annualreport2006

&CliniCalSCientifiC

SeCtion

Statement of Purpose

• To represent within the Canadian Diabetes Association Canada’sclinicians and scientists concerned with diabetes.

• To provide leadership in patient care, education, research and inorganizational matters.

• To fulfill an advocacy role for Canadians with diabetes.

Clinical & Scientific Section Canadian Diabetes Association

C&SS Annual Report 2006 1

As I come to the end of my term as Chair of theClinical & Scientific Section (C&SS), it is time toreflect not only on the continuing accomplish-ments of the C&SS, but also on how it has grownto become a far more powerful voice within thebroader diabetes community.The Section Executive(Amir Hanna, Past Chair; Ehud Ur, Vice Chair,Scientific;Vincent Woo,Vice Chair, Clinical; SarahCapes, Treasurer; and Councillors Ian Blumer,Maureen Clement, Rejeanne Gougeon, CélineHuot, Tina Kader, Daniel Metzger, Ron Sigal,Parmjit Sohal and Minna Woo) have acceptedmany challenges and responsibilities over the pastyear in support of C&SS positioning.

The Canadian Diabetes Association 2003 ClinicalPractice Guidelines for the Prevention and Managementof Diabetes in Canada remain a focal point fordiscussion and interest beyond our initial expecta-tions. We continue to hold firm regarding ourrigorous methodology as the anchor for our guide-lines’ positioning, and use emerging controversy asan opportunity to strengthen our approach. Publicchallenges in the media and specifically within thepages of the Canadian Medical Association Journalhave tested the resolve of the C&SS Executive andtheir firm commitment to both methodology andprocess.We continue to receive accolades interna-tionally regarding our work, and are called uponto offer advice and input into the work of othersacross Canada and around the world.

The revision process for the 2008 Clinical PracticeGuidelines is now underway with Dr.Vincent Wooin the position of Chair, Executive Committee.More than 80 experts have committed to partici-pate in the guidelines’ development. MethodologyCo-Chairs Gillian Booth, Sarah Capes and DereckHunt have met the methodological challenges headon with extensive training and reference supportfor all authors.

As an interim step in the development of guide-

lines, new lipids guidelines entitled Dyslipidemia inAdults With Diabetes were published in CanadianJournal of Diabetes in September 2006. Under the leadership of Lawrence Leiter, Chair, the LipidExpert Committee membership was composed ofJacques Genest, Stewart Harris, Gary Lewis, RuthMcPherson, George Steiner and Vincent Woo.The guidelines set tighter lipid targets and pro-posed an integrated approach to lipids manage-ment in Canada. The enhanced coordination andinterest in integrated approaches and messagingregarding targets has been reinforced in this workthrough the tremendous support of the CanadianHypertension Education Program and the CanadianCardiovascular Society. While the dyslipidemiaguidelines are published in Canadian Journal ofDiabetes as a separate paper, the current version of the complete guidelines continues to be the e-guidelines version, which is located at theAssociation’s website (www.diabetes.ca). Readersare invited to view online the separate and distinctareas of the macrovascular area of the guide-lines (Vascular Protection, Hypertension andDyslipidemia), as well as the full guidelines docu-ment.

As the intensity of guidelines preparation continues,opportunities also present themselves for interiminformation requirements. Under the authorshipof Agnès Räkel, Jean Marie Ekoé and Céline Huot,a technical review entitled The Diabetic Foot andHyperbaric Oxygen Therapy has been written and willbe published in a future issue of Canadian Journal ofDiabetes.

This year marks the 10th anniversary of the jointProfessional Sections meetings. We have watchedthis event grow from the first meeting, where thetwo sections came together to enhance educationalopportunities in London, Ontario, to the additionof the Canadian Society of Endocrinology andMetabolism (CSEM) in Ottawa in 1999, to the current meeting being planned for Toronto,

Message from the Chair, Clinical & Scientific Section

The Year in Review

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October 19–22, 2006. Our commitment toknowledge transfer from bench to bedside hasadvanced tremendously. As the largest diabetesmeeting held in Canada, the CDA/CSEMProfessional Conference and Annual Meetings in Toronto is projected to welcome more than 3,000researchers, clinicians, educators, healthcareproviders and consumers to a vibrant learningenvironment. The commitment of all volunteersinvolved in the planning of this event facilitates itssuccess, and congratulations are in order to thisyear’s Co-Chairs Edmond Ryan (C&SS), LindaMailhot-Hall (DES) and David Hanley (CSEM),and all those who worked with them to plan andexecute the event.

Last year, our Research colleagues announced the Association’s commitment to an expandedresearch portfolio.We have noted the progress thisyear with the extension of grant ceiling levels forboth Operating and Applied Grants, and increasein doctoral studentships and unique top-up grantsin the Personnel Awards category. Partnershipgrowth continues, with unique opportunities forboth traditional and non-traditional partnerships.This year’s financial contribution to research wasmore than $6 million and will grow to more than$7 million in the next fiscal year. In addition,two new awards will be offered in the next grantcycle: a Clinician Scientist Award and a One-YearInnovation Grant.

Public Policy and Advocacy agendas provideongoing challenges for the Association, and repre-sent an area where the Professional Sections willbe encouraged to play a critical and active role asthe challenges of the National PharmaceuticalStrategy, the Common Drug Review, and specificprovincial directives, such as Bill 102 in Ontario,continue. Our clinical and research expertise pro-vides a valuable perspective for the Association aspolicy issues are addressed.The clinical and scien-tific evidence guides this positioning and is thestrength of organizational messaging.

I would be remiss if I did not acknowledge thefar-reaching significant achievements of someof our colleagues:

• Dr. Daniel Metzger is this year’s recipient of theCanadian Diabetes Association’s Charles H. BestAward;

• Dr. Bernard Zinman is this year’s recipient ofthe American Diabetes Association OutstandingClinician Award; and

• Dr. Ann Macaulay is a 2006 recipient of theOrder of Canada.

As a strong diabetes community, we are alsodeeply saddened when we lose a valued colleagueand friend, as we did this summer with Dr. LiamMurphy. Liam was Director of the DiabetesResearch Group, Head of the Section of Endo-crinology and Metabolism at the University ofManitoba and Consortium Head of Endocrinologyand Metabolism at the two major teaching hospi-tals, St. Boniface Hospital and the Health ScienceCentre. He will be missed by his colleagues acrossthe country.

It is with the greatest confidence that the C&SSwill continue to flourish that I welcome Dr. EhudUr as the new Chair and thank Dr.Amir Hanna for his work in positioning an excellent Executive to continue the Section’s good work. To all theC&SS members who have supported my positionas Chair, your expertise and support is greatlyappreciated. It has been a pleasure to function onyour behalf over the past few years, to meet andlearn from so many of you across the country andto witness your commitment to making a differ-ence for people with diabetes in Canada.

Thank you.

Stewart Harris MD MPH FCFP FACPM

Message from the Chair, Clinical & Scientific Section

The Year in Review (Continued from page 1)

2005 CDA/CSEM Professional Conference and Annual Meetings

Edmonton,Alberta

October 19–22, 2005

Conference Co-Chairs Edmond Ryan MD (C&SS), Lori Berard RN (DES) and André LacroixMD (CSEM) provided leadership for an outstanding conference that attracted 2,300 delegates toEdmonton in October 2005.Attendees were provided with challenging and provocative sessionsthat encompassed the world of diabetes and endocrinology from bench to bedside. Sessionhighlights from the conference include:

• Designing Communities for Healthy Living

• Abdominal Obesity in the Metabolic Syndrome: Implications for Assessment and Management

• Activins and Inhibins in the Normal and Abnormal Regulation of Gonadotropins

• Responding to Emerging Clinical Practice Guidelines Issues:A Look at Lipids

• Diabetes and Cardiovascular Disease:The PROactive Study

Once again, the numbers of abstract submissions for oral and poster presentations increased,further substantiating the importance of the CDA/CSEM Professional Conference and AnnualMeetings as a venue for introducing and sharing important new clinical and researchdevelopments.

Conference Co-chairs Edmond Ryan MD (C&SS), Linda Mailhot-Hall RD (DES) and DavidHanley MD (CSEM) have organized an equally exciting program for the 2006 CDA/CSEMProfessional Conference and Annual Meetings, to be held in Toronto, Ontario from October 18 to21, 2006. The trade show continues to grow, as does sponsor support of the conference—anincreasingly popular Canadian diabetes event.

3C&SS Annual Report 2006

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Liaisons And Partnerships

Nutrition

The National Nutrition Committee had a busy year. Its main accomplishments were:

• Publication of the Beyond the Basics Resource. This 148-page manual contains material to

assist anyone, particularly those persons with diabetes, in improving their eating habits and

meal planning for diabetes prevention and management.The manual promotes variety in food

choices, encourages the selection of foods that are high in nutrients and fibre, energy-diluted

and low in fat.The Resource was created for consumers, and serves as a companion piece to the

Beyond the Basics poster.

• A review paper entitled “The Impact of Low-carbohydrate Diets on Glycemic Control and

Weight Management in Patients With Type 2 Diabetes” was published in the September 2006

issue of Canadian Journal of Diabetes.

• Development of a tool on strategies to achieve healthy lipids and new low-density lipoprotein

cholesterol targets for diabetes, that includes lifestyle changes and medications.This tool will

Clinical Practice Guideliness – Dyslipidemia

Lipid Expert Committee

Lawrence Leiter MD FRCPC FACP, Chair

Jacques Genest MD FRCPC

Stewart Harris MD MPH FCFP FACPM

Gary Lewis MD FRCPC

Ruth McPherson MD PhD FRCPC

George Steiner MD FRCPC

Vincent Woo MD FRCPC

The Canadian Diabetes Association published new clinical practice guidelines for dyslipidemia

in the September 2006 issue of Canadian Journal of Diabetes. Entitled “Dyslipidemia in Adults

With Diabetes” the guidelines updated the existing Macrovascular Chapter of the 2003 Clinical

Practice Guidelines for the Prevention and Management of Diabetes in Canada. The necessity of this

revision was two-fold: first, important clinical trials on the treatment of dyslipidemia in diabetes

were published that provided significant evidence relevant to pharmacologic agent choice

and treatment targets. Second, revised lipid guidelines were being developed under the auspices

of the Canadian Cardiovascular Society and the groups recognized the importance of

presenting harmonized messages. Readers can view the complete guidelines document at

http://www.diabetes.ca/cpg2003/.

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be launched at the CDA/CSEM Professional Conference and Annual Meetings, and will assist

healthcare professionals and patients to implement the new dyslipidemia guidelines.

• Publication of the educational tool entitled Alcohol + Diabetes.

• Preparation of a technical review of the medical literature and recommendations for best

practices in the nutritional management of gestational diabetes mellitus.

• A search and review of the medical literature was conducted on nutrition interventions for

groups at high risk for developing type 2 diabetes.

• Several consultations with Health Canada took place regarding the update of Canada’s Food

Guide to Healthy Eating.

Research

Canadian Diabetes Association Research Strategic Plan

The Association has now completed the first year of operationalizing the research strategic plan.

The research plan aligns with the goals of the broader Association strategic plan, which

recognizes the role of research throughout various aspects of the Association’s Mission and

Vision through to 2009. The Association will:

1. Fund and/or facilitate the best research in Canada as aligned with the Associations strategic

goals.

2. Support retention and expansion of diabetes research expertise in Canada.

3. Support the prevention and/or reversal of type 1 and type 2 diabetes.

4. Disseminate research findings.

5. Advocate increasing overall investment in diabetes research in Canada.

Over the past year and moving into 2006–2007, we have a number of successes to highlight. In

the 2006 Awards and Grants Competition we received 205 applications across our core port-

folio of research programs. Of these, approximately one-half were in the Operating Grant

competition and we were successful in funding 26% of applications, representing an increase in

the success rate over last year. In addition, we began a phased-in approach to increase our funding

ceiling to $100,000 per year for a maximum of three years.We also made a determined effort to

improve the success rate of our Doctoral Student Research Competition by offering funding to

more than 25% of applicants. Overall, in the 2006–2007 grant year, we are funding a total of 119

research programs, including Personnel Awards and Partnerships.

For the 2007 Competition, two new grant/award categories will be offered: Clinician Scientist

Award and Innovation Grants. The aim of the Clinician Scientist Award is to support the

development and retention of clinician scientists working in diabetes research in Canada, while

the Innovation Grants are intended to promote creativity and hypotheses development by

diabetes researchers. Also, the Association is now a member of the Common CV, and as such

researchers will submit their Common CV with their application.

C&SS Annual Report 2006

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Partnerships

Research partnerships continue to provide opportunities for the Association to fund research and

build research capacity through novel mechanisms. Synergies among funding partners provide

specialized research opportunities that otherwise would not be possible. These unique

agreements are strong indicators of the partners’ commitments to the development of future

scientists and clinicians in Canada. This year we are continuing with a number of ongoing

partnerships and have entered into an exciting new one as well.

Chronic Disease New Emerging Teams (NET) Partnerships

This is a partnership with the Canadian Institutes of Health Research (CIHR) Institute of

Nutrition, Metabolism and Diabetes (INMD), the Institute of Circulatory and Respiratory

Health (ICRH), the Institute of Gender and Health (IGH), the Heart and Stroke Foundation of

Canada (HSFC) and the Kidney Foundation of Canada (KFOC).The objective of this initiative is

to support the development of research teams and to foster multidisciplinary and cross-theme

research in the area of chronic disease.This year, six teams will receive their fifth year of funding.

CDA/CIHR Doctoral Student Research Awards

This partnership with the CIHR INMD concluded in 2006.

Target Obesity

This is a partnership with the HSFC, the CIHR INMD, the Institute of Cancer Research ICR,

Institute of Gender and Health (IGH), Institute of Human Development, Child and Youth Health

(IHDCYH), and Institute of Musculoskeletal Health and Arthritis (IMHA). The aim of this

initiative is to provide special opportunities in the area of obesity research training.This year, one

New Investigator, four Post-Doctoral Fellowships and four Doctoral Student Research Awards

are receiving their third year of funding.

CDA/Novo Nordisk Canada Inc.Doctoral Student Research Award

This partnership was forged with Novo Nordisk Canada Inc. to enhance the Association’s

doctoral student research award program. One student, in the final year of their third-year

award, is receiving funding through an unrestricted educational grant from Novo Nordisk

Canada Inc.

Cardiovascular Complications of Diabetes

This is an exciting new partnership with the Canadian Institutes of Health Research (CIHR),

Institute of Circulatory and Respiratory Health (ICRH), Institute of Aboriginal Peoples’ Health

(IAPH), Institute of Infection and Immunity (III), and the Institute Nutrition, Metabolism and

Diabetes (INMD), the Heart and Stroke Foundation (HSF), Pfizer Canada, Finnish Funding

Agency for Technology and Innovation (Tekes), and Health Canada. There are two granting

opportunities associated with this partnership, i.e.Team Grants and High Risk Seed Grants, with

funding announcements expected in November for funding beginning in January 2007.

7C&SS Annual Report 2006

Visionary Partnerships

As we move forward to enhance our research portfolio, new innovative and uniqueopportunities will be a strategic focus of attention. Such partnerships will not affect corefunding activities, but will be supported as special initiatives.

University of British Columbia

The Association’s partnership with the University of British Columbia has had a successfulyear of fund development.The goal is to recruit three scientists and provide salary supportfor their first five years.

The first year of the strategic plan has seen tremendous growth in the research programs andis positioned to set the stage for future progress.

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Advocacy

Diabetes Report 2005

Released in December 2005, Diabetes Report 2005 analyzed federal, provincial and territorial

programs, and concluded that there continued to be startling variations in drug plan coverage

and financial support levels for people with diabetes, and significant inconsistencies in coverage

for diabetes medications, supplies and devices. As a result of the analysis, which showed that it

cost someone with diabetes but no complications anywhere from $0 in the Northwest Territories

(to manage type 1 diabetes) to $3,894.68 in Newfoundland (to manage type 2 diabetes), Diabetes

Report 2005 called for the creation of a national catastrophic drug plan that would ensure

Canadians did not pay more than 3% of their net family income on all medications, devices and

supplies. The release of the report generated over 17.5 million media hits, and has been

distributed to all federal, provincial and territorial elected officials, as well as key civil servants in

each jurisdiction.

National Advocacy Leadership Forum 2006 and Diabetes Day on the Hill

This year’s National Advocacy Leadership Forum was held June 5–6, 2006. On the first day, more

than 100 diabetes advocates were trained on advocacy techniques and developed messaging in

support of the Association’s ask for a national catastrophic drug plan. On the second day, the

training was put into action during the first-ever Diabetes Day on the Hill. Diabetes advocates

briefed their Members of Parliament individually in the morning, and six diabetes advocates told

their personal stories during the luncheons held for the Conservative Caucus, the Liberal Caucus

and the NDP Caucus at noon.The Minister of Health, the Parliamentary Secretary of the Hill and

the Opposition Health Critics attended and spoke at their caucus luncheons. After Question

Period, the Speaker of the House hosted the Association at a Parliamentary Reception in his

private dining room. By day’s end, diabetes advocates had briefed 86 MPs personally, there were

statements made in both the Commons and the Senate, and the Health Minister’s office requested

representatives of the Association meet with his officials and the Parliamentary Secretary to

discuss the Canadian Diabetes Strategy after the reception. Since June 2006, three MPs have used

the Association’s briefing materials to speak in support of our ask for a national catastrophic drug

plan in community newspaper articles and householders that were mailed to their constituents.

Disability Tax Credit

The National Advocacy Council (NAC) continues to work with the federal government’s Canada

Revenue Agency to encourage a better understanding of diabetes in order to try to help

Canadians with diabetes to qualify for the Disability Tax Credit (DTC) worth $6,596.The federal

government agreed that all insulin-dependent children age 15 and under can claim the DTC

because they meet the eligibility criteria for “life-sustaining” therapy. Anyone over age 16 must

have a physician certify that the insulin therapy takes on average a minimum of 14 hours each

week to administer and monitor blood glucose levels.Very few Canadians with diabetes qualify

under this criteria, and this remains a source of concern for the Association.

9C&SS Annual Report 2006

National Pharmaceutical Strategy/Common Drug Review

The NAC has developed a draft set of principles for the Association’s position on the nine

components of the National Pharmaceutical Strategy that the federal, provincial and territorial

Ministers of Health will release shortly.The Association’s most developed position is on a national

catastrophic drug plan; however, the principles are also designed to ensure that the needs of

Canadians living with diabetes are addressed in relation to a single national formulary, faster

access to breakthrough medications, real-world drug safety, clinical practices and cost-

effectiveness strategies.The principles were developed from and influenced by the Association’s

experience with the Common Drug Review, and reflect our growing concern that if current

cost-benefit criteria remain the sole determinant, there will be no new diabetes medication

recommended for federal, provincial or territorial formulary coverage.

Employment Discrimination and the RCMP

The NAC evaluates requests for assistance received from people who feel they have been

discriminated against due to their diabetes, and when the issue relates to an area of national

relevance, provides support to the individual involved. This year, the NAC supported the legal

case of Kenneth Hall, who had been refused employment with the Royal Canadian Mounted

Police (RCMP) because he has diabetes. After filing the case with the Canadian Human Rights

Tribunal, the NAC’s C&SS representative worked with the RCMP to develop new employment

guidelines for Canadians with diabetes that are more inclusive and result in the employment of

Canadians with diabetes being assessed individually by the RCMP on a case-by-case basis. This

successful outcome will form the basis of future NAC efforts to meet and encourage similar

guidelines in other safety sensitive positions.

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Awards And Recipients

Gerald S.Wong Service Award

This award was established in 1994 to honour the memory of Dr. Gerald Wong, an advocateof the highest standard in diabetes care and education, and is awarded to a physician inrecognition of significant contribution to the diabetes community.

2006 Lawrence A. Leiter 1999 Keith G. Dawson2005 N.Wilson Rodger 1998 Errol B. Marliss2004 Robert J. Gardiner 1997 John A. Moorhouse2003 Amir Hanna 1996 Meng-Hee Tan2002 Bernard Zinman 1995 Robert Ehrlich2001 Sara J. Meltzer 1994 George Molnar

2000 Denis Daneman

Canadian Diabetes Association, Great-West Life,London Life and Canada Life Young Scientist Award

This award encourages, by appropriate recognition, outstanding research conducted in

Canada by young scientists in the field of diabetes.

2006 C. Bruce Verchere 1997 Jean-Pierre Dépres

2005 André Marette 1996 Daniel Drucker

2004 Gregory S. Korbutt 1995 Diane Finegood

2003 Michael B.Wheeler 1993 George Fantus

2002 Robert A. Hegele 1991 Gerald Van de Werve

2001 Gary Lewis 1990 Amira Klip

2000 Pere Santamaria 1988 Bernard Zinman

1999 Hertzel C. Gerstein 1987 Jerry Radziuk

1998 Patricia Brubaker

11C&SS Annual Report 2006

For the year ending August 31, 2006

Revenues Budget Actual

Sponsorship: Guidelines --- ---Membership Fees $25,004 $22,450Professional Conference (net) 38,545 122,975Other Income (CPG sales) 9,996 46,936Total 73,545 192,361

Expenses Budget Actual

Clinical & Scientific Section Awards $2,544 $2,675Continuing Health Education 30,576 1,494Revisions of Guidelines 161,808 121,187Literature 0 7,438Membership 13,176 6,485Awareness 7,056 1,915 Annual General Meeting 28,112 31,736National Executive 15,096 12,282Editorial Advisory Board 3,060 ---Administration 93,996 90,468Total 355,424 275,680

Net Surplus (Deficit) ($281,879) ($83,319)

Unaudited Financial Statements

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C&SS Executive Position Member Member/Liaison to Council/Committee

Chair Dr. Stewart Harris All C&SS Ad Hoc and Standing Committees

CDA National Board of Directors

C&SS Nominating Committee

Executive Committee, 2008 Clinical Practice

Guidelines Revision

Past Chair Dr.Amir Hanna Chair, C&SS Nominating Committee

Editor-in-Chief, Diabetes Dialogue

Steering Committee, 2008 Clinical Practice

Guidelines Revision

Vice Chair, Clinical Dr.Vincent Woo Chair, 2008 Clinical Practice Guidelines Revision

National Awards Committee

Vice Chair, Scientific Dr. Ehud Ur National Research Council

Associate Editor, Canadian Journal of Diabetes

Steering Committee, 2008 Clinical Practic

Guidelines Revision

Secretary/Treasurer Dr. Sarah Capes Executive Committee, Clinical Practice Guidelines

2008 Revision

2006 National Conference Program Committee

Councillor Dr. Ian Blumer Expert Committee, 2008 Clinical Practice

Guidelines Revision

Chair, 2008 Clinical Practice Guidelines

Dissemination Committee

Councillor Dr. Maureen Clement Steering Committee, 2008 Clinical Practic

Guidelines Revision

National Advocacy Council

Joint Professional Sections Continuing Health

Education Committee

Councillor Dr. Réjeanne Gougeon National Nutrition Committee

Expert Committee, 2008 Clinical Practice

Guidelines Revision

Councillor Dr.Tina Kader Expert Committee, 2008 Clinical Practice

Guidelines Revision

Clinical & Scientific Section Executive Activities

October 2005 - October 2006

C&SS Executive Position Member Member/Liaison to Council/Committee

Councillor Dr. Daniel Metzger National Camp Advisory Committee

Camp Medical Task Force

National Editorial Board, Canadian Journal of

Diabetes

Councillor Dr. Ronald Sigal Steering Committee, 2008 Clinical Practice

Guidelines Revision

Operating Grants Review Committee

Councillor Dr. Parmjit Sohal 2006 National Conference Program Committee

Expert Committee, 2008 Clinical Practice

Guidelines Revision

Councillor Dr. Minna Woo 2006 National Conference Program Committee

Operating Grants Review Committee

ADQ Representative Dr. Céline Huot Joint Professional Sections Continuing Health

Education Committee

13C&SS Annual Report 2006

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Canadian Diabetes Association MissionTo promote the health of Canadians through diabetes research, education, service and advocacy.