Catalyst Grant Feature- Developing and Implementing a Personalized Care Pathway to Improve the Management of Young-Onset Type 2 Diabetes in Peel Region

Project Objective: Collaboratively engage patients and community members to adopt a personalized diabetes care pathway to meet the diverse needs of young adults across all ethnicities in the Peel Region. 

Now called simply, PATHWAYS, this Catalyst Grant project looks at building a care pathway for better managing young-onset type 2 diabetes in Peel Region. Led by Dr. Calvin Ke from the University of Toronto, the study explores how we can ensure better outcomes for those who are diagnosed under the age of 40. 

“This is a group that’s at extremely high risk of developing complications, so we’re very focused on improving overall management, but we’re also looking at it from an equity perspective. These are the people who are diagnosed youngest in life, they have families, they are of working age, diabetes quality of life issues hit them particularly hard,” Ke says. 

With the number of people diagnosed with young-onset type 2 diabetes having doubled in the last 30 years, there is a need to look for new solutions. “Currently all adults with type 2 diabetes are treated in similar ways, we don’t have customized treatment pathways or management tools that address the unique needs of people at different stages of life,” says Ke. 

Adapting the process of the successful JADE program in Hong Kong, Ke’s team is looking to change this. In collaboration with their partners, the Diabetes Management Centre at Trillium Health Partners, CarePoint Health, LAMP Community Health Centre and Punjabi Community Health Services, as well as a group of 30 people diagnosed with the condition, they are exploring the current barriers and facilitators to care and successful self-management in those with young-onset type 2 diabetes.  

The information they collect will inform the development of a tool to better support a very diverse range of people living with the condition. Designed for use by diabetes educators, who are often the main source of information for patients, the tool will move beyond a standardized diabetes assessment and create a more personalized report for the patient. This report would provide a cardiovascular risk prediction, the current status of modifiable risk factors, and personalized recommendations.  

The goal is to arm people with young-onset type 2 diabetes with information about their health and ways to improve their potential outcomes. Study participants with lived-experience expressed that having long-term predictions and guidelines was more helpful than the current standard of five year predictions. For someone diagnosed at 30, what may happen in five years could be very inconsequential. However, understanding that if they don’t make changes or keep up with their healthcare they may have a stroke in 15 years was helpful in framing the need to take action right away to prevent this. Lifetime risk predictions seemed more useable and understandable to the test group, Ke explains. And, while it did create negative emotions to see these predictions, respondents also thought it was important context.  

“Some people thought the numbers were scary. A lot of people thought they showed this was an urgent issue, and they very commonly tied it to the experience of their family members, because young adults with type 2 diabetes often have a family history of type 2,” Ke says. “They talked about their family members who may have had kidney failure, a heart attack or a stroke and how seeing that risk in themselves created a sense of motivation.” 

This ability to look at the long-term helped participants see the benefits of improving self-management and created more openness to that conversation. While not everyone in the study felt this strategy worked for them, the suggestions received offered good opportunities for further discussion about personalization. The research team now has a psychologist with expertise in diabetes involved to help them understand how their tool can consider these different emotional responses, including highlighting the potential positive outcomes of taking early action. 

Moving forward, the team is looking at other features they could build into the tool and how to pilot the project in Peel Region.  

“In Canada and around the world, tools that are developed for young onset type 2 diabetes management are really lacking. And there's very few, if any, evidence-based tools for this population specifically, and certainly none that's been developed with this type of engagement and consultation,” says Ke. “Ultimately, once we develop everything, we want to be able to implement it and find out how effective it is in the real world.”