Kimberley Rickard was tired, allthe time. It was hard just towalkacross the parking lot to her of-

fice in Fredericton, New Brunswick. “Iwas doing less and less, and I didn’trealize how much the extra weightwas slowing me down.”In November of last year, she read

an article in a local paper about AlisonToron, a health coach with Live Well!Bien Vivre!, a free wellness programoffered by the Canadian Diabetes As-sociation (CDA) in partnershipwith theMedavie Health Foundation and theGovernment of New Brunswick. Ms.Toron recommended the two-minuteCANRISK type 2 diabetes risk assess-ment. After taking the test, Ms. Rickardlearned that shewasn’t just tired – shewas at high risk of developing type2 diabetes. “My mother has it, andshe has not had a good quality oflife. I could see I wasn’t going to beany good to help her as she ages if Ididn’t take care of myself.”One-on-one coaching sessions with

Ms. Toron helped her put an effectiveplan in place and overcome someingrained “all-or-nothing, black-and-white thinking” that had previouslyheld her back, says Ms. Rickard. “Itwas never negative – just positiveand encouraging.”Down more than 63 pounds, she

says she feels fantastic and “can’tstop smiling.” In addition to loweringher risk of type 2 diabetes from highto medium (her goal is to reduce it tolow) she says her new lifestyle hasalso increased her self-esteem and

confidence. “I put myself and what’sgood for me first now.”John Farrell of Ottawa has similar

health priorities these days. When his21-year-old son Ryan was diagnosedwith type 1 diabetes eight years ago,John made it his mission to learn ev-erything he could about the disease.But until a fewmonths later, when hehad a checkup and learned he hadprediabetes, John was unaware hewas also at risk.He had been athletic in high school,

but as a bankmanager, he spent longhours at his desk. “I’d just becomesedentary,” he says. “I had somebad habits.”After his diagnosis, John changed

his diet, using the knowledge he’dgained doing research on Ryan’sbehalf, and made exercise a priority.“Walking led to jogging, jogging ledto running. Each step became easier asmy body became more conditioned.I dropped 50-some pounds withinabout eight months,” he reports.Together, John and Ryan began

running in 5K and 10K events, andthen in half-marathons. They joinedTeam Diabetes, the CDA’s nationalactivity-based fundraising program,in 2012 and have collected more than$10,000 in donations from friends andco-workers, some of which has beenmatched by John’s employer.“Ryan and I have participated in

more than 10 half-marathons together,and he wasmy coach for my first twomarathons,” says John. Along theway, he adds, “Team Diabetes has

been there with support, informationand on-course encouragement.”Before his diagnosis, “I couldn’t run

across the street without wheezing. Ican now run 42.2 kilometres.” Evenmore importantly, John’s blood glu-cose (sugar) is now at normal levels.The number of people living with

diabetes in Canada has doubled in thelast 12 years. That growth rate contin-ues as another Canadian is diagnosedevery threeminutes. “Today, there arean estimated 10.7 million Canadiansliving with diabetes or prediabetes,”says Rick Blickstead, president andCEO of the CDA.But with awareness, it is possible to

create a different future, he stresses.“It is critical that people know that,

with early diagnosis, they can takeaction to stay healthy.“It is a 24/7 disease that takes a lot

of self-management. Its complicationsaccount for 30 per cent of strokes,40 per cent of heart attacks, 50 percent of kidney dialysis, 70 per centof non-traumatic amputations andit is a leading cause of blindness.It’s so important to avoid getting itif you can.”By investing two minutes in the

type 2 diabetes risk test, and seeing adoctor if you’re at risk, “you’re takingcontrol of your life,” says Mr. Blick-stead. “It may be through exercise,it may be through diet – for somepeople it’s through medication. Butthe first step to building a healthierlife is to take the test.”More than 63,000 people have

already taken the risk assessment attake2minutes.ca so far this fall, and theorganization has challenged its Twitterfollowers@DiabetesAssoc to take thetest and pass it along by tagging twoof their friends to see who can makethe longest chain.“It’s about one person helping

another person, or two people, whocan help someone else, to create amassive explosion of opportunity,”says Mr. Blickstead.

This content was produced by RandallAnthony Communications, in partnershipwith The Globe and Mail’s advertising

department. The Globe’s editorial depart-ment was not involved in its creation.

DIABETESTAKING IT ON TOGETHER

THE GLOBE AND MAIL MONDAY , NOVEMBER 2 , 2015 SECTION CDA

SPONSOR CONTENT

Canada’s top SuperWelterweight Championmanages type 1 diabetesthrough healthy choices.CDA 2

Research programscontinue to advancetreatment options. CDA 4

Clothesline funds research,education and outreachprograms. CDA 6

INSIDE

Online? Visit globeandmail.com/adv/diabetes2015

Are you at risk for diabetes?If you know, you have the power to change your future

of Canadians are currently living with diabetes or prediabetes.This will rise to 33% by 2025 if current trends continue.

deaths in Canadian adultsis attributable to diabetes.At least29% 1 in 10

diabetes.ca | 1-800-BANTING

KNOW YOUR RISK

TAKE 2 MINUTES FOR TYPE 2DIABETES

If you are over the age of 40, theCanadian Diabetes Association(CDA) recommends that you gettested for type 2 diabetes everythree years, and more frequently ifyou have any of these risk factors:

• A parent or sibling with diabetes

• Are a member of an ethnicgroup at high risk for type 2 dia-betes (African, Hispanic, Asian,South Asian and Aboriginal)

• Are overweight

• Have high blood pressure orhigh cholesterol

• Have been diagnosed withprediabetes

• Have polycystic ovary syndrome

Don’t ignore these risk factors.Take two minutes to take the testand know your risk today.

If you already have type 2 diabetes,your children and siblings are atrisk. Encourage your family andfriends to take the test and takecharge of their health.

Visit take2minutes.ca

The Canadian Diabetes Association (CDA) is the registered national charity that helps the more than 10 million Canadians with diabetes orprediabetes live healthy lives, and educates those at risk. Join the CDA in the fight against diabetes! Donate now at diabetes.ca/donate.

Every 3 minutes another Canadian is diagnosed with diabetes

DIABETES HAS REACHED EPIDEMIC PROPORTIONS IN CANADA.

CDA 2 • SPONSOR CONTENT THE GLOBE AND MAIL • MONDAY , NOVEMBER 2 , 2015

DIABETES: TAKING IT ON TOGETHER

Exercise and a balanced life key to long-term health

Living a healthy and normal lifeafter being diagnosed with dia-betes is possible, and Canadians

across the country are proving it everyday. However, it isn’t always easy.In 2003, Arlene Kramble-Krasnesky,now 51, was a full-time police officerwith the Winnipeg Police Service,and a just-as-full-timemother of four,including a newborn. When she wasfirst diagnosed with type 2 diabetes,she didn’t even take her foot off theaccelerator. “I guess I was kind of indenial,” she says now, looking back.“I didn’t feel like I had the time to dealwith it properly.”

A day of reckoning was inevitable,and she hit the wall in 2012 when herdoctorwas forced to takeheroff amedi-cation that had delayed the need forlifestyle changes. “Over a three-monthtime frame, I just crashed. I couldn’tfunction on any level. I couldn’t work,and I couldn’t even get from the bedto the bathroom.”

Salvation came in the formof insulinand a referral to a certified diabeteseducator named Sandy Koropas. “Shehelped me make wholesale lifestylechanges; she was the catalyst forchange. The insulin stabilized me,but Sandy met me ‘where I was’,case-managing me as an individualand gettingme intoworkshops about

diabetes research and nutrition, aswellas support groups.” Ms. Kramble-Kras-nesky is now eating well and gettingthe exercise she needs to maintain ahealthy bodyweight. She’s also takinga master’s degree in family therapy.

Kevin Higson of Hamilton, Ontario,used his diagnosis of type 1 diabetes atthe ageof 16 as the catalyst for realizinghis greatest ambitions. He’d grownup with sports, but drifted away fromthem in high school, where he admitshe partied hard and got into smokingand drinking. Then he got sick, reallysick. “I was scared,” he says.

The diabetes diagnosis he receivedwas a wake-up call he heeded withenthusiasm. “I don’t know, I just tookto it,” he says. “I knew how to eatfrom my mom, and I was really goodat checking my blood sugar levels.”He also started going to the gym andtraining to be a boxer. Today, at 26, heis the Canadian Super WelterweightChampion. “People think diabetes isa setback, but if you take the rightprecautions and eat right you can livea normal life,” he says. Or even anextraordinary one.

People like Ms. Kramble-Krasneskyand Mr. Higson are proof, says certi-fied diabetes educator Lori Berard ofWinnipeg, that in managing diabetes,the cornerstone is a healthy lifestyle,

including eating a healthy diet andkeeping physically active.

“These are things you can do everysingle day that will help you achievethe glucose [sugar] levels you are aim-ing for.” The good news is that havingdiabetes does not mean you haveto give up foods you enjoy or sugarentirely. “There is nothing you cannoteat; you just have tomaintain the rightbalance,” says Ms. Berard.

Exercise is a key component, espe-cially for those diagnosed with type 2diabetes where being overweight isoften anaggravating factor. It isn’t aboutstarting up a regimen of gut-bustingexercises, she says, just gettingmovingand starting with small steps.

Getting up fromyour desk andwalk-ing around the office, going for walksin themall and taking up swimming aresome simple activities that will lead tobetter diabetes management. And notonly does maintaining a healthy dietandgettingexercisehelpbettermanagediabetes, it helps reduce overall stresslevels and the risk of complications.

“Wehavemedications that aremagi-cal, we have strategies to achieve glu-cose [sugar] control, but what is goingto make you feel better every day andreduce the risk of complications is ahealthy diet and getting some physicalactivity,” says Ms. Berard.

Above left, Arlene Kramble-Krasnesky (left) credits the support of her diabetes educator, Sandy Koropas (right) in helping her make important lifestylechanges. Above right, Canada’s Super Welterweight Champion Kevin Higson hasn’t let type 1 diabetes prevent him from reaching his goals. SUPPLIED

KNOW YOUR RISK

A HEAD-TO-TOE LOOKAT DIABETES-RELATEDCOMPLICATIONS

HEART DISEASE AND STROKEOver time, high blood sugar levelscan damage blood vessels andincrease your risk of heart diseaseand stroke. Have your blood sugar,cholesterol and blood pressurechecked regularly.

NERVE DAMAGEAn inability to noticeminor injuriesto your toes and feet can lead toserious infections and amputation.Get tested with an easy and pain-less examination by your doctor.

KIDNEY DISEASEHave your kidneys checked tomake sure they are filtering bloodproperly. Without treatment, dam-aged kidneys will eventually fail,and dialysis or a kidney transplantwill be needed.

EYE DAMAGEDiabetes can cause vision problemsranging from blurriness to blind-ness. Good blood sugar controlis your best prevention. Visit youroptometrist regularly.

ANXIETY AND DEPRESSIONBoth are more common in peo-ple with diabetes and can impactblood sugar management. Signsand symptoms can vary, so getscreened regularly.

For more information, visitdiabetes.ca/complications.

HEALTHY LIVING

“We have medicationsthat are magical, we havestrategies to achieve glu-cose [sugar] control, butwhat is going to makeyou feel better every dayand reduce the risk ofcomplications is a healthydiet and getting somephysical activity.”

Lori Berardis a certified diabetes educatorand past chair of the CanadianDiabetes Association’sDiabetes Educator Section

To keep prediabetes under control, Darryl Sittler has adopted a healthy lifestyle thatincludes regular exercise and well-balanced meals. ROGER HALLETT PHOTO

Sittler takes a shot at preventingtype 2 diabetesHockey legend Darryl Sittler knows the pain of losing family members to diabetes-related illness.That’s why he’s urging Canadians to find out if they are at risk.

At 65 years old, retired profes-sional hockey player DarrylSittler still hits the gym several

times a week and keeps an eye onwhat food is on his plate.The Hockey Hall of Famer says an

unhealthy lifestyle is simply not anoption for him because he has predia-betes – a condition where his glucoselevels are higher than normal, but notyet high enough to be diagnosed astype 2 diabetes. It’s a concern for Mr.Sittler because there’s a long historyof diabetes in his family.“From the time I was a young kid, I

was aware of diabetes,” he explains,recalling his childhood as the third ofeight children raised in St. Jacobs,Ontario. “I can remember as a kid,my grandmother had diabetes. Shewent blind at age 59, and she passedaway at age 66 due to complicationsfrom this disease.”A few years later, diabetes found

its way into Mr. Sittler’s immediatefamily.His father was diagnosed with

type 2 diabetes in his late 40s. Tenyears later, he died of heart diseaseafter going through several strokesand a heart attack – common risksfor people with type 2 diabetes.Mr.Sittler’s brothers, Ken and Gary,were also diagnosed with diabetesand last February Gary lost his fightagainst the disease when he suffereda heart attack.“Having the knowledge of my dad

and my brothers, I try to be proac-tive,” says Mr. Sittler.The Canadian Diabetes Association

(CDA) estimates that more than 5.7million Canadians have prediabetesand almost one million Canadiansalready have type 2 diabetes anddon’t even know it.To combat this growing problem,

Sun Life Financial has proudly com-mitted more than $13-million sinceNovember 2012 to help fight diabetesand its related complications.

“The question people often ask usis, ‘Why diabetes?’” says Paul Joliat,Assistant Vice-President, Philanthropyand Sponsorships at Sun Life Financial.The answer comes down to impact,

explains Mr. Joliat. Prior to Sun Life’scommitment to diabetes, the companysupported a number of Canadian

health and wellness organizations.“But we decided that in order to havea greater impact on the health-caresystem,wewould focus our efforts onone area... and quite quickly diabetesrose to the forefront,” he says.“We saw that it was a disease that

was impacting millions of people in

this country and around the world,”adds Mr. Joliat. “And not just the in-dividuals with the disease, but theirfamilies, so we thought this was aperfect place to more directly investour philanthropic funds.”Mr. Joliat and his team at Sun Life

looked to the experts in the field of

diabetes to see where the most helpwas needed and the response wasunanimous: prevention.“One of the biggest things we are

trying to do right now is create aware-ness and educate the public about type2 diabetes and invite them to see ifthey’re at risk,” he says.Sun Life Financial and the CDA are

encouraging Canadians to take thesimple CANRISK online test (operatedby the Public HealthAgencyof Canada)to assess their risk of type 2 diabetes.Simply visit take2minutes.ca and click“Start” to begin.Mr. Sittler is a staunch advocate of

prevention. He says he has fully ad-opted a healthy lifestyle that includesregular exercise and well-balancedmeals. He does make room for anoccasional treat to satisfy a tenacioussweet tooth though, because, as Mr.Sittler explains, it’s all about balance.“I’m a realist,” he says. “I’m consci-

entious about exercise, so I’m surethat helps.”Besides hitting the gym several

days a week, Mr. Sittler says he oftentakes the stairs instead of an elevatoror walks somewhere even when hecan get a ride. “Every little bit kind ofhelps, you know? You have a betterchance of succeeding if you make ita lifestyle, not a binge.”Regular visits to his family physician

are also an integral part of Mr. Sittler’sdiabetes prevention plan. Honest con-versations about lifestyle should beincluded in every Canadian’s healthyroutine, he says.“Some people out there might be

reading this and thinking, ‘Well, that’snotme’, but it doesn’t hurt to be proac-tive and find out where you’re at,” hesays. “You have a choice of knowing.”

Wondering if you are at risk for type2 diabetes? Go to take2minutes.ca,take the test and find out.

PREVENTION

ONLINE?

Life’s brighter under the sun

TAKECHARGEOF YOUR HEALTH

www.take2minutes.ca

GO ONLINE. GET SCREENED.

29% of Canadians are affected by diabetes1 and a full third ofthose don’t even know they have it.2 And, at least 50% of theinstances can be prevented or delayed.1

Take the two minute test to find out if you’re at risk of developingtype 2 diabetes.

TEAM UP AGAINST

DIABETES

1 Source: Canadian Diabetes Association2 Source: International Diabetes Federation

CDA 4 • SPONSOR CONTENT THE GLOBE AND MAIL • MONDAY , NOVEMBER 2 , 2015

DIABETES: TAKING IT ON TOGETHER

Debbie Sissmore lost her sight at age 30 due to complications from type1 diabetes. The avid long-distance runner was Canada’s 60th person toreceive an islet cell transplant, allowing her body to once again produceinsulin. SUPPLIED

Research advances save lives andcontinue to provide new hope

Debbie Sissmore was four yearsold when she was diagnosedwith type 1 diabetes almost 49

years ago. Shewas 30, newlymarriedand working as a Grade 2 teacher,when complications of the diseasetook her sight.“Nowwe have better insulins, insu-

lin pumps, carb counting and metersso that you can read your own bloodsugar results. The advances in treat-ment have been extraordinary,” shesays. But in those early days, homeblood glucose (sugar) testing wasn’tavailable. She hadone insulin injectionper day, using a glass syringe.Ms. Sissmore has brittle diabetes,

which means it was extremely dif-ficult to manage her blood sugar.High blood sugar levels over a sus-tained period of time can lead tothe development of diabetes-relatedcomplications, including diabeticretinopathy, the leading cause ofblindness in Canadian adults. “At thetime, I thought that was it – I lost myindependence, my career, my goalsand my dreams,” she says.With the support of her husband,

the Canadian National Institute forthe Blind and her friends and family,Ms. Sissmore rebuilt her life. In addi-tion to volunteering for the CanadianDiabetesAssociation (CDA), she turnedto long-distance running.With a guideholding one end of a towel while sheheld the other, the guide alerted her touneven footing, curbs and obstacles.Since then, she’s run countless racesand half-marathons, as well as theNew York City marathon.In 2003, she became the 60th

person in Canada to have an islet cell

transplant. “It saved my life. We’realmost at my 12-year anniversary,post transplant. I take a small amountof insulin today, a fraction of what Iused to take, but the most importantthing by far is that my blood glucose[sugar] levels have remained in aperfect target range. I’ve maintainedexcellent control since then, with nofurther signs of any diabetes-relatedcomplications.”Research has played a significant

role in her life, but more is needed,she stresses. “The future is brighterfor those living with diabetes now,because of the great tools available.But we have a long way to go. Greatresearch is going on, but we needfunding.”One project of particular promise

for themore than 500,000 Canadianswith diabetic retinopathy is underway at the Université de Montréal.Dr. Mike Sapieha’s recent CDA-fundedresearchwas published in a prestigious“Scientific Show Stopper” article inThe Journal of Clinical Investigation.“The blood vessels that are sick in

diabetic retinopathy represent a verylow percentage of the cells withinthe retina – the bulk of the cells areneurons and associated cells calledglial cells,” explains Dr. Sapieha, theCanada Research Chair in Retinal CellBiology and Associate Professor ofOphthalmology at Université de Mon-tréal. “We wanted to know whetherthese cells could be driving some ofthe damage.”Through a series of studies, Dr.

Sapieha and his team found that,with diabetes, the nerve cells withinthe retina produce molecules that are

otherwise present at high levels onlywhen the eyes are developing in thewomb. “Thesemolecules are a familyof proteins called neuronal guidancecues. For example, they ensure that asthe brain develops, your little toe willreceive the right nerve so you’ll be ableto sense when it is being touched.”In diabetic retinopathy, these mol-

ecules increase to abnormal lev-els. “When this embryonic programbecomes reactivated, the vesselsopen up just a bit. Their junctions arecompromised, and then you get theleakage– the edema–associatedwithdiabeticmacular edema.Wealso foundthat this sameprotein, semaphorin 3A,can be highly inflammatory.”With funding from venture capital

company AmorChem, Dr. Sapiehaand his team are now at work on com-poundsdesigned to inhibit semaphorin3A. “We’re developing inhibitorsthat seem to work well at prevent-ing diabetic macular edema and theinflammation within the retina thatcauses new pathological vessels togrow. We’re in the advanced stagesof development before going intoclinical trials.“We’re at a very exciting period right

now, because we’re able to developcompounds that have a very tangibleimpact on a disease that affects somany people.”

For ways to donate and supportgroundbreaking Canadianresearch that can help preventdiabetes-related complications,visit diabetes.ca/donate.

VISION

EDUCATION

“Different foods, par-ticularly the carbohydratecomponents of them, willaffect blood sugar levels indifferent ways. People needto be aware of which foodscontain them, and thenmake healthy choices, notonly within the carbohy-drate food group area, butwith other foods as well.”Joanne Lewisis a registered dietitian, certifieddiabetes educator and the managerof diabetes education at the CanadianDiabetes Association

Smart food choices help manageblood sugar levels and improve health

When it comes to living withdiabetes, food knowledgeis power. Eating the right

amount of the right food at the righttime leads to better overall health andreduces the risk of complications suchas kidney and heart disease.

“Different foods, particularly thecarbohydrate components of them,will affect blood sugar levels in differ-ent ways. People need to be aware ofwhich foods contain them, and thenmake healthy choices, not only withinthe carbohydrate food group area, butwith other foods aswell,” says JoanneLewis, a registered dietitian, certifieddiabetes educator and the managerof diabetes education at the CanadianDiabetes Association (CDA).

Typically, people living with eithertype 1 or type 2 diabetes need to lookfor foodswitha“lowerglycemic index.”These are foods that produce smallerfluctuations in bloodglucose (sugar) sothat it does not spike quickly and dropjust as fast, causing a roller-coaster ridefor the body that makes it difficult tokeep blood sugar levels in the targetrange.Healthcareprofessionals arenowusing the Canadian Diabetes Associa-tion 2013 Clinical PracticeGuidelines forthe Prevention and Management ofDiabetes in Canada to “individualize”target blood sugar levels basedon age,duration of diabetes and other factors.

For many people diagnosed withdiabetes,managing the relationshipbe-tween food and blood sugar levels can

seem complex and daunting. The CDAhas responded by developing a hands-on healthy eating and skills-buildingprogram led by certified communityfacilitators, saysKarenCoulson,programmanager for the CDA’s Food Skills forFamilies program in B.C. Participantslearn about preparing and cooking newfoods, understanding nutrition labelsand navigating the grocery store.

“It teaches the skills and knowledgepeople living with diabetes need tomake healthy choices,” she adds. Theprogram is also beneficial to thosewhodonot have diabetes butwant to lowertheir risk of developing type 2 diabetesand other chronic illnesses. Ultimately,the goal is to get Canadians to eatmorefruits andvegetables– foodswith lowerglycemic index levels.

“It’s a fun and easy way to teachpeople how to get back to cookingfrom scratch and reducing their reli-ance on over-processed foods,” saysMs. Coulson.

Although the Food Skills for Fami-lies program is currently only widelyavailable in B.C., the CDA has certifiedthree staffmembers to support expan-sion elsewhere. The CDA is running itsfirst pilot program in Ontario this fall,and there are plans to expand to NewBrunswick in 2016 through an alliancewithRBCand theCongressofAboriginalPeoples.

For helpful resources about healthyeating and diabetes management,visit diabetes.ca/healthyliving.

Programs like Food Skills for Families help people make healthier choicesabout food and learn how to cook tasty meals. SUPPLIED

KNOWLEDGE

ADVICE

DONATE TO RESEARCH

ONLINE?

THE LIFE-CHANGING ROLE OFDIABETES EDUCATORS

Diabetes educators are healthcareproviders who are experts in dia-betes education: they are dietitians,nurses, pharmacists and physicians.From the initial diagnosis to yearslater, diabetes educators are thereto help people with diabetes livethe healthiest life they can. Diabe-tes educators are their partners inthe 24/7 task ofmanaging diabetes.For many people, their diabeteseducators are life changers.

On November 4, let’s celebratethe second annual Diabetes Edu-cator Day! Drop by your diabeteseducator’s office and say hello, orthank them for being there on yourdiabetes journey.

Call the Canadian Diabetes Asso-ciation at 1-800-BANTING(226-8464) for help in finding a dia-betes education centre near you.

EDUCATEyourself about diabetes.

Be aware of the risk factors and learn all you can to adopt a healthylifestyle. Take the type 2 diabetes risk test at take2minutes.ca and visitthe Canadian Diabetes Association’s website at diabetes.ca for the mosttrusted information.

BEWAREof diabetes myths.

We all know someone in our family or have a friend who “knows every-thing.” Did they get their doctor/dietitian/nurse’s degree overnight? Trustyourself and what your body is telling you.

STAYactive.

Look for ways to maintain regular physical activity – take the stairs, walkaround theblockbefore yougohome, play a friendly gameof hockeywithyour friends and family, or go for a naturewalk in a park. And this is a greatexcuse to treat yourself and buy a good pair of walking or running shoes!

EATbreakfast.

The food we eat turns into sugar in our blood, which is used as energy.Think about your body like a car: a car needs gas for energy, just as ourbody needs food for energy.Without gas, a carwill not go anywhere.Weneed to eat breakfast to get our “gas” and go each morning.

LEARNto say “no, thank you.”

Give yourself permission to walk away from excess or unhealthy foodchoices. You really are what you eat.

Information provided by Sondra Sherman, certified diabetes educator,registered dietitian at the Jewish General Hospital in Montreal, and co-chair of the Canadian Diabetes Association’s Diabetes Educator Section– Montreal Chapter. Ms. Sherman has also participated in internationalrunning events as a member of Team Diabetes, the CDA’s nationalactivity-based fundraising program.

Five tips for preventingtype 2 diabetesTo lower your risk of developing type 2 diabetes, take thefollowing simple steps to invest in your health:

diabetes.ca | 1-800-BANTING

Numbers Aren’t Enough.

All trademarks are used under licence by LifeScan Canada Ltd.© 2015 LifeScan Canada Ltd. AW105-398A 10/15.

OneTouch.ca/Verio

To navigate the world of diabetes,you should have more thanjust numbers.

Introducing the OneTouch Verio®meter. It’s the first meter withautomatic colour–coding,letting you know if you’re inor out of range. In a glance,it helps you better understandwhat your results mean.

Wherever you’re going, theOneTouch Verio® meter can helppoint you in the right direction.

Go speak to your healthcare professionalto learn more.

CDA 6 • SPONSOR CONTENT THE GLOBE AND MAIL • MONDAY , NOVEMBER 2 , 2015

DIABETES: TAKING IT ON TOGETHER

After weight-loss surgery in 2009, Lisa Benrubi lost 110 pounds and has been able to taper off insulin and another medication for controlling diabetes; shesays her quality of life has improved significantly. SUPPLIED

Top, After taking control of his health following a diagnosis of type 2 diabetes, Shaun MacDonald donatedclothes that no longer fit him to Clothesline. Bottom, Ben and Michael regularly attend D-Camps, a summer campprogram for children with type 1 diabetes that is operated by the Canadian Diabetes Association with the sup-port of donations from Clothesline. SUPPLIED

Weight-loss procedure effective inreducing type 2 diabetes

Lisa Benrubi made herself a deal:although she had lost 30 poundsby participating in a support

program to help manage her type 2diabetes, she had reached a plateau,no matter what lifestyle adjustmentsshe made. “I decided that I wouldgive myself one more year with theprogram, and that if I hadn’t lost anymore weight I would opt for weight-loss surgery.”In September 2009, Ms. Benrubi

underwent lap-band surgery, andover the next year, she gradually lostweight. “As I lost the pounds, I wasable to taper off the insulin and thenultimately taper off almost all of theother diabetes medication I was on.”She says that the difference in her

life has been far-reaching. “In addition

LaniHydeandher familyhavebeendonating for years to Clothesline,the Canadian Diabetes Asso-

ciation’s (CDA’s) program that raisesmoney for diabetes research, programsand education by selling gently usedclothes, electronics and small house-hold items to the thrift retailer ValueVillage.This year, Ms. Hyde added a little

something extra to her donationbags. Prompted by the instructionsfor a Clothesline contest that wasgiving away free D-Camps sessions todonors, she taped a piece of paper oneach bag that said “D-Camps” – thenameof thenational campingprogramthat the CDA operates for children andyouth with type 1 diabetes.Ms. Hyde’s sons, Ben, 14, and Mi-

chael, 12, were already signed up forD-Camps at Camp Kakhamela in Gib-sons, B.C. So shewas thrilledwhen shelearned that her family had won oneof the free sessions from Clothesline.This meant Ben’s two-week D-Camps

to the side effects of all medications,diabetes affects every single aspectof your life – from meal planning,social eating and travelling to yourfinances. I was self-employed, andmymedications were costing me morethan $10,000 annually.”Six years after the surgery and 13

years since being diagnosedwith type2 diabetes, Ms. Benrubi has lost a totalof 110 pounds, kept the weight off, isfree of the conditions associated withdiabetes and says that she now hasthe blood glucose levels of someonewith prediabetes.Her experience is one that is very

familiar to Dr. Chris Cobourn, CEO ofSmartShape Weight Loss Centre andthe bariatric surgeon who performedMs. Benrubi’s surgery.

“There is a direct link betweenobesity and type 2 diabetes,” he says.“Ninety per cent of patients with type2 diabetes are obese or overweight. Asa person’s bodymass index increases,there is an exponential rise in the riskof that person becoming diabetic.”The good news is that there is

a comparable link between losingweight and controlling blood glucoselevels. “As people lose weight, theirdiabetes can go into remission,” saysDr. Cobourn. “It’s not a cure, becauseif you regain the weight, the diabeteswill return. The key is losing theweightand keeping it off.”Dr. Cobourn cites a randomized trial

in Australia that compared the resultsof lap-band surgery with the bestconventional therapy of diet, exercise

session was covered by the CDA andthe family had to pay only forMichael’sone-week session.“We have a lot of medical expenses,

so it really helped financially,” saysMs.Hyde, whose sons both have type 1diabetes. “But evenmore importantly,D-Camps has been really great for mykids.”Launched in 1985, Clothesline raised

$10.1-million last year throughdonationsof used clothing and household itemsfrom 1.7 million homes across Canada.All of the net proceeds fromClotheslinedirectly support the CDA and world-class diabetes research, education,advocacy and support programs suchas the CDA’s D-Camps program, whichincludes D-Tour retreats for youngadults, and family camps.The benefits from Clothesline also

extend to the environment: each year,theprogramdivertsmore than 51millionkilograms of clothing from landfill sites.For Shaun MacDonald, a French

teacher at Algonquin Public Schoolin Woodstock, Ontario, donating toClothesline was not only a way to sup-port the CDA, it was also a milestone

and counselling. “Diabetes remissionrates were 73 per cent for the groupthat had the surgery compared to 13per cent for conventional therapygroups,” he says.The study concluded that the

amount of weight loss by partici-pants was the main driver for diabe-tes remission, with those who hadsurgery losing an average of 21 percent of their body weight and thenon-surgical group losing only twoper cent of their body weight overthe two-year period.Both groups received ongoing coun-

selling to help manage weight loss– and this support plays an essentialrole in helping people make the life-style and behaviour changes neededto keep weight off. Ms. Benrubi saysthe ongoing support provided bySmartShape has been fundamentalto her success.“SmartShape offered a lot of sup-

port, but the key word is ‘offer’,”she says. “It’s up to you to use thatsupport – to make use of the onlinesupport groups, to check in with thedietitian and to work with the teamof nurses to make adjustments tothe band. Six years after the surgery,I still use all their services: they aresupportive, non-judgmental and verypassionate about what they do.”Dr. Cobourn and his team have

performedwell over 5,000 proceduresover the past 11 years at facilities inVancouver, Calgary, Winnipeg, Mis-sissauga and Toronto. A network ofaffiliates across Canada means thatno matter where a patient lives, heor she is close to a clinic that canprovide support services ranging fromlap-band adjustment to counsellingon nutrition, exercise and behaviourmodification.“The operation on its own won’t

lead to sustained weight loss anddiabetes remission,” says Dr. Cobourn.“But the operation combined witha comprehensive multi-disciplinaryprogram can help people reach thesegoals and see significant improve-ment in their physical and emotionalhealth.”

in his mission to lose weight.Since being diagnosed with type

2 diabetes last March, Mr. MacDon-ald has lost about 30 pounds. Thissummer, he and his family donatedabout 30 pounds of clothes as partof Clothesline’s 3-Pound Challenge,with most of the items coming fromMr. MacDonald’s previous wardrobeof larger-sized clothing.“I started going to the gym daily,

counting calories and carbs, eatingmore vegetables and eliminatinganything with white flour,” says Mr.MacDonald, who at six-foot-two usedto weigh about 255 pounds. “Myultimate goal is to be at 195 pounds,and I haven’t weighed that since highschool.”ForMs. Hyde’s sons, the Clothesline

program has meant access to life-changing camps. The oldest, Ben, wasonly three years oldwhen doctors toldhis family he had type 1 diabetes. Twoyears later, he and his parents wentto their first family camp at CampKakhamela. In 2010, he started goingto the program’s overnight camps.“We do the same things kids do

in regular camp but we have extranurses and staff to help us,” say Ben.“There’s tons of activities, like kayak-ing, canoeing, high ropes, archery androck climbing.”Ben says going to D-Camps has

also allowed him to form supportiverelationships with other kids whohave diabetes.“When everyone around you also

has type 1 diabetes, you kind of bondtogether,” he says. “At the camp,diabetes is normal.”Ben’s brother, Michael, who was

diagnosed with type 1 diabetes justover a year ago, agrees.“You feel normal at camp and you

don’t have toworry about people notunderstanding that you have to checkyour blood sugar or inject insulinwhenyou’re eating something,” he says. “Atcamp, there’s a special place to testyour blood sugar and you’re check-ing together with your cabin groupso you’re not the only one doing it.”Another great thing aboutD-Camps?

“You don’t have to carry around yourkit for blood sugar testing,” saysMichael. “A camp counsellor carriesit in a backpack, so you can run andjump around and not have to worryabout a thing.”

SUCCESS

“Ninety per cent ofpatients with type 2 dia-betes are obese or over-weight. As a person’s bodymass index increases, thereis an exponential rise in therisk of that person becom-ing diabetic.”Dr. Chris Cobournis CEO of SmartShape Weight LossCentre

“When everyone aroundyou also has type 1 dia-betes, you kind of bondtogether. At the camp,diabetes is normal.”Ben Hydeis 14 and attends the CanadianDiabetes Association’s D-Campsprogram for children with type 1diabetes

SUPPORT

Clothesline program supports research, outreachactivities and more

DONATE

CLOTHESLINE’S#3LBCHALLENGE

Keep Clothesline in mind whencleaning and getting rid of gentlyused clothing, electronics andsmall household items!When youdonatewith Clothesline, everyonewins – feel good knowing thatyour used items are going to aworthwhile cause and that reus-able items are recycled, whichhas a positive effect on the envi-ronment.

To schedule your free pickup,visit diabetes.ca/clothesline orcall toll-free at 1-800-505-5525.

You can also drop off your dona-tions in person at one of Clothes-line’s bright red drop boxes. For alocation near you and more infor-mation about the 3-Pound Chal-lenge, visit diabetes.ca/dropbox.

THE GLOBE AND MAIL • MONDAY , NOVEMBER 2 , 2015 SPONSOR CONTENT • CDA 7

Visit globeandmail.com/adv/diabetes2015

Through the workplace motivaction program, employees can make use of personalized coaching from a certifieddiabetes educator to provide them with the emotional support and information they need. ISTOCKPHOTO.COM

The school-based program At MyBest encourages children to stayactive and make positive choices asa way of laying a foundation for alifetime of health. SUPPLIED

Partnering with employers to reducethe incidence of type 2 diabetes

Anew partnership betweenAstraZeneca and Canadiancompanies is providing em-

ployees with the support they needto reduce their risk of type 2 diabetesand prevent complications for thosewith diabetes.“We asked ourselves, if we were

to bring about meaningful changefor someone in the workplace whomight be faced with type 2 diabetes,what would we do?” says PriscillaNykoliation, seniormanagerof externalrelations at AstraZeneca, a leader inthe development of medications fortreating type 2 diabetes.The company consultedwith experts

to find out what kinds of programsalready existed, soon discoveringthat the few employers that providedworkplace screening days offered littlefollow-up beyond instructing peoplewith concerning blood test results tosee a physician.Since earlier research conducted by

AstraZeneca revealed that type 2diabe-

Afree, school-based curriculumis helping kids across Canadalearn habits that should set

them on the path to better lifelongphysical and emotional health. The AtMy Best program grew out of a seriesof consultations with physicians andother experts almost a decade ago.“When we asked them ‘what are

the pressing health issues we’re fac-ing here in Canada’, what came backresoundingly was a challenge withchildhood obesity,” says Helen-MarieSeibel, senior manager of corporateresponsibility at AstraZeneca, thesponsor of the program. “As a result,we decided to invest in the develop-ment of a program that would addressthat issue, but in a really proactive andthoughtful manner. We found a part-ner in Physical and Health EducationCanadaCanada (PHECanada), and theytook the lead in bringing together theright educators and curriculumwriterswho are experts in this area.”Launched in 2008, the first phase of

the program,which is endorsed by theCollegeof Family Physicians of Canada,focused on children in Kindergarten toGrade 3, and is aimed at fostering notjust physical activity andhealthyeating,but emotional and mental well-beingas well. A second curriculum set span-ning Grades 4 to 6, and encompassingthe concepts of personal, broadercommunity, environmental and socialhealth, was added in 2013.“It’s really a program that’s designed

to enhance kids’ awareness of self,their emotions and the links betweenphysical activity, healthy eating andan overall sense of wellness andhappiness,” says Chris Jones, execu-tive director of PHE Canada. “A lot ofdestructive habits that result in adultshaving health issues are formed inchildhood.”Since its inception, At My Best has

reached an estimated 450,000 chil-dren across Canada, in at least 4,500schools.Carol Scaini, a physical education

and guidance teacher with the Peel

Heart disease and stroke are theleading cause of death for peo-ple with type 2 diabetes. A new

collaboration between AstraZenecaand the Montreal Heart Institute (MHI)will advance our understanding of thebiological mechanisms that contributeto diabetes and cardiovascular diseaseby identifying thegenes responsible forthese conditions – ultimately offeringthe promise of personalized treatmentoptions tailored to a patient’s geneticprofile.In one of the largest initiatives of its

type to date, the MHI will search thegenomes of up to 80,000 patients forgenes associated with cardiovasculardisease and diabetes, their complica-tions and treatment outcomes. DNAsamples will be taken from AstraZen-eca’s extensive biobank that havebeen collected over a 12-year periodunder informed consent from patientswho have entered clinical trials to testcardiovascular or diabetes treatments.MHI is a leader in clinical and basic

research, ultra-specialized care and

tes andmental health conditions suchas anxiety and depression are oftenintertwined, the teamwho developedthe new workplace program wantedto make sure employees had accessto comprehensive support.“We know how hard it can be when

you’re concerned about your health,”says Ms. Nykoliation. “So we workedwith our partners to design a programthat offered hands-on support to em-ployees who score at high ormediumrisk for type 2 diabetes.”The result is motivaction, a unique

workplace program that combineshealth screening with the offer ofpersonalized telephone coachingfrom a certified diabetes educator tothose at risk.“If someone reallywants towork on

stress management first, and eatingbehaviours second, that’s what the

educator will do,” Ms. Nykoliationexplains. At the end of six months,screening tests are repeated, and indi-viduals who need further support areconnectedwith a community resource–most commonly a pharmacy-basedcertified diabetes educator. A researchcomponent is also being woven in:participants will fill out validated ques-tionnaires to gauge mental health,behaviour and quality of life beforebeginning the program, and againafter completing it.“Our overarching goal is to provide

evidence that investing in workplacehealth solutions to address chronicconditions such as diabetes yields sus-tainable value,” says Ms. Nykoliation.“Helping people to prevent, or slow,the progression of a disease like [type2] diabetes through lifestyle changesand treatment optionsmeans keeping

District School Board in Ontario, hasseen first-hand the difference At MyBest has made in the lives of many ofher students. “Parents have said theirchildren are choosing healthier foodsat the grocery store, or now want tohelp cookor pumpup thebike tires andgo for a ride,” she says. “We also seethe results in the kids – they’re moreawake during the day, seem healthierand happier, andwedon’t see asmanybehaviour issues.”Plans are now under way to more

formally evaluate the impact of theprogram, and to implement it in com-munities that are particularly vulnerableto health problems like type 2 diabetesand cardiovascular disease.“I thinkwe’ll see down the road that

the childrenwho have had the benefitof this kind of intervention do betteracademically,” predicts Mr. Jones. “IfI’m eating well, exercising, gettingplenty of sleep and am moderatingmy timeon the Internet, then I’mmoreable to learn effectively, form stableand lasting relationships and establishhealth-promoting behaviours that lastinto adolescence and adulthood.”

prevention. Theywill use leading tech-nologies to identify regionsofDNA thatresult in a predisposition to, or cause,cardiovascular disease and diabetes,or are associated with responses totreatments. This knowledge can thenbe used to develop new treatmentoptions targeted to treat subsets ofpatientswith particular genetic profilesand offer a personalized healthcareapproachwhereby patients are treatedwith medications to which they aremost likely to respond.It’s an exciting research endeavour

that could transform the way doctorstreat patients with cardiovascular dis-ease anddiabetes, saysDr. Jean-ClaudeTardif, director of the MHI ResearchCentre, which is affiliated with theUniversité de Montréal. “This large-scale partnership betweenAstraZenecaand theMontreal Heart Institute holdsgreat potential for breakthroughs inpersonalized cardiovascular medicinewhereby medications will be tailoredto responsive patients based on theirgenetic profile.”

people in the workplace longer.”So far, feedback from participating

employers, which include MagnaInternational, has beenextremely posi-tive. One suchworkplace is LaurentideControls Ltd., where the programwasrolled out in May.“The fallout from type 2 diabetes can

be so detrimental. We quickly realizedhow susceptiblewe are, unknowingly,to this potential health threat. Even ifonly one person in the entire companyjumped onboard, became aware theywere at risk and reacted proactivelywith support from both the motivac-tion team and Laurentide – we’llconsider this programahuge success,”says Andrea Croft, projects coordina-tor & health and fitness committeeteam leader at Laurentide. “We’re sograteful that AstraZeneca invited usto participate.”

WORKPLACE

“We asked ourselves, if wewere to bring about mean-ingful change for someonein the workplace whomight be faced with type 2diabetes, what would wedo?”Priscilla Nykoliationis senior manager of external relationsat AstraZeneca

EDUCATION

RESEARCH

National wellness program helpschildren establish healthy habits

New collaboration lays ground-work for personalized treatmentof diabetes, heart disease

BY THENUMBERS

1 in 5Canadian adultshave prediabetes

1 in 2of those withprediabetes willdevelop type 2diabetes

Mid-50sAverage age oftype 2 diabetesdiagnosis

$17-billionEstimated cost oftreating diabetesin 2024

Reducing theprevalence rateof diabetes by

2%would reducedirect healthcarecosts by 9%

Source: ROI of OneLife: Diabetes

AstraZeneca Canada is focused on deliveringgreat medicines through innovative science– medicines that improve the lives ofCanadians with diabetes.

The AstraZeneca logo is a registered trademarkof AstraZeneca AB, used under license byAstraZeneca Canada Inc.

CDA 8 • SPONSOR CONTENT THE GLOBE AND MAIL • MONDAY , NOVEMBER 2 , 2015

DIABETES: TAKING IT ON TOGETHER

Drew Wilby, a busy father of three and executive director of corporateaffairs for the Saskatchewan Ministry of Justice, monitors his blood glucoselevels to ensure he’s within a healthy target range; his son, Blake, who alsohas type 1 diabetes, is also monitored regularly. SUPPLIED

Research by Dr. Kaberi Dasgupta and her team suggests that the partners of women who have diabetes during pregnancy are more likely to develop diabe-tes, a finding that underlines the important role that our environments play in influencing behaviour. From left to right: Dr. Kaberi Dasgupta, PhD studentSamantha Hajna, research assistant Rani Cruz and post-doctoral fellow Anne-Sophie Brazeau. OWEN EGAN

Blood glucose meters provide more thanjust a number for people with diabetesThesedays, it seems thatmanyof

us are busy tracking everythingfrom the number of steps we

take each day to our sleep patternsat night. For people with diabetes,however, tracking blood glucoselevels isn’t just an interesting bit ofdata to upload to an app – it’s criticallyimportant information for knowingwhether “their number” is within asafe and healthy range.“Monitoring my blood sugar levels

has been a part of my life since I wasdiagnosed with type 1 diabetes whenI was 10,” says Drew Wilby, now 33.“The technology has changed a lot

since my first meter, so I can nowget much more information than justa single number showing my bloodsugar level.”Lori Berard, a registered nurse and

certified diabetes educator with theDiabetes Research Group ClinicalResearch Program at the Health Sci-ences Centre in Winnipeg, says thatin her work with patients she helps

people “understand this number–howexercise, food, medication and stressall affect blood glucose.”To that end, blood glucose meters

that provide more information than anumber alone can be very helpful. “It’suseful if a meter can flag to someonewhere they’re at within a range,” shesays. “These cuesprovide anextra levelof feedback for a patient, so they can

identify the highs and lows and thenuse this information to make lifestyleor perhapsmedication changes to getback within their target blood glucoserange.”Twenty-three years of livingwith dia-

betes hasmadeMr.Wilby very attunedto his body; testing his blood glucosethen confirms if his levels are too highor too low. He uses a OneTouch Veriometer to see if his blood glucose levelis within a target range.“For me, a healthy place to be is

between 5 and 9,” he says. “When thenumber drops, I’ll have some sugar tobringmy levels up, and if it’s above thehigh end, I know I need some insulinto bring the levels down. I can alsomonitor daily fluctuations to see ifthere are patterns to when I might behaving highs and lows so I can makeadjustments.”When blood glucose levels are too

high, there is an increased risk ofdeveloping diabetes-related complica-tions such as cardiovascular diseaseand nerve or eye damage. Thosewith type 1 diabetes, like Mr. Wilby,can adjust their insulin doses to bringtheir blood glucose levels down to ahealthy range. For people with type 2diabetes who are treating their condi-tion with medication, a consistentlyhigh number within the target rangewould, says Ms. Berard, “be a signalto go and see your doctor to get yourmedication adjusted.”LifeScan will soon be releasing the

OneTouchVerio Flexmeter,which alsoincludes a colour indicator to providea visual cue so that users can quicklysee if their blood glucose levels arewithin the target range.Mr.Wilby’s son, Blake, now two,was

diagnosed with type 1 diabetes whenhe was 14 months old. “For Blake,blood glucose meters will save hislife,” says Mr. Wilby. “We rely on ourmeter to give us reliable and accuratedata that we then use to adjust hisfood and insulin – we’re testing himthroughout the day tomake sure he’swithin range and staying healthy.”

MONITORING

ONLINE SUPPORT

NATIONAL SURVEY REVEALS THECHALLENGES OF MANAGING DIA-BETES

A recent online survey shines lighton the challenges people livingwith diabetes face when tryingto manage their eating habits,make time for exercise and moni-tor their blood glucose levels. Thesurvey was conducted by theOneTouch brand and its resultswill help guide the personalizedinformation offered by its Best-Days patient support program,a resource that includes practicalideas onmonitoring andmanagingdiabetes. The programalso includesrecipes fromVancouver chefNathanFong,who has type 2 diabetes, andexercise tips from Sébastien Sas-seville, who talks about managinghis type 1 diabetes while runningacross Canada, climbing Everestand achieving other impressive actsof athletic endurance. To readmoreabout the results of the survey,please visit globeandmail.com/partners/diabetes2015, and visitmyBestDays.ca for tips on manag-ing diabetes.

PLEASE DONATE

LOOK WHO’S 40!

This year, the Canadian DiabetesAssociation (CDA) is celebratingthe 40th anniversary of its researchprogram. With the support of peo-ple like you, the CDA has fundedmore than $125-million in diabetesresearch since 1975.

Help support exciting diabetesresearch in Canada – like that beingdone by Dr. Lipscombe and Dr.Dasgupta–by findingout themanyways you can donate to the CDA atdiabetes.ca/donate.

“It’s useful if a meter canflag to someone wherethey’re at within a range.These cues provide anextra level of feedback for apatient, so they can identifythe highs and lows andthen use this information tomake lifestyle or perhapsmedication changes...”Lori Berardis a registered nurse and certifieddiabetes educator with the DiabetesResearch Group Clinical ResearchProgram at the Health Sciences Centrein Winnipeg

“Our findings are consis-tent with previous stud-ies that have shown thatwhen one partner gainsweight the other is likelyto gain weight as well.When one partner be-comes physically activethe other partner is alsolikely to become active.”Dr. Kaberi Dasguptais an associate professor of medicineat McGill University who receivesresearch funding from the CanadianDiabetes Association

New research on diabetes inwomen is providing greaterinsight into how thedisease can

increase the risk of breast cancer andeven affect the health of the partnersand spouses of womenwith diabetes.These findings are based on two

separate studies: one led by Dr. Lor-raine Lipscombe at Toronto-basedWomen’s College Hospital and theInstitute for Clinical Evaluative Sciences,and another by Dr. Kaberi Dasguptaat the Research Institute of the McGillUniversity Health Centre in Montreal.Dr. Lipscombe’s previous research

funded by the Canadian DiabetesAssociation (CDA) examined the rela-tionship between diabetes and breastcancer. Recently, in a different study,sheanalyzedmore than38,000womennewly diagnosed with breast cancer,and found that those who also haddiabeteswere significantlymore likelytopresentwith late-stagebreast cancer.Thesewomen also had a higher risk oftheir cancer spreading and of develop-ing larger tumours than women with-out diabetes, increasing their chancesof dying of breast cancer.“One of the main reasons is the

shared risk factors for diabetes andbreast cancer,” explainsDr. Lipscombe,a physician specializing in diabetes andan associate professor of medicine atthe University of Toronto. “There aremany risk factors for type 2 diabetesand many risk factors for breast can-cer, but some risk factors in particularhave been found to contribute to bothconditions.”Insulin resistance is perhaps the

most critical risk factor common toboth diseases, says Dr. Lipscombe. Inwomen who carry excess fat aroundthe abdomen, insulin resistance cre-ates a harmfulmetabolic environmentwhere the body produces extra insulinto try and maintain healthy glucose(sugar) levels.“But while this keeps blood sugar

under control, extra insulin can pro-mote the growth of breast cancer,”says Dr. Lipscombe, noting that insulinadministered as treatment for diabetesdoes not increase the risk of cancer.In Dr. Lipscombe’s study, women

with diabetes also had lowermammo-gram rates – a finding that underlinesthe importance of ensuring that thisgroup is screened regularly for breastcancer. At the same time, womenwith breast cancer and diabetes maybe less likely to get chemotherapy forbreast cancer.

“Is it because they don’t tolerate it aswell, and does the treatment have to bemodified?” asks Dr. Lipscombe. “Theseare issues that need to be looked at.”At McGill University, Dr. Dasgupta’s

study on the partners of women withgestational diabetes is also raising a lotof questions. Funded by the CDA, thestudy looked at more than 20 years’worth of health administrative, birthand death registry data in Quebec.The researchers found that partners ofwomenwho developed diabeteswhilepregnant are 33 per cent more likely todevelop diabetes themselves.“We lookedat almost 80,000couples,

where half hadmomswith gestationaldiabetes and half did not,” says Dr.Dasgupta, associate professor ofmedi-cine at McGill University and physicianscientist at theMcGill University HealthCentre. “Andwe showed that the dadswhosepartnershadgestational diabeteshad a 33 per cent higher relative riskof developing diabetes in the future.”

The idea behind this study, says Dr.Dasgupta,was to show that behavioursand environments matter when itcomes to health.“We wanted to show that people

who are not biologically related sharesomedegree of riskwhen they’re livingclosely together,” says Dr. Dasgupta.“Our findings are consistent with pre-vious studies that have shown thatwhen one partner gains weight theother is likely to gain weight as well.When one partner becomes physicallyactive the other partner is also likely tobecome active.”Both Dr. Dasgupta andDr. Lipscombe

are following up their researchwith dia-betes prevention programs focusing onwomenwho had gestational diabetes.“Many people have tried helping

women with gestational diabetes,but the problem is when you’ve justhad a baby it’s hard to focus on yourhealth,” says Dr. Lipscombe. “We aredoing CDA-funded research to provide

thesewomenwith programs that caterto what they need. We also need toengage their partners because thesewomen are often working hard ontheir own.”

RESEARCH

Investigating links between diabetes in women,breast cancer and their family’s health

THE GLOBE AND MAIL • MONDAY , NOVEMBER 2 , 2015 SPONSOR CONTENT • CDA 9

Visit globeandmail.com/adv/diabetes2015

Many people struggle with makingtheir health a priority while jugglingwork and family life. By workingclosely with her doctor, managingstress and putting her health first,Tracey Ruiz was able to lose weightand stop taking medication to con-trol her diabetes. SUPPLIED

Worldwide, approximately 50 per cent of deaths of people with type 2diabetes are caused by cardiovascular disease. Lifestyle changes andmedication can help reduce the risk. SUPPLIED

Holistic approach proves successfulin managing diabetesTracey Ruiz believed she would

likely develop type 2 diabetessomeday: she was overweight

and both her parents had the disease.However, as a 42-year-old motherof two running a thriving business,Tracey found her health ranking lowamong her priorities.“I thought I could take better care of

myself when I was less busy – that Ididn’t have to worry about diabetesuntil my fifties or sixties,” she recalls.That belief was dashedwhen Tracey’sphysician told her that she had type 2diabetes and it was serious. “My doc-tor said that I would probably have togo on insulin and that I had significantliver damage.”Her physician offered another op-

tion: take a high dose of an oraldiabetes medication and change herlifestyle to control her glucose levelsover the next month. “I was shockedbut I wanted to avoid insulin,” shesays. “I actually felt empowered.”Ms. Ruiz plunged into “doing the

right things” – working closely withher doctor, cuttingwork hours, and en-hancing diet and fitness. She achievedearly success, losing 35 pounds andreducinghermedicationdose, butoverthe following months she regainedthe weight and her blood glucoselevels rose.

“I had startedworking longer hoursagain, didn’t eat properly or getenough sleep,” she says. “One day,my husband and some friends didan ‘intervention,’ expressing concernfor my health.” With this support, Ms.Ruiz found a new determination. Overa year, she lost enough weight to gooff the medication.“I know the risks will always be

there and every day, I am motivatedto make the best choices to managemy diabetes.”The first reaction to a chronic-disease

diagnosis is often a sense of failureor discouragement, says Dr. ColleenCannon, a Vancouver-based clinicalpsychologist specializing in healthpsychology. The jolt is especially jar-ring for those with heavy family andwork responsibilities.“You’re used to taking care of busi-

ness no matter how you feel – likestaying up latewith sick kids and goingto work on minimal sleep,” says Dr.Cannon. “With diabetes, themessageyou receive is that keeping your bodyhealthy must become a top priority,and that can be overwhelming.“Rates of depression and anxiety for

peoplewith diabetes are higher than inthe general population– and that’s notokay.Makingpositive changebecomeseven harder.”Dr. Cannon counsels people on how

to sustain healthy behaviour changeusing a three-pronged approach: in-formation, motivation and strategies.“Your family doctor is a good source ofinformation about options for control-ling glucose levels and about choicesif lifestyle change alone isn’t enough.”Small, positive changes can add up

to make a big difference. “I guide my

patients toexamine their commitmentsand give up the non-crucial ones tomake health a priority. In terms ofstrategies: set specific behaviouralgoals that you can work on todayor this week and don’t try to changeeverything immediately. Startwith onesmall adjustment you can reasonablyfit into your life.”Improving diet and adding exercise

are important foundations, but inmostcases, patients require additional helpthrough oral antidiabetic drugs.

“We begin with lifestyle modifica-tions, including better nutrition andmore physical activity,” says Dr. Al-exandro Zarruk, medical director oftheWest Island Metabolic Unit and aninternist at Lakeshore General Hospitalin Montreal. After a month or two, Dr.Zarruk re-evaluates his patients andprescribes medication in 75 to 80 percent of cases.“Adding medication helps people

bettermanage the disease in themidstof busy lives,” he says. “If you’re aworking mother, it’s challenging tofit in 150minutes of weekly exercise.”The initial medication is typicallymetformin, says Dr. Zarruk, addingthat for some patients, this is the onlydrug required, but for many others,an add-on medication is appropriate.“We have a lot more tools in our

medical toolbox today to treat diabetesand adjustmedications to fit individualneeds,” says Dr. Zarruk. “This includesa new class of medication, the SGLT-2inhibitors, which reduce blood sugarand help lower blood pressure.”Some patientsmay think that taking

medication is a sign of “failure,” butDr. Zarruk delivers a differentmessage.“We’ve stabilized your levels and gotyou out of danger – now let’s focuson limiting complications and gettingyou even better.”

SUPPORT

“We have a lot more toolsin our medical toolboxtoday to treat diabetesand adjust medications tofit individual needs. Thisincludes a new class ofmedication, the SGLT-2inhibitors, which reduceblood sugar and help lowerblood pressure.”Dr. Alexandro Zarrukis medical director of the West IslandMetabolic Unit and an internistat Lakeshore General Hospital inMontreal

“Some diabetes medica-tions use the kidney itselfto dispose of excess glu-cose. Because they needa functioning kidney tobe effective, they are nolonger useful if your kid-ney function goes belowa certain threshold.”Dr. Tharsan Sivakumaris an endocrinologist at the Instituteof Diabetes & Endocrinology

As a complex chronic disease,diabetes can harm the healthyfunction of various organs in

the body, including the kidneys –withthe individual often unaware of theunfolding damage.

Among the complications as-sociated with diabetes, cardio-vascular (CV) disease looms

large. A person with diabetes faces asignificantly higher risk of developingheart disease or having a stroke thanpeople in their age group withoutdiabetes – and if they do developcoronary heart disease, for example,they will likely do so 10 to 15 yearsearlier than people who don’t havediabetes.Cardiovascular disease – including

heart disease, stroke and peripheralvascular disease (affecting vesselsoutside the heart) – is the cause ofat least 50 per cent of the deaths inpeople with type 2 diabetes. And CVdisease is the main contributor topremature death, reducing averagelife expectancy by 12 years amongpopulations with type 2 diabetes.Research indicates that CV risks often

begin to increase during prediabetes,when blood glucose levels are higherthan normal but not high enough fora diabetes diagnosis.“When physicians treat a patient

with type 2 diabetes or prediabetes,they recognize it is critical to workwith the patient to decrease the CVrisks as much as possible, as soon aspossible,” says Dr. Vincent Woo, as-sociate professor of medicine, sectionof endocrinology, at the University of

Diabetes is the leading cause ofkidney disease in Canada and asmany as 50 per cent of people withdiabetes have some degree of kidneydamage. Early detection of changes –for example, damage to small bloodvessels in the kidney filters – can allowphysicians to take steps to slow thedecline in kidney function.“One of the challenges in treating

diabetes is that it’s one of those ‘silent’diseases. It can bewreaking havoc ondifferent organ systems and you maynot have any symptoms,” says Dr.Tharsan Sivakumar, an endocrinologistat the Institute of Diabetes & Endocri-nology in the Greater Toronto Area.“That’s why it’s extremely importantto have your physician monitor yourkidney function and check regularlyfor the leakage of protein in the urine.By testing for protein in the urine, wecan determine if damage to the filtra-tion systemof the kidneys is present.”Dr. Sivakumar talks to his patients

about the serious risks to their kid-ney health. “I explain that withoutintervention, the damage can lead tokidney failure, which will mean goingon dialysis.”It is possible to slow the progres-

sion of kidney disease with goodglycemic control (control of bloodglucose levels), typically through useof oral diabetes drugs and/or insulin.Controlling blood pressure is vital, and

Manitoba in Winnipeg.Treatment to lower the risk includes

a number of strategies, explains Dr.Woo. “Webeginwith lifestyle changes,including proper nutrition, increasedphysical activity, and, if applicable,quitting smoking. Depending on theindividual patient,wemay also includetherapies to control blood pressure totarget levels.”

physiciansmay also prescribe kidney-protective medications.If a person’s kidney function contin-

ues to decline, medication changes orchanges to their insulin regimen maybe needed, Dr. Sivakumar explains.“Some diabetes medications use thekidney itself to dispose of excess glu-cose. Because they need a functioningkidney to be effective, they are nolonger useful if your kidney functiongoes below a certain threshold.” Othermedications that are metabolizedin the kidneys may also need to bediscontinued when kidney damageworsens.“There are some diabetes medica-

tions that effectively control glucoselevels at all levels of kidney functionup until the patient has kidney failure,”he says. “For some, the doses may

need to be adjusted but some othermedications can be continued at thesame dose even if kidney functionchanges.”

People with type 2 diabetes areoften prescribedmedications, such asACE inhibitors, to lower their blood-pressure levels and add protectionagainst heart disease and stroke.Recent data shows that 64.5 per centof adults with diagnosed diabetes alsohave diagnosed hypertension (highblood pressure) – twice the hyperten-sion rates of adults without diabetes.

People diagnosed with type 2 dia-betes may also be prescribed a statinmedication to lower LDL (“bad”) cho-lesterol, as well as low-dose aspirinor other medication to help preventblood clots.“For some patients, blood pressure

will be themost important to treat; forothers, it may be cholesterol or someother risk factor,” Dr. Woo says. “Bothdiabetes and CV disease are complex,and a personwith type 2 diabetesmayindeed have several risk factors forheart disease or stroke that all needto be treated.” And that may meanthat a person diagnosedwith diabetesends up taking several medications,in addition to diabetes medication to

directly control blood glucose levels.Given the links between diabetes

and cardiovascular disease, researchershave long pursued the goal of devel-oping a diabetes medication that alsoreduces CV disease risks. According toDr.Woo, a study released in September2015 in the New England Journal ofMedicine has produced “very encour-aging” results on that front.“This randomized clinical trial in-

volvedmore than 7,000 patients withestablished diabetes plus establishedheart disease. Some received themedication empagliflozin and othersreceived a placebo,” Dr. Woo says.“Compared with those on the pla-

cebo, patientswho took empagliflozinwere 38 per cent less likely to die as aresult of a heart attack, stroke or othercardiovascular problemover theperiodof the trial, almost three years. Theywere also 35 per cent less likely to behospitalized for heart failure and 32 percent less likely to die of any cause. Theresults are very significant.”The study also demonstrated the

medication’s safety, with few sideeffects reported. Health Canada hasrecently approved empagliflozin foruse in Canada and Dr. Woo says,“Physicians should strongly consideradding it to the diabetes medicationregimen of patients with cardiovas-cular disease.”

AWARENESS

TREATMENT

Kidney damage often a complication from diabetes –but it doesn’t need to be

Managing cardiovascular-disease risk a critical part ofdiabetes treatment and care

PREVENTION

TAKE ACTION TO PREVENTKIDNEY HEALTH COMPLICATIONS

The following tips can helpmanagediabetes and kidney disease:

• Take your diabetes medicationsas prescribed.

• Ask your doctor to check yourkidneys every year followingyour initial diabetes diagnosisand when new medications areadded.

• Keep your blood sugar at target.Talk to your doctor about whatyour target range should be.

• Keep your blood pressure attarget. Talk to your doctor aboutyour personal target.

• Eat a well-balanced diet.

• Exercise (ideally 45-60 minutes,four to five times per week).

• Don’t smoke.

DATA

In diabetes, your kidney health matters

of people with diabetesmay show signs ofkidney damage2

As many as

1 McFarlane P, Gilbert R, MacCallum L, et al. Canadian Diabetes Association 2013 Clinical Practice Guidelines forthe Prevention and Management of Diabetes in Canada: chronic kidney disease in diabetes. Can J Diabetes2013;37(suppl 1):S129-S136.2 The Kidney Foundation of Canada, 2004. Diabetes and Kidney Disease. Available online: http://www.kidney.ca/diabetes-and-kidney-disease (Accessed May 2015).

50%

Diabetes is

the leading causeof kidney disease in Canada1

MADE POSSIBLE THROUGH THE FINANCIAL SUPPORT OF THE BOEHRINGER INGELHEIM AND LILLY CANADA DIABETES ALLIANCE.

“Compared with those onthe placebo, patients whotook empagliflozin were38 per cent less likely todie as a result of a heartattack, stroke or othercardiovascular problem.”Dr. Vincent Woois associate professor of medicine,section of endocrinology, at theUniversity of Manitoba

Did you know?If you can lose 5-10% of your body weight, you will lower your risk of developing diabetes by 58%.(Johns Hopkins | www.hopkinsmedicine.org/digestive_weight_loss_center/conditions/diabetes.html)

Weight loss surgery can put type 2 diabetes into remission. (Diabetes Dialogue |Winter 2015)Following bariatric surgery: A1C levels will return to normal in about half of all surgical patients.

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*source: Diabetes Dialogue | Winter 2015