National Framework for Diabetes Bill

Second Reading

June 8, 2021

Hon. Marie-Françoise Mégie

Moved second reading of Bill C-237, An Act to establish a national framework for diabetes.

She said: Honourable senators, I am delighted to sponsor Bill C-237, An Act to establish a national framework for diabetes in Canada.

I would like to briefly review some general concepts, so we all understand what we’re talking about. There are three main types of diabetes. The first is Type 1 diabetes, also called juvenile diabetes. People with this condition cannot produce insulin because their immune system destroys pancreatic cells. The disease accounts for between 5% and 10% of diabetes cases. It often occurs in childhood or adolescence, and more rarely in adulthood.

Type 2 diabetes occurs when the pancreas does not produce enough insulin or the body does not absorb insulin properly, resulting in high blood sugar levels. This type of diabetes usually occurs in adulthood, but it’s becoming increasingly common in teenagers who don’t have healthy lifestyle habits or are obese. I would encourage you to take a look at a major obesity study tabled in the Senate in March 2016 that emphasized its negative health effects. There’s also gestational diabetes, a temporary form of diabetes that occurs during pregnancy because of hormonal changes. Women with gestational diabetes are at greater risk of developing type 2 diabetes later on.

There is also a condition called prediabetes. People with prediabetes have blood sugar levels that are higher than normal but not high enough for them to be diagnosed as diabetic. Nearly half of all people with prediabetes develop type 2 diabetes later in life. Unfortunately, most people are not aware they have this problem.

Now that I have set the scene, let’s talk about research and treatment, which go hand in hand. As you may recall, in my speech last week, I talked about the history of Sir Frederick Banting and Charles Best, who, along with their colleagues James Collip and John Macleod, discovered insulin in a University of Toronto lab in 1921. That discovery revolutionized the treatment of diabetes around the world and remains one of the most famous medical discoveries in Canada’s history.

Dr. Banting sold the rights to his discovery to the University of Toronto so that diabetics around the world could have access to this life-saving medication at an affordable price. On January 11, 1922, the first injections of pancreatic extracts saved the life of a 14-year-old boy who was in a diabetic coma.

The treatment of diabetes has changed considerably over the past 100 years. As Diabetes Québec said, and I quote:

Before the discovery of insulin, diabetics were doomed. Even on a strict diet, they could last no more than three or four years. However, now they can expect to live a long and healthy life.

In the 1950s, the method a person used to control his blood glucose levels was to drop a reagent tablet into a small test tube containing a few drops of urine mixed with water. The resulting colour — from dark blue to orange — indicated the amount of sugar in the urine. I’m sure some of us had to take that little test.

Belgian doctor Jean Pirart, a pioneer in diabetes treatment, discovered the link between good glucose control, sugar in the blood, and the prevention of complications for the first time around 1947.

In 1955, British biochemist Frederick Sanger described the chemical structure of insulin. That made it possible to understand the differences between human insulin and the animal insulin that had been used to treat diabetes up to that point. It was also during that period that the first oral hypoglycemic agents appeared.

The 1970s and 1980s marked a turning point in the treatment of diabetes. Such innovations as blood glucose monitors and blood glucose test strips gave people with diabetes and their doctors tools that would become indispensable.

Many types of insulin and the first oral hypoglycemic agents soon reached the market. Despite all of that, in some cases, managing blood sugar levels was still an imprecise science in those days.

In 1980, with the arrival on the market of insulin pumps and the creation of genetically engineered insulin, intensive insulin therapy — multiple injections mimicking normal pancreatic function — revolutionized the treatment of type 1 diabetes, and has now become an increasingly common treatment for type 2 diabetes.

In 1999, a procedure involving the transplantation of islet cells into people with diabetes was developed in Canada. Dr. Ray Rajotte and Dr. James Shapiro were the first to perform the procedure, which would become known as the Edmonton Protocol for people with diabetes. People who received this transplant would no longer need insulin injections, even after three years.

Diabetes research also contributes to other advances in health. Several retrospective epidemiological studies and experimental studies have shown that metformin, a drug used for diabetes, could have an antitumor effect in certain types of cancer. You can see how this research branched into other areas.

However, the many monitoring and injection devices are still very expensive. Depending on the province or territory they live in, many Canadians with diabetes cannot afford the drugs, devices and supplies they need or do not have access to the appropriate professional resources.

As you can understand, in addition to drugs, interdisciplinary follow-up is needed for patients to self-manage their diabetes. This requires the resources of several health professionals, including doctors, nurses, pharmacists, nutritionists and others.

According to a report produced by the Canadian Federation of Nurses Unions, more than half of all diabetics in Canada, 57% to be exact, do not follow to the letter the treatment they are prescribed because they can’t afford the drugs they need and may not have access to certain resources, depending on where they live. Unfortunately, that is a reality that many First Nations, Inuit and Métis people know all too well.

In fact, the sponsor of this bill at the other place, MP Sonia Sidhu, noted the following, and rightly so:

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. Those living in a first nation community who are in their twenties have an 80% chance of developing the disease during their lifetimes, compared with 50% among the rest of the population of the same age.

Moreover, through my medical practice and my expertise with diabetic foot, I have seen first-hand the health complications of diabetes. If it is not diagnosed early or if blood sugar levels are not managed, diabetes can trigger a series of serious complications. If diabetes is poorly managed for 10 to 15 years, all the organs can be affected: the heart, causing a heart attack; the blood vessels, causing a stroke; the kidneys, requiring dialysis if it reaches an advanced stage; the eyes, leading to blindness; the nervous system, causing neuropathy in the feet that can lead to ulcers and amputation; erectile issues; and I could go on.

More than a dozen people undergo amputation as a result of diabetes complications every day. That is around 5,000 amputations a year.

Diabetes weakens the body and increases the risk of infection, which can sometimes be difficult to treat successfully. That explains why contracting COVID-19 results in more serious symptoms and complications among certain people with diabetes, as well as among seniors and people with other chronic health conditions.

In Canada, nearly one person dies every hour as a result of diabetes-related complications. I am sorry to have listed all these complications, colleagues. I will stop there. I just wanted you to understand the crucial importance of this national framework. As Diabetes Canada points out, treating diabetes currently costs the health care system $30 billion, and those costs will rise to almost $40 billion within eight years unless something is done.

By investing just $150 million, we would save $20 billion and prevent more than 770,000 new cases of diabetes in Canada over seven years.

With all this information, colleagues, I am sure you will agree that this is the right time to study this bill promptly in committee to support the millions of people in Canada who are affected by this disease.

The government could be guided by the Diabetes 360° strategy, a framework developed by and for the diabetes community. This framework was developed in collaboration with 120 stakeholders, with strong support from the Canadian Cancer Society and the Heart and Stroke Foundation of Canada.

This framework has four objectives, which are to ensure that 90% of Canadians live in an environment that preserves wellness and prevents the development of diabetes; 90% of Canadians are aware of their diabetes status; 90% of Canadians living with diabetes are engaged in appropriate interventions to prevent complications; and 90% of Canadians engaged in interventions are achieving improved health outcomes.

We should not be reinventing the wheel. The Diabetes 360o strategy should form the foundation of our national strategy. The latest budget shows that our government understands the urgent need for action, as follows:

Budget 2021 proposes to provide $25 million over five years, starting in 2021-22, to Health Canada for additional investments for research on diabetes (including in juvenile diabetes), surveillance, and prevention, and to work towards the development of a national framework for diabetes. This framework will be developed in consultation with provinces and territories, Indigenous groups, and stakeholders, and will help to support improved access to prevention and treatment, and better health outcomes for Canadians.

Budget 2021 proposes to provide $10 million over five years, starting in 2021-22, to the Public Health Agency of Canada for a new Diabetes Challenge Prize. This initiative will help surface novel approaches to diabetes prevention and promote the development and testing of new interventions to reduce the risks associated with Type 2 diabetes.

In addition to fulfilling these budget promises, this bill will be very useful as it will ensure the development of a national diabetes framework no matter the government in power.

I thank the members in the other place for their unanimous support of this bill. Passing the bill in the Senate would be an excellent way to mark the 100th anniversary of the discovery of insulin in Canada. We should vote in favour of this bill not just for monetary considerations, but also for social, family and human considerations.

After nearly overwhelming you with my list of complications, I will not go into the stories of families with a member dealing with this disease. You have surely heard many such stories from your friends and family.

Diabetes Canada has produced analyses of the impact of diabetes on groups that may be marginalized by medical research. You will find documents on the Diabetes Canada website that explain how diabetes affects seniors, different ethnic groups, including Indigenous peoples, and lower-income earners differently.

The Canadian Indigenous Nurses Association identified several factors as to why this is the case. Geographical isolation, lack of health care services, poor Internet connectivity to facilitate distance care and reduced access to nutritious food all contribute to the prevalence of diabetes in indigenous communities.

I want to get back to basic research, which is essential to finding a cure. In 2003, a team led by Dr. Bhatia, from McMaster University, managed to cure diabetes in a mouse. There is a glimmer of hope at the end of the tunnel.

Honourable senators, I hope I can count on your cooperation to pass this important bill on a terrible disease that affects millions of Canadians before we adjourn for the summer.

I know that some of you want to speak on this issue. However, if I may, I would truly appreciate it if you agreed to wait until third reading to do so.

Esteemed colleagues from all groups in the Senate, I have one request for you. I hope we can all decide together, today, to pass this important bill at second reading and send it to the Standing Committee on Social Affairs, Science and Technology. In doing so, we would help save lives and protect our health care system and our society from a heavy financial and human burden. Thank you.

Hon. Yonah Martin (Deputy Leader of the Opposition)

Honourable senators, I, too, wanted to just call for the question after Senator Mégie’s very compelling speech, but I have some brief remarks. I would like to put this on record, and then I would be prepared to call the question if the chamber is ready. I see lots of nodding heads. That’s a very good sign.

Honourable senators, I rise today to speak to Bill C-237, An Act to establish a national framework for diabetes. This bill requires that the Minister of Health act in consultation with the representatives of the provincial governments, with Indigenous groups and with other relevant stakeholders, to develop a national framework to support improved access to diabetes prevention and treatment. The ultimate objective is to ensure better health outcomes for all Canadians. This is a very noble and important objective. The preamble to the bill explains this well.

One in four Canadians lives with prediabetes or diabetes. We know from research that both diabetes awareness and education can help identify early signs of diabetes and thus prevent or delay its onset.

This is so important, and it really illustrates the importance of awareness and education when it comes to this disease. The bill before us requires the Minister of Health to develop a national framework that will specifically include several components. They were very clearly explained by Senator Mégie, so I will not repeat some of those important items. All of these components are spelled out in the legislation as well, of course.

The last provision in the bill, that of ensuring that Canada Revenue Agency is administering the disability tax credit in a manner that helps as many people with diabetes as possible, was actually a provision added to the bill during the committee discussions in the other place. I believe this amendment certainly improves the bill.

Colleagues, we know that coordination among different orders of government is critically important in tackling key health challenges. As we all know, the delivery of health care is a provincial responsibility, though the federal government assists by playing a coordinating role in national efforts. That is precisely what this bill aims to strengthen in relation to diabetes.

The pandemic through which we are currently living has probably reinforced for all of us the importance of ensuring effective, national coordination when we face overarching problems that affect us all. This is no less the case when it comes to challenging illnesses such as diabetes.

Honourable senators, you will not be surprised when I tell you that this bill received strong support, as mentioned by Senator Mégie, in the other place. In that respect, it is truly a cross-party effort. The sponsor of the bill is Member of Parliament Sonia Sidhu. Speaking to her bill at second reading, Ms. Sidhu stated that, when she was first elected in 2015, it was her goal to bring the issues of Canadians living with diabetes to our Parliament and to elevate the issue on a national agenda. She has served as chair of the All Party Diabetes Caucus and, since 2017, has travelled extensively to consult with medical professionals and stakeholders about how best to meet the needs of those suffering from diabetes.

I was quite taken by Ms. Sidhu’s second reading statement as she spoke about her family. The quote read:

In my family, there are 35 diabetics and we don’t talk about it. I have to do my blood sugar under the table when I visit my mother. We don’t discuss it, and they don’t treat.

Last year, I lost my uncle to it because they just won’t treat. They won’t admit to it. They don’t want to deal with it because the stigma is so bad.

On a personal level, I can relate in terms of being diagnosed with prediabetes or diabetes itself. I actually was in that category. For two and a half years, I had to undergo various tests. I can assure the chamber and I can confirm what Senator Mégie was saying is true. It can be quite a daunting task when you have to really navigate your way through a complex system and specialists who do not always necessarily fully communicate. Getting treatment, which isn’t one-size-fits-all, can be very challenging. I have gone through that.

There is a stigma or a label. I know for myself, when I was going through airport security, sometimes I would just say, “I’m a diabetic,” and I’d have all this food in my bag. They would just say, “Oh, yes, yes. Go ahead.” I was treated as if I had to be given special consideration because of my illness. It felt like this label and, in essence, the stigma that we’re used to when someone is living with diabetes.

“I’m a diabetic” versus “I’m living with diabetes” or “I’m working on my health.” These are different ways to speak about it. However, as Ms. Sidhu mentioned, in her family they didn’t talk about it. I think many families may be in the same position.

I want to say I admire her dedication to a cause that we hope will ultimately help improve the lives of so many Canadians. As she pointed out, a new case of diabetes is diagnosed every three minutes and 90% of these cases are Type 2, which means they can be prevented through better awareness, education and lifestyle changes. If this bill and the framework it establishes can help in that effort, it will have been well worth it.

I’m living proof that you can improve your eating habits, stay active and be conscious, aware and educated in order to take charge of your health. For that reason, this is a personal bill for me as well. I want to applaud MP Sidhu and, of course, the work of Senator Mégie. I know we are all in agreement that we want to help as many Canadians as possible.

I also want to reference what Member of Parliament Chris d’Entremont said about this bill in the other place. He was the Conservative critic on this bill. Mr. d’Entremont mentioned his own son was diagnosed with Type 1 diabetes at the age of 17. He spoke about how his family, like so many Canadian families, had to adapt to the disease together with their family member. The family became involved in many organizations that support patients with diabetes. They came to recognize some of the problems that remain to be addressed, particularly around the coordination and pooling of resources.

A 2013 report from the Auditor General specifically referenced these coordination challenges. One of the gaps we know exists is the absence of a true national strategy. When she testified to the bill at the House of Commons Standing Committee on Health, Ms. Kimberley Hanson, Executive Director of Federal Affairs at Diabetes Canada, referenced the key role that Bill C-237 might play in building on work that Diabetes Canada and its partner organizations have already undertaken. She said:

Bill C-237 will improve diabetes prevention and treatment, promote essential diabetes research, improve data collection and address health inequalities. . . .

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.

Honourable senators, important progress has been made over many years, making life better for people who have diabetes, but what we need to continue to strive for is a cure. Ms. Juliette Benoît, a 17-year-old diagnosed with diabetes when she was 11, told the House of Commons Standing Committee on Health that successful research work has enabled her to have an insulin pump that permits her to administer insulin without injection and provides a continuous blood glucose reader, allowing her to know her sugar levels faster and, again, without injections. She noted, however, this is not a cure. She said this was part of the reason that Bill C-237 was so important to her personally. Through the framework it fosters, it will promote the conditions that will lead us to the cure everyone is hoping for.

Honourable colleagues, as many of you know, Bill C-237 is particularly symbolic this year: 2021 marks the one-hundredth anniversary of the discovery of insulin by Canadian researcher Sir Frederick Banting. I note Dr. Charles Best also played a significant role. In fact, the last school in which I taught was Banting Middle School and Dr. Charles Best Secondary School was just down the road. It seems quite fitting, does it not, standing here today as someone diagnosed with prediabetes, to be able to take control of my health and stand in support of a national framework?

The discovery of insulin was what earned Sir Frederick Banting and his fellow researcher John Macleod a Nobel Prize for Medicine, as well as a knighthood. That discovery has been a life-saving one for millions of people through the generations. That should inspire us to continue to strive, in our own small ways, to build on the work of Sir Frederick Banting.

I’m pleased to lend my support as the friendly critic of this bill. I want to thank Ms. Sidhu for the work she has undertaken on behalf of so many people who are impacted by this disease and acknowledge the passionate work of the bill’s sponsor in the Senate, our colleague the Honourable Dr. Marie-Francoise Mégie.

I believe that we should adopt this bill at second reading today, refer it to committee for further study this week and ask the committee to report back to the chamber so we can take one final step and complete the legislative process to enact Bill C-237 into law. Perhaps, in doing so, we will make a small contribution to one day eradicating this disease once and for all. Thank you.

The Hon. the Speaker pro tempore

Is it your pleasure, honourable senators, to adopt the motion?

Hon. Senators: Agreed.

(Motion agreed to and bill read second time.)