TNDMS - The National Diabetes Management Strategy
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The National Diabetes Management Strategy seeks to clarify the status of diabetes management and to evaluate models of care and interventions to improve the quality of diabetes management in Canada.


Sir Frederick Banting
Discovery of Insulin


start of new






About TNDMS ...

About the Strategy


A National Partnership to Evaluate Diabetes Care in Canada

With the objective of advancing the management of diabetes in Canada, Western University and the Canadian Diabetes Association (CDA) joined together to establish the National Diabetes Management Strategy (NDMS). Each committed $1 million to the Strategy and committed to raise a further $3 million to support the activities of the CDA Chair and the various components of the Strategy. Generous donations from the private sector have complemented the commitments made by Western and the CDA and will firmly secure the key components of Strategy.

Western is recognized as a world leader in many research areas, including diabetes. Our strength and leadership in diabetes dates back to 1921, when Sir Frederick Banting was an instructor at Western University and conceived the idea that led to the discovery of insulin. For over 50 years, the CDA has been the national leader in promoting the health of Canadians through diabetes research, education, service and advocacy. The CDA has grown to include a presence in more than 150 communities across the country.

As healthcare data collection moves to an electronic medical record format, there is a unique opportunity to track and measure the interactions between physician and patients, and to evaluate the impact of diabetes care models and interventions on patient outcomes.


Why is a National Diabetes Management Strategy Needed?

Diabetes continues to affect ever-increasing numbers of people in Canada and around the world, while public awareness of the disease remains low. If predictions of diabetes prevalence are fulfilled, in 2030, 439 million people worldwide will have diabetes (1) and total direct healthcare expenditure on diabetes worldwide will exceed $490 billion USD. (2) In Ontario alone, it is estimated that by the year 2010, more than 10% of adults will have diabetes. (3)

While prevalence rates vary by province and by research source, current estimates put the national prevalence of diabetes at 6.2%, or 2 million people. (4)

The growing epidemic of type 2 diabetes in Canada can be attributed in large measure to the following:

  • an aging population
  • increasing prevalence of obesity (the major modifiable risk factor for type 2 diabetes)
  • sedentary lifestyle, and
  • growth in populations at high risk.

In addition, socioeconomic and environmental factors affect obesity and diabetes rates.

Despite multiple therapeutic options, treatment in many patients appears to be inadequate to minimize their risk of developing complications. For example, approximately 50% of Canadians with diabetes are not achieving blood glucose targets, (5)  70% are not achieving blood pressure targets (6) and 40% are not achieving cholesterol targets. (6)

In Canada, the vast majority of people with diabetes receive care exclusively from a family doctor. (7). However, the prevalence of diabetes is increasing at a time when many communities are experiencing shortages of family physicians. In addition, many physicians are limiting access to their practices or planning on limiting the number of hours they work. (8). New models of care that use interdisciplinary approaches to enhance the management of chronic disease are essential to ensure that Canadians with diabetes have access to primary health care.

There are no simple solutions to address this diabetes epidemic. Broad-based strategies are needed to ensure adequate human and financial resources to provide population-based diabetes and obesity prevention strategies, screening for diabetes and pre-diabetes, individual risk factor reduction through the achievement of metabolic targets and lifestyle modification goals, and management of diabetes-related complications and comorbidities.


  1. International Diabetes Federation. Global burden: prevalence and projections, 2010 and 2030 . Available at:
  2. International Diabetes Federation. Available at:
  3. Lipscombe LL, Hux JE. Trends in diabetes prevalence: incidence and mortality in Ontario, Canada 1995–2005: a population-based study. Lancet. 2007;369:750-756.
  4. Public Health Agency of Canada. Report from the National Diabetes Surveillance System: Diabetes in Canada, 2009. Available at:
  5. Harris SB, Ekoe J-M, Zdanowicz, Webster-Bogaert S. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Res Clin Pract. 2005;70:90–97.
  6. Manoela B, Casanova A. Dawson K, et al. Management of vascular risk factors in an cohort of patients with type 2 diabetes mellitus (DM) in Canada: significant gap between guidelines recommendations and current practice. American Diabetes Association Scientific Sessions; June 2008. Abstract 1212–P.
  7. Jaakkimainen L, Shah BR, Kopp A. Sources of physician care for people with diabetes. In: Hux JE, Booth GL, Slaughter PM, Laupacis A (eds). Diabetes in Ontario: An ICES Practice Atlas. Toronto, ON: Institute for Clinical Evaluative Sciences; 2003:9.181–9.191. Available at: morg_id=0&gsec_id=0&item_id=1312
  8. Canadian Medical Association. Correspondence from Brian Day, President, Canadian Medical Association, to James Rajotte Chair, Standing Committee on Industry, Science and Technology. February 23, 2008. Available at: Click here


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