Health Committee on March 26th, 2021

[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.

[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]

Thank you, Ms. Sidhu.

We will now hear from Diabetes Canada.

Ms. Hanson, go ahead with your statement. You have six minutes, please.

[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.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We will go now to JDRF Canada.

Please go ahead with your statement for six minutes.

[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.

[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]

Thank you, Juliette, for sharing your personal and powerful story.

As Juliette has made clear, diabetes is a relentless, 24 hours a day, seven days a week, 365 days a year disease. Passing this bill will create a framework for a national diabetes strategy leading to tangible interventions with real health outcomes. It will mean easier, healthier and safer lives for Canadians living with diabetes, like Juliette. I can't think of a better way to honour Banting and Best's legacy.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, all.

We will go now to questions. We will start with Mr. d'Entremont, please, for six minutes.

Go ahead.

[Chris d'Entremont, Conservative, West Nova, NS]

Thank you very much, Mr. Chair.

I would like to begin by thanking Juliette for appearing before us today.

I could never have imagined being 17 years old and making a presentation before a committee like this. Even at 51, I often find it difficult. So I thank her for her testimony and wish her a happy birthday.

My son was diagnosed with type 1 diabetes five years ago now. So he's in a similar situation to hers, except that he was 17 at the time.

[The Chair, Liberal, Ron McKinnon]

Pardon me, Mr. d'Entremont.

I think the interpreters are having a hard time hearing you. Maybe you can raise your mike a bit, please.

[Chris d'Entremont, Conservative, West Nova, NS]

Sorry about that.

I'm going to say thank you to Sonia for bringing this bill forward. I am a parent of a type 1, as I was saying to Juliette, and my son was diagnosed five years ago. You should get a pin—a five-year pin, a 10-year pin. Kim's agreeing with me here. It is difficult.

Juliette brought up something very important here. Not only are we continually, as parents or as patients, trying to find ways to manage the disease, but in the back of our heads we have to find that way to work towards the cure. That's why I think it's a great balance today to have Diabetes Canada here and also JDRF. It does talk about the research component with it.

Again, here we are talking about diabetes, something that is very close to my heart.

My question to Sonia, though, is, as this bill comes forward, it talks about lots of great ideas and that we should work together, we should have a national framework for this, but who's going to enact it? Once MP Sidhu is finished with this, and it passes in the House of Commons, who is supposed to enact the bill or what the bill is asking for?

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. d'Entremont. I was listening to your speech in the House when you were, as a parent, explaining André's situation. I would agree with you. In my 18 years as a health expert, I saw many parents like that.

Who is it addressed to? All demographics. I would expect the federal government would take a role in coordinating that data collection and promotion of information to encourage prevention, and providing funding to research that will lead to a cure, and ensuring an affordable and reliable supply of treatment and devices.

I would expect that a framework would include clear directions on which department and levels of government would be responsible for implementing the various aspects of it, through education and promoting awareness of what it does, even delayed onset diabetes. I'm talking about type 1. It will prevent type 2 risk factors of obesity and many others.

[Chris d'Entremont, Conservative, West Nova, NS]

Thank you very much for that.

This is the confusing part. I'll probably go to Ms. Hanson in a few moments on this one. The challenge we have is that this is a federal government bill that talks about a national or federal framework, but we have provinces that are responsible for health care in Canada. They're taking care of their populations. Diabetes 360° ° has been around for awhile.

Maybe, Kim, you can give us an idea of how long Diabetes Canada has been talking about diabetes 360°, and what kind of uptake you have at this point beyond Ms. Sidhu's bill?

[Kimberley Hanson]

Thanks so much, MP d'Entremont. Those are excellent questions.

We developed diabetes 360° beginning in September of 2017. We are really pleased to see that the discussion carries on today. We would love to be able to cap that off with a formal commitment to a national diabetes framework, such as this bill proposes.

As I believe you are aware, we have strong support at the federal level, thanks to this committee. The finance committee has also recommended the strategy three times in a row. Importantly, we have really strong engagement from the provinces and territories. In November of 2020, Diabetes Canada convened a second round table that had representatives from every provincial and territorial government, as well as the federal government, in attendance.

The strong consensus from provinces and territories was that they are committed to working as much as they're able towards implementing provincial or territorial diabetes strategies, but they see the need for a coordinated approach, for a common framework and language, and for a way of sharing best practices. They would look to the federal government to provide that as soon as possible.

In response to the question you just asked MP Sidhu, I would agree with what she said. When this bill passes and receives royal assent, I would encourage the government to give strong consideration to implementing a multisectoral and multi-level government advisory committee or governance structure that features representatives of the provincial governments who—you're absolutely right—are going to have to implement the treatment-based approaches involved in this framework, and also patient groups.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. d'Entremont.

We go now to Mr. Van Bynen, please. Go ahead for six minutes.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

I want to start by saying congratulations to my colleague, Ms. Sidhu, for the unanimous passing of her private member's bill. Sonia has been a strong advocate for Canadians with diabetes and this bill is key to supporting and improving access to prevention and treatment for Canadians.

I was proud to jointly second this PMB, and am looking forward to seeing the framework come to fruition and learning more about the work involved today.

Ms. Sidhu, your part of the PMB states the government must work with the provinces and the territories, indigenous organizations and key stakeholders to strengthen efforts. Can you tell the committee whether this work has begun and what it entails?

[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.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you. That's a good transition.

Ms. Hanson, when HESA was studying the diabetes strategy for Canada in 2019, you appeared as a witness on behalf of Diabetes Canada. As part of this study, the report outlined a number of recommendations from the government. Can you tell us if any of the recommendations you have made have helped shape this private member's bill, and how?

[Kimberley Hanson]

I like to think that the study the committee conducted has informed this private member's bill in a number of respects, MP Van Bynen. The study overall affirmed that we have a problem and that we need to do something much more coordinated in order to address it.

I see in this bill the comprehensive and holistic approach to addressing the problem that is proposed in diabetes 360°, the focus not only on prevention but also on treatments specific to diabetes.

I see the focus on measurement, which is critical—unless and until we can better quantify the burden of diabetes in Canada, we will continue to fail to reduce it—and also the strong emphasis on addressing health inequalities, which we know exacerbate the burden not only of COVID-19 but also of diabetes.

When I read MP Sidhu's draft bill, I was very heartened to see how much it is in alignment with diabetes 360°. I think the passage of this bill into law will strongly advance our requests for a nation-wide diabetes strategy.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

Mr. Prowten, you also appeared as a witness back then, on behalf of JDRF Canada. I'd like to ask you the same question, please.

[Dave Prowten]

I don't want to repeat what Kim said, but I think what we recognize is that the need for good data is critical to turning the ship around. This is the way I would look at it.

A simple example is that if we don't know who has type 1 and type 2—and some of our provincial and territorial health records don't actually distinguish—if you don't have that base-level information, it's then very hard to make decisions to reshape the system.

Those sorts of fundamental pieces of information are critical to the way we can enact a program going forward. Information leads to better decisions at the provincial and territorial level. That's why I think there's probably an overlap between what the federal role can be and that of the provincial and territorial level.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you.

Since the start of the pandemic, we've heard about the importance of data sharing in the medical field. More specifically, we heard that there's a need for greater Canadian data sharing, something you've alluded to. While we've mostly heard it in the context of COVID-19, I'm wondering whether you, Mr. Prowten, or Ms. Hanson could share with us whether this is needed in diabetes as well.

If so, how would a pan-Canadian mechanism for data sharing benefit the efforts to prevent and manage the disease across the country?

[Kimberley Hanson]

Maybe I can start quickly, and Dave, I know you'll want to talk about the registry.

Today in Canada, we can't tell you how many of the number of people who we know have a diagnosis of diabetes have type 1 versus how many have type 2. That's very basic and fundamental to understanding different treatment pathways and drug pricing and usage.

Unless and until we can create some kind of national data repository that allows us to amalgamate and understand data that shows us the picture of diabetes in this country, then really, we're throwing spaghetti up on a wall and hoping it's going to stick, where developing treatment protocols is concerned.

Obviously, provinces need to have jurisdiction over the health care system within their regions, and we completely support that. The federal government, however, could play a critical role in compiling data that would help us better understand the picture of diabetes at a national level and that would help provinces and territories better put into context their own perspectives. We think that data is a critical underpinning of this strategy.

Dave, did you want to add?

[Dave Prowten]

I was just going to make one point. I think we have a very unique opportunity with diabetes, because there are devices such as continuous glucose monitors and pumps that can feed data to the clinician.

We've talked a lot about virtual care during COVID. That's one big opportunity, but also, that data could then be amalgamated. You could actually start using data that has been generated from patients literally every five minutes.

I think there's a really significant opportunity in the case of this disease to compile this data and make really important decisions.