Health Committee on Oct. 2nd, 2018

[Lucie Tremblay]

If I may, I would like to add something.

I was saying earlier that not all nurses in Quebec are prepared to provide care in communities, such as diabetic care, especially in indigenous communities. If a nurse arrives in a remote region where there are not many services, and she is not prepared to deal with a major health problem—we talked about epidemics earlier—, that is already a crisis.

I sincerely hope that your recommendations will highlight the need for this kind of training for all nurses so that all Canadians have access to care. I cannot overstate the importance of this.

You talked earlier about people who are dying, and that worries me. I am a nurse and cannot help thinking about patients' well-being. When people have a limb amputated or have to undergo dialysis, both of which could have been prevented, this leads to costs not only to the health system, but also to society. It means that these people do not contribute fully to the country's economy. This is a very important point and I have to stress it.

In the case of the first nations, this is especially serious because access to care is already limited. If, in addition, people are not prepared to deal with the challenge, that poses a further problem.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Before we go to Ms. Sidhu, I want to ask a question on that.

Earlier, Dr. Whiteside, I think you said that people in lower socio-economic levels are four times more likely to get diabetes. How do indigenous communities rate? Are they four times more likely to get it?

[Dr. Catharine Whiteside]

No. The indigenous communities are three to five times more likely to develop diabetes.

To give you a sense of this problem related to complications, I mentioned there is an amputation every four hours in Ontario because of untreated diabetic foot ulcers. In the northern regions of Ontario, the amputation rate is much higher.

The reason is exactly as Ms. Tremblay has indicated. The access to care is highly limited and the intervention early enough to prevent these amputations simply doesn't exist. This is a huge problem, not just in Ontario, but in the northern regions of all the provinces and territories.

Alberta is probably the furthest ahead of the provinces. They have instituted a province-wide foot care program for individuals with diabetes, with particular emphasis on the indigenous communities. They have set up hubs of aggressive treatment centres for diabetic foot ulcers throughout the province.

Again, there are examples in Canada where this problem is being addressed more aggressively. I think a national diabetes strategy would enable the sharing of some of these better and best practices province by province to improve these outcomes.

[The Chair, Liberal, Bill Casey]

What causes the foot ulcers?

[Dr. Catharine Whiteside]

The foot ulcer is a biomarker of some of the most problematic complications of diabetes. It includes peripheral vascular disease and neuropathy, which is the effect of diabetes on nerves. It often is associated with poor glucose control, and emphasizes that when you identify someone at risk for a diabetic foot ulcer, you've identified those individuals with diabetes who have the highest risk of all complications.

Again, this is an area where I think evidence and the application of information at the level of point of care would be absolutely critical to address this particular issue.

[The Chair, Liberal, Bill Casey]

Okay. Thanks very much.

Ms. Sidhu, you have five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I consulted last year on healthy eating defeating diabetes. If someone needs that information, they can get it from me.

The point I got is that from Winnipeg to Vancouver, early detection would be beneficial. The cost of medical coverage needs to be standardized across the country, for example, glucose testing strips, lancets, and educational awareness for non-compliance. Then I think we can save hundreds of dollars with less burden on the health care system.

Diabetes 360° is a comprehensive strategy that will cover all these things that are outlined in detail, concrete steps that government can take to address the growing issue of diabetes in Canada.

Diabetes Canada, can you explain how your strategy covers all the local, regional, provincial and other jurisdictions to fit into the national framework?

[Kimberley Hanson]

I think the key guiding principle of the architecture of diabetes 360° is that it's meant to be an overarching strategic framework to improve patient outcomes, which must be implemented in partnership with various levels of government, NGOs and the private sector. It is intended to be implemented in a way that is customized province to province to territory, region by region in some cases, based on the unique needs of those communities.

To Mr. Grewal's points earlier, we might have a different set of priorities in the Region of Peel from what we would have in Yellowknife. That's intended, and will be supported by the national data repository, which will let us know how those various interventions are working in those regions. The national partnership that we're recommending be implemented for seven years in budget 2019 will be specifically designed to work with the provinces and territories, and other actors, to implement the recommendations.

[Sonia Sidhu, Liberal, Brampton South, ON]

As JDRF has suggested, there's a lack of a registry. Sweden has a successful one. Do we address that matter, too, the lack of a registry?

[Kimberley Hanson]

Absolutely. We have a series of recommendations for what we're calling foundational elements, or elements that will support the implementation of all of our diabetes 360° targets. The first among them is a national registry or repository of data about not only who has diabetes and who doesn't have diabetes, but the kind of health care interventions they are getting. Then, ideally, it would include what lab tests they are getting, what lab results, what prescriptions they're filling at the pharmacy. When we can get an integrated perspective of the health care interventions that a patient is receiving, we can much better understand the value of each of them and where Canada can best invest its health care dollars for greatest benefit to the patients.

[Dr. Catharine Whiteside]

May I add, actually, that Diabetes Action Canada has already launched a national diabetes repository. By the end of this calendar year, we will have 100,000 subjects with diabetes in our repository of data. These data are being derived from electronic medical records in primary care from the provinces of Ontario, Alberta, Manitoba, Quebec and Newfoundland. Our intent is to include all of the provinces and territories in Canada by the end of our five-year mandate. These data will be linked to provincial administrative data to do exactly what Ms. Hanson has just described, and that is to be able to understand the extent of diabetes, its complications and what the outcomes are like.

We're starting. It took Sweden about a decade and a half to get to its full registry. With JDRF, we're also launching a type 1 diabetes true registry. This work is already beginning.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

On the education perspective, I know TGH is managing diabetes by apps. Old people are not tech savvy. How can we educate them? Do you have any examples? Can we educate them through YouTube, as an educational element? Is your strategy addressing that kind of population?

[Dr. Catharine Whiteside]

I'd like to mention that there are groups in Canada, particularly the aging, community and health research unit, led by nursing at McMaster University, which are leaders in the world in this area. They're doing a study right now in Ontario, Alberta, Quebec and P.E.I., to address exactly this issue. How do you intervene with seniors who have diabetes and multiple chronic conditions, so that they improve their self-management, are able to navigate the system and literally stay out of acute care and emergency? They will be testing an app, but actually, it's more direct intervention with nurse navigators and nursing.

[Kimberley Hanson]

In that vein, one recommendation that we have in diabetes 360° is to support greater connection between the patient and community-based supports. Right now, as a patient with diabetes, there is nowhere I can go to know where to find a cooking class, or if there is a local support group of people like me with type 1, or how I could maybe connect with a local group that walks, to improve my fitness.

There's no central hub for that kind of information. If we were to create that, we would be able to really easily connect a patient with local support programs that were in their mother tongue, perhaps, that were culturally relevant and specific, and that would help people like seniors, perhaps, who might be less inclined to engage with an app, connect in real life with people in their community, who are often doing this already on a volunteer basis. It increases the patients' ability to manage their disease without increasing the burden on the health care system, just by putting the information all together in one spot. That will be one plan we would implement with diabetes 360°.

[The Chair, Liberal, Bill Casey]

Time is up.

That concludes our meeting. I often say that this committee has the very best witnesses of any committee on the Hill, and you have certainly been the top of the best. You've provided us with a ton of information in a short period of time. I want to thank you all on behalf of the committee.

I want to thank the committee, too, for doing their homework and asking the right questions.

Ms. Sidhu, I believe it was you who pushed for this study, so thank you for that.

I hope we add our voice in a successful and effective way to what you're advocating. You've certainly painted quite a picture for us today.

Again, I want to thank you very much for taking the time to come back to our committee.

The meeting is adjourned.