International Diabetes Collaboration
Acting Program Leader: Dr. Julia Lowe
Three quarters of people with diabetes are now living in countries that are going through rapid economic development and changes in lifestyle. In the next 20 years, East Asia (China mainly), Africa, the Middle East, and South-East Asia will shoulder the greatest increase in diabetes prevalence. The University of Toronto, in conjunction with Canadian Association of General Surgeons and Canadian International Development Agency (CIDA), has developed a sustainable, integrated, multi-level Diabetes Education, Training, and Capacity Building model to tangibly impact the lives of those living with diabetes internationally.
The Guyana Diabetic Foot Project has already resulted in a 50% reduction in diabetes related major amputations. The project uses proven U of T educational resources such as the International Interprofessional Wound Care Course to train Guyanese key opinion leaders. In partnership with the BBDC, the Global Diabetes Collaboration Initiative plans to attract funding in order to expand these programs into the Caribbean, Sub-Saharan Africa, and the Indian subcontinent and in addition to bring effective strategies back to our own disadvantaged populations in Ontario and in Canada.
Our International Diabetes Collaboration team has been working with clinicians in two low resource countries, Ethiopia and Guyana, to improve diabetes care.
Diabetes-related amputations are a major problem in Ethiopia, which has the fourth highest number of persons with type 2 diabetes in Africa. Collaborating with their Ethiopian colleagues and extending the successful model developed in Guyana, Canadian clinicians have built a diabetic foot centre at Tikur Anbessa (Black Lion) Hospital in Addis Ababa, Ethiopia. Canadian funds supported renovations, necessary basic equipment including plantar pressure redistribution supplies, and travel for Canadian visitors. U of T wound care experts regularly visit Ethiopia to establish the centre and train a local interprofessional team. This training complements the ongoing endocrinology residency program supported by the Toronto Addis Ababa Academic Collaboration as well as the International Interprofessional Wound Care Course held in South Africa and United Arab Emirates.
Funded by a World Diabetes Foundation grant in 2016, the three-year Guyana Diabetes Care Project has partnered with the Ministry of Public Health and the national referral hospital, the Georgetown Public Hospital Corporation, as well as Orbis, an international eye care NGO, and the WONDOOR global health program to implement a multi-component project that will: introduce screening and treatment for diabetic retinopathy to Guyana, begin universal screening for diabetes in pregnancy, validate the Indian Diabetes Risk Score in Guyana and expand the use of the Guyana Health Information System, an electronic medical database.
The major project goal is to improve the health of 23,300 persons in Guyana by 2019. This will be achieved by:
- Educating adults in lifestyle changes that prevent type 2 diabetes
- Identifying and treating previously undiagnosed persons
- Screening pregnant women for diabetes in pregnancy and treating women with this condition
- Screening people with diabetes for diabetic retinopathy and treating persons with sight threatening diabetic retinopathy by laser
- Increasing the knowledge and capacity of health care providers practising diabetes care and train further colleagues
- Reducing the negative consequences of specific complications of diabetes, specifically foot ulcers, diabetes in pregnancy, gestational diabetes and diabetic retinopathy.
Fundus cameras to screen for diabetic retinopathy have been purchased and local optometrists trained in their use. With the recent purchase of new laser and ancillary equipment and training, laser photocoagulation will soon be available to those with sight threatening diabetic retinopathy. Screening for diabetes in pregnancy has begun and the completion of the WHO chronic disease STEPS survey will allow the validation of the Indian Diabetes Risk Score.
In the News