Framework for Diabetes in Canada

Objectives

The Framework for Diabetes in Canada provides common policy direction for improving access to diabetes prevention and treatment, achieving better health outcomes, reducing the impact of diabetes, identifying gaps, avoiding duplication and supporting progress monitoring and reporting.[1][2][3]It seeks to prevent diabetes where possible, support people living with diabetes and address inequities in risks, access, care and outcomes.[4][5]

• Address health equity by responding to social, economic, environmental, systemic and historical determinants of health, including poverty, racism, colonisation, intergenerational trauma, food security, education, employment, housing and access to services.[6][7][8]
• Apply person-centred approaches that tailor policies, programmes, services and care to the needs, circumstances, dignity and preferences of individuals, families and caregivers.[1][7]
• Differentiate between diabetes types in prevention, care, research, data collection and interventions, recognising that type 2 and gestational diabetes may be prevented or delayed while no known prevention exists for type 1 diabetes.[1][9]
• Advance six interconnected areas: prevention; management, treatment and care; research; surveillance and data collection; learning and knowledge sharing; and access to diabetes devices, medicines and financial supports.[1][7]
• Prevent or delay type 2 and gestational diabetes through healthier environments, risk reduction, public awareness, screening, early detection, validated risk-assessment tools, physical activity, healthy eating and tobacco prevention and cessation.[9][8][4]
• Improve management, treatment and care through early detection, blood-glucose management, self-management support, access to appropriate professionals and therapies, nutritious food, physical activity and prevention or delay of complications.[8]
• Strengthen research spanning prevention, diagnosis, treatment, complications, social determinants, personalised care, technologies and cures for type 1 and type 2 diabetes.[5][10]
• Recognise the distinct rights, interests, circumstances and self-determination of First Nations, Inuit and Métis peoples, using ongoing Indigenous-led engagement and community-led planning.[11][2][12]
• Support innovation, leadership, collaboration and information exchange to develop sustainable solutions and improve diabetes knowledge, prevention, care and access.[13][7]

Implementation

Implementation is envisaged as a sustained, multi-sectoral and collaborative effort in which governments, health systems, communities, civil society, researchers, industry and people with lived experience take complementary action within their respective mandates and local contexts.[1][2][12]The Framework is a common direction rather than a single delivery programme, and provincial and territorial governments were consulted but their endorsement was not sought.[13][1]

• Engage people living with diabetes and their caregivers, populations at elevated risk, Indigenous peoples and organisations, health professionals, researchers, non-governmental organisations, industry and governments in setting priorities and advancing action.[1][14]
• Use engagement mechanisms including key-informant interviews, bilingual dialogue sessions, online feedback, federal-provincial-territorial processes, an External Advisory Group of stakeholders and affected individuals, and an Internal Advisory Group of federal departments.[15][16]
• Continue Indigenous-led engagement to ensure that First Nations, Inuit and Métis perspectives, rights and priorities inform future diabetes supports and self-determined community plans.[11][12][16]
• Coordinate responsibilities across jurisdictions: the federal government supports surveillance, policy, research, regulation, financial supports, Indigenous health services and collaboration, while provinces and territories oversee healthcare delivery, insurance, standards, education, prevention programmes and provider certification.[16]
• Deliver care through multidisciplinary teams, including doctors, nurses, pharmacists, dietitians, diabetes educators and other providers, with links between primary care, specialist care, community services, pharmacies, nursing stations and virtual services.[8][17]
• Expand flexible support options, including virtual care, digital tools, peer support, culturally relevant information and community-led interventions, while addressing digital literacy and unreliable internet access in northern, rural and remote communities.[18][17][19]
• Build provider and community capacity through culturally responsive, anti-racist and stigma-aware training, recruitment and retention, collaborative practice, accessible resources, clinical decision tools and evidence-based guidelines.[18][17][19]
• Scale evidence- and community-based prevention initiatives, including the Canadian Diabetes Prevention Program, and develop flexible, sustainable funding models and learning systems to extend proven or promising interventions.[8]
• Strengthen data collection, linkage, sharing and use through partnerships across federal, provincial, territorial, regional, local and Indigenous jurisdictions, while protecting privacy, addressing fragmentation and improving inclusion of priority populations.[10][20][17]
• Use the Canadian Chronic Disease Surveillance System to produce national estimates and time trends for diabetes and other chronic conditions, and improve surveillance by differentiating diabetes types and incorporating demographic information where possible.[20][17]
• Report on the Framework’s effectiveness and the state of diabetes prevention and treatment through a Minister of Health report to Parliament within five years of the Framework report, including conclusions and recommendations.[1][21][15]

Monitoring & Evaluation

The Framework establishes surveillance and data collection, research, and learning and knowledge sharing as interconnected components intended to identify gaps, reduce duplication, inform policy and service delivery, and enable progress monitoring and reporting.[11][2][7][9][3]Its statutory accountability mechanism requires the Minister of Health to assess the Framework’s effectiveness and the state of diabetes prevention and treatment within five years of the Framework report being tabled, with conclusions and recommendations reported to Parliament.[1][21][15]

• Use the Canadian Chronic Disease Surveillance System, supported by the Public Health Agency of Canada and provincial and territorial administrative data, to produce national estimates and time trends for diabetes and other chronic conditions among people eligible for provincial or territorial health insurance.[20][22]
• Strengthen surveillance to distinguish diabetes types and, where feasible, include demographic information for populations at elevated risk.[17]
• Expand data sharing and linkage across sectors to report on diabetes types, risk factors, complications, comorbidities, management, access to care, treatments, medical devices and related costs.[17]
• Link health data more effectively with social and demographic determinants, including Indigeneity, race, income, age, employment and housing, while protecting privacy and confidentiality, in order to identify inequities and assess progress.[20]
• Improve the timeliness, consistency and inclusiveness of data collection, including nutrition data and information from people with disabilities and racialised communities, using accessible tools and non-stigmatising language.[17]
• Address gaps in progress indicators and sociocultural outcome measures, particularly for marginalised communities, and improve systems for collecting, sharing, analysing and applying data across levels of government.[10]
• Use research and validated risk-assessment tools to strengthen evidence on prevention, diagnosis, therapies, quality improvement, care delivery and health outcomes.[8][10]
• Support health-inequality measurement, monitoring and reporting through the Pan-Canadian Health Inequalities Reporting Initiative, and improve data standardisation and use through the developing Pan-Canadian Health Data Strategy.[23][24]
• Table the initial Framework report before both Houses of Parliament within one year of the Act coming into force, publish it on the Department of Health website within 10 days of tabling, and table the subsequent effectiveness report within the first 15 sitting days after its completion.[21]
• Report to Parliament in 2027 on federal efforts, collaboration with provincial, territorial and local governments and diabetes stakeholders, and the current state of prevention and treatment.[12]

The source does not provide a consolidated national indicator set, quantified performance targets, a detailed evaluation methodology, a routine reporting schedule, or a named operational accountability body beyond the Minister of Health’s statutory reporting duties and the collaborative surveillance arrangements.[10][20][17][12][15]

Costing & Financing

Budget 2021 committed 35 million Canadian dollars over five years beginning in 2021-22 for diabetes-related action, including research, surveillance, prevention and development of a national framework.[14]The Framework otherwise identifies financial supports, sustainable funding needs and rising treatment costs, but does not set out an overall implementation budget, costing methodology, recurrent financing plan, quantified funding gap or economic assumptions.[9][8][19][25]

• Allocate 25 million Canadian dollars for diabetes research, surveillance, prevention and work towards the national Framework.[13][14]
• Provide up to 15 million Canadian dollars through the Canadian Institutes of Health Research and JDRF Canada Partnership to Defeat Diabetes for type 1 diabetes research, matched by JDRF Canada and its donors.[13][14][10]
• Provide 10 million Canadian dollars over five years for the Diabetes Challenge Prize, supporting novel approaches and interventions to prevent or reduce type 2 diabetes risks.[14]
• Recognise the 2017 joint funding of 30 million Canadian dollars for type 1 diabetes research through the Canadian Institutes of Health Research-JDRF Partnership to Defeat Diabetes.[10]
• Develop flexible and sustainable funding models, as programme and service costs may impede participation in prevention activities.[9][8]
• Support access to diabetes devices, medicines and financial assistance, including the Disability Tax Credit, Medical Expense Tax Credit and other income supports for eligible individuals.[7][19]
• Monitor costs of care, treatment and medical devices, recognising that treatment costs have risen with diabetes prevalence and the uptake of newer, higher-cost medicines.[17][25]
• Address limited funding for diabetes research and for translating discoveries into therapies, while pooling resources and networks across sectors where appropriate.[7][10]

Economic pressures include increasing human and societal costs from rising diabetes prevalence, comorbidities and complications, alongside greater demand for health-care and wider economic-system resources.[4][6]Federal, provincial and territorial responsibilities include Indigenous health services, disability-related financial supports, health insurance and healthcare delivery, but no allocation by jurisdiction is specified.[16]