Framework for Diabetes in Canada

Objectives

The National Framework for Diabetes provides a common policy direction to reduce the impact of diabetes in Canada, improve access to prevention and treatment, support better health outcomes, identify gaps, avoid duplication and enable progress reporting.[1][2]It seeks coordinated action on diabetes prevention, management, treatment and care while recognising the distinct needs associated with different types of diabetes.[3][4]

• 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.[3][5]
• Prevent or delay type 2 and gestational diabetes where possible, strengthen early detection, reduce complications and avoid applying prevention objectives indiscriminately to type 1 diabetes.[4][6]
• Address health inequities and the social, economic and environmental determinants of health, including systemic racism, colonisation, intergenerational trauma and socioeconomic conditions affecting populations facing marginalisation.[7][8][6]
• Apply person-centred, compassionate and culturally appropriate care that reflects the experiences, knowledge, physical, social, emotional, mental, spiritual and cultural wellbeing of people living with diabetes and their caregivers.[3][6][9]
• Support populations at elevated risk, people living with diabetes and caregivers, Indigenous Peoples, health professionals, researchers, non-governmental organisations and governments.[3]
• Strengthen diabetes prevention through healthier community and school environments, physical activity, healthy eating, tobacco prevention and cessation, awareness of risk factors, and validated diabetes-risk assessment tools.[10][6]
• Expand equitable access to diabetes medicines, devices, services, education, self-management support and financial assistance, including accessible supports for people with disabilities.[11][12]
• Advance biomedical, clinical, health-services, policy and population-health research, including research on earlier diagnosis, comorbidities, social determinants, longer-term living with diabetes and priority populations.[9][13]
• Develop comprehensive and equitable surveillance that differentiates diabetes types and reports on risk factors, complications, comorbidities, management, access to care and treatment costs.[14]

Implementation

Implementation relies on sustained, multisectoral and complementary action by governments, health and non-health sectors, communities, civil society, industry, researchers, health professionals, people living with diabetes and caregivers.[3][15][16]Activities are intended to be adapted to organisational mandates, community priorities and local contexts rather than delivered through a single centralised service model.[3][12]

• Coordinate federal engagement with provinces and territories through existing mechanisms, including the Federal, Provincial and Territorial Group on Nutrition, the Federal, Provincial and Territorial Sport, Physical Activity and Recreation mechanism, and the Federal, Provincial and Territorial Health Support Committee.[17]
• Distribute delivery responsibilities across jurisdictions: support national surveillance, regulation, research, policy and guideline development, Indigenous health services and collaboration federally; deliver healthcare, insurance, standards, education, prevention programmes and data collection provincially and territorially; and enable Indigenous organisations and civil society to support policies, services, advocacy, education and community interventions.[15]
• Engage people with lived experience, caregivers, populations at elevated risk, Indigenous groups, non-governmental organisations, health professionals, researchers and governments through consultations, interviews, dialogue sessions and online feedback.[7][18][19]
• Undertake Indigenous-led engagement with First Nations, Inuit and Métis Peoples, communities and organisations, recognising diverse circumstances, reconciliation, self-determination and community-led plans to address diabetes.[1][12][15]
• Deliver coordinated, multidisciplinary care through doctors, nurses, pharmacists, dietitians, diabetes educators, specialists and other providers, alongside nutritious food, physical activity opportunities, therapies and self-management support.[6]
• Expand virtual care, peer support, community-based services and culturally safe, anti-racist and stigma-informed training, particularly to improve access in rural, remote and underserved communities.[9]
• Scale evidence- and community-based interventions for populations at higher risk, including approaches building on the Canadian Diabetes Prevention Programme.[6]
• Strengthen research translation, knowledge exchange and data use across jurisdictions, including through collaboration among researchers, practitioners, industry, policy-makers and people with lived experience.[13][20]
• Coordinate surveillance through the Canadian Chronic Disease Surveillance System, a network of provincial and territorial systems supported by the Public Health Agency of Canada, and improve health-data collection, access, sharing and use through the Pan-Canadian Health Data Strategy.[20]
• Improve access to medicines, devices and financial supports through coordinated roles for governments, insurers, pharmaceutical companies, manufacturers, health professionals and researchers; Health Canada regulates the safety and effectiveness of relevant treatments and technologies.[11]
• Use provincial and territorial drug plans and diabetes-supplies programmes, private insurance, the Non-Insured Health Benefits Programme for eligible registered First Nations and recognised Inuit, and federal tax and income-support measures, while addressing affordability, transport, language, internet-access, discrimination and coverage barriers.[11][21]
• Report to Parliament within five years on the Framework’s effectiveness and the state of diabetes prevention and treatment, including conclusions and recommendations; the Minister of Health must table and publish the report in accordance with statutory requirements.[3][22][19]

Monitoring & Evaluation

The Framework establishes surveillance and data collection, learning and knowledge sharing, and information exchange as core elements of a national diabetes response, intended to identify gaps, avoid duplication, support evidence-informed action, and monitor progress.[1][5][4][2]Statutory accountability centres on a Minister of Health report to Parliament assessing the Framework’s effectiveness and the state of diabetes prevention and treatment within five years of the Framework report being tabled.[3][22][19]

• Use the Canadian Chronic Disease Surveillance System, supported by the Public Health Agency of Canada and provincial and territorial systems, to generate national estimates and trends for chronic diseases including diabetes.[20][23]
• Collect, analyse, interpret and disseminate population data in a timely manner to plan and evaluate policies, programmes, clinical services, education and research.[20]
• Develop more comprehensive and equitable diabetes surveillance that differentiates diabetes types and records risk factors, complications, comorbidities, management and priority populations.[14]
• Improve diabetes data by linking it, where appropriate and privacy-protecting, with sociodemographic determinants including Indigeneity, race, income, age, employment and housing.[20]
• Monitor access to care, treatments, medical devices and diabetes-related costs alongside clinical and population-health indicators.[14]
• Address national data gaps and strengthen systems to collect, share, access, analyse and apply data across federal, provincial, territorial, municipal and community settings.[6][13][20]
• Evaluate interventions, diagnostic tools, devices, quality-improvement initiatives and personalised treatment approaches through research and innovation.[13]
• Develop appropriate sociocultural outcome measures for marginalised communities and address gaps in diabetes research indicators.[13]
• Use validated diabetes-risk tools and early-detection measures, while scaling proven or promising interventions through a learning-system approach.[6]
• Table the statutory assessment report before both Houses of Parliament within the prescribed sitting-day period and publish it on the Health Canada website within 10 days of tabling.[22][19]

The supplied material does not set quantitative national targets, a consolidated indicator framework, routine reporting timetable beyond statutory parliamentary reporting, detailed evaluation methodology, independent evaluator, or a named formal accountability body.[3][20][14][24][25][22]

Costing & Financing

Financing combines announced federal investments in diabetes research, surveillance, prevention and innovation with existing public, private and tax-based supports for medicines, devices and disability-related costs.[17][18][11][21]Budget 2021 committed 35 million Canadian dollars over five years from 2021–22 for diabetes-related action, although the supplied text does not provide a complete costed implementation plan or long-term financing model for the Framework.[18]

• Allocate 25 million Canadian dollars to diabetes research, surveillance, prevention and work towards a national diabetes framework.[17][18]
• Commit up to 15 million Canadian dollars through the Canadian Institutes of Health Research to the JDRF Canada and Canadian Institutes of Health Research Partnership to Defeat Diabetes for type 1 diabetes research, with matching support from JDRF Canada and its donors.[18]
• Provide 10 million Canadian dollars over five years for the Diabetes Challenge Prize to develop and test novel approaches to diabetes prevention.[17][18]
• Recognise the 2017 Canadian Institutes of Health Research and JDRF Canada partnership, which jointly funded 30 million Canadian dollars for type 1 diabetes research.[13]
• Support prevention through the Healthy Canadians and Communities Fund-funded Canadian Diabetes Prevention Program, a 12-month lifestyle intervention, although no funding amount is specified.[6]
• Develop flexible and sustainable funding models for prevention and intervention programmes, research, data improvement and learning-system activities.[6]
• Use provincial and territorial drug plans and diabetes-supplies programmes, private insurance, the Non-Insured Health Benefits Programme, the Disability Tax Credit and the Medical Expense Tax Credit to support affordability, while recognising that eligibility and coverage vary by jurisdiction.[11][21]
• Address rising treatment costs associated with newer, higher-cost medicines and the out-of-pocket costs that may remain where coverage is incomplete.[21]

Funding for diabetes research and translation of discoveries into therapies is described as limited, and people with disabilities may need additional assistance for underfunded or unfunded supports.[13][12]The supplied text does not specify total Framework costs, a full budget, resource requirements, financing targets, quantified funding gaps, the value of matching contributions, or economic assumptions.[1][13][19][15]