go too far down that path, we forget the fact that the environment that people live in is critical. Recent research in Toronto has really looked at the built environment and how that impacts on the risk for diabetes.
12:50 p.m.
Chief Scientific Advisor, National Office, Canadian Diabetes Association
The built environment meaning the walkability of neighbourhoods. If you live in a suburban rabbit's warren where you are forced to use a car, you will be less active. The risk for new immigrants in developing diabetes, if they live in one of those least walkable neighbourhoods, compared to the most walkable neighbourhoods, is 50% higher.
12:50 p.m.
Liberal
Francis Scarpaleggia Liberal Lac-Saint-Louis, QC
Wow. That's very interesting.
I guess stem cell research is part of a search for a cure?
12:50 p.m.
Scientific Director, Institute of Nutrition, Metabolism and Diabetes, Canadian Institutes of Health Research
Absolutely, yes.
You heard the Edmonton Protocol mentioned a few times. Canada is well known in that regard for leading stem cell therapy to derive cells that could act like a pancreas. A pancreatic cell that produces insulin is on the horizon. It's not pie-in-the-sky thinking, but it's not yet ready to be used in humans.
12:50 p.m.
Liberal
12:50 p.m.
Scientific Director, Institute of Nutrition, Metabolism and Diabetes, Canadian Institutes of Health Research
It's the next step. Instead of transferring islet cells from a human subject, it's taking cells from the skin, say, and telling those skins cells, no, we don't want you to be a skin cell anymore, we want you to become a pancreas cell that produces insulin. That is not far from the distant future in animal studies. We need steps along the way, and I totally agree with Dr. Hux that a multi-pronged approach—which is what CIHR funds—along the breadth of the health research spectrum is what's required, because we need to find a cure and we need to prevent, but we also need to manage people who are already affected.
12:50 p.m.
Liberal
Francis Scarpaleggia Liberal Lac-Saint-Louis, QC
In terms of managing, I was listening to Dr. Legault, who said we need more support in the schools; we need more guidance from medical practitioners who can counsel their patients on healthy living and refer them to a dietitian if they need one. It's all true, and they are very good points, and in some ways they're obvious. But when I look at the real-life situation where I live, the schools are chronically underfunded. They don't seem to have enough money to help kids with autism in the schools. They don't have enough special needs specialists and counsellors. Married to that is the fact that more and more, in my area, if your doctor retires, you're not going to find another one. It seems like such an intractable problem from a public health perspective, because the school commissions are underfunded and they're dealing with many different demands, and fewer and fewer people are going to have a steady family doctor.
I just don't know where the answer lies, Dr. Legault, other than greater funding generally for the health care system and for education, and to make sure that some of that new funding goes into these areas. I don't know if you feel discouraged by the state of affairs. You see the same thing I do: school commissions that just don't have enough resources. In fact, there's even a trend now to want to get rid of school commissions in Quebec.
I'd just like your general reaction to this state of affairs.
12:55 p.m.
Medical Doctor, Montreal Children's Hospital, McGill University, As an Individual
If I were pessimistic, I'd probably be out of business, but I need to have an optimistic point of view from this.
I think those are two different things. I think the efforts to try to curtail the epidemic of childhood obesity is a much more challenging task in itself. From a diabetes perspective, though, because that's what we're here for, I think it's doable.
We're focusing in Quebec here because we know the reality, but certain areas of the province do have pretty good school services for diabetic children. It's a matter of school boards sometimes making choices, and they're making choices, I'm sure, based on budgetary constraints. But there is a way for public health, I think, to be involved, to try, at least, to get more knowledge out there. The nurses who are working in the schools are actually obviously catering to 8 to 10 schools, on average. They're not physically present. There needs to be a general way for them to know about type 1 diabetes as opposed to type 2 diabetes, which is often the case. They need to try to find out, as was pointed out by the people from the CDA, what the priorities are for this particular child, age-wise, autonomy-wise. And if it takes only someone supervising the child for half an hour, I think this is perfectly doable, and I don't think that's stretching the budget to a really unreasonable amount.
I agree that the fight against obesity is a completely different type of approach, and it probably involves major support and longstanding work. But I think diabetes is perfectly manageable. It's just a matter of committing to it and making concerted efforts so that everybody's on the same page. The problem is there are many jurisdictions, and I don't know that abolishing school boards is necessarily going to help—
12:55 p.m.
Liberal
12:55 p.m.
Medical Doctor, Montreal Children's Hospital, McGill University, As an Individual
I don't think so either, but I'm not the one making those decisions.
But we can work around this. It's just a matter of making sure the nurses are also properly trained. For the most part, the nurses are trained by an adult-type system, where you get calls because a child has a high blood sugar level, which is obviously a cause for concern for someone who has type 2 diabetes because that doesn't happen very often, but it does happen daily for a type 1 diabetic. So we need to make sure they know what they're talking about.
I'm finishing there.
12:55 p.m.
Conservative
The Chair Conservative Joy Smith
You finished well, Dr. Legault.
I want to thank you, Dr. Legault, and all the doctors in front of us today, who have given us some very insightful information. It has been extremely helpful. Your contribution here is very much appreciated. With that, I will dismiss the committee.
Thank you, committee members.
The meeting is adjourned.