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Language reflects and shapes our thoughts, feelings, behaviours and experiences and can have a profound impact on the lives of people with and at risk for diabetes. Inappropriate language has a negative impact on self-efficacy, well-being and confidence of people living with diabetes, can seriously undermine experiences with health-care providers and, more broadly, can contribute to diabetes stigma. To date, Diabetes Canada has had no formal position to facilitate positive and affirming attitudes towards diabetes, which is reflected by the use of more appropriate language around diabetes. This consensus statement was developed by Diabetes Canada, by a working group comprised of health-care professionals and lived experience subject matter experts (LESME: patient partners) and validated by volunteers from Diabetes Canada's Professional Section and Diabetes Action Canada's Patient Circles. The principles outlined in this document will be valuable in three broad domains: 1) Diabetes Canada's internal and external communications, 2) increasing public awareness of diabetes and reduction of stigma around diabetes and 3) enhancing the health, wellness and self-efficacy of persons living with diabetes. A major strategy to effect change in this third domain will be to disseminate these concepts broadly among all current (and future) health-care professionals to help integrate positive and supportive attitudes in everyday clinical practice.

In the past century, since the discovery of insulin, methods of insulin delivery and glucose monitoring have advanced technologically. In particular, the introduction of insulin pumps, providing continuous subcutaneous insulin infusion (CSII), and continuous glucose monitors (CGMs) have been revolutionary for people living with type 1 diabetes. In this review, we have focussed on automated insulin delivery (AID) systems and discuss the implications of both approved and off-label options for the user and health-care providers. By pairing insulin pumps with CGM, AID systems facilitate automated adjustment in insulin delivery based on CGM readings. A subset of these have been developed commercially and were granted regulatory approval. In contrast, unregulated do-it-yourself AID systems, designed and set up by people living with type 1 diabetes and their families, have advanced rapidly and are gaining popularity worldwide. These patient-driven technologies have demonstrated impressive user self-reported improvements in glycemic control and quality of life, but have not been evaluated in any formal randomized controlled trials or by regulators. This presents challenging uncertainty for health-care providers, in addition to ethical and legal implications in supporting people with diabetes who wish to use these technologies. The current knowledge, opinions and practices relating to the use of AID systems across Canada are unknown. Gathering this information will highlight current practice and areas of knowledge gaps and concern and will assist in focussed education. This understanding is crucial to ensure people with type 1 diabetes using these systems have access to optimal, consistent and safe patient-centred care.

Objective To identify interventions that improve cultural safety for Indigenous people living with diabetes in the health care setting, and their potential impact on patients and health care professionals. Methods Using a systematic approach, we conducted a rapid review of quantitative, qualitative and mixed studies between January 2000 and February 2018 in Medline, Embase, Web of Science, ERIC, CINAHL, and PsycINFO. Two reviewers independently identified, selected and reviewed studies relating to cultural safety in diabetes care for Indigenous populations in Canada, New Zealand, Australia, and the USA. Results Out of the 406 studies identified, we retained 7 articles (2 strong quality, 5 moderate quality) for analysis. Included studies evaluated three main types of strategies to improve cultural safety: educating health professionals, fostering culturally safe practices by modifying clinical environments, and integrating Indigenous health professionals in the workforce. Studies showed that culturally safe interventions had positive effects on clinical outcomes for patients, increased patient’s satisfaction and health professional confidence in providing care, as well as patient access to health care. Conclusions While based on a small number of studies, the review establishes moderate evidence that interventions to improve cultural safety can have positive effects on the treatment of diabetes in Indigenous populations. Further research with stronger study designs should be conducted to further validate the present conclusions.

Introduction Type 1 diabetes is an autoimmune disease resulting from insulin deficiency and must be carefully managed to prevent serious health complications. Diabetes education and management strategies usually focus on meeting the decision-making needs of children and their families, but little is known about the decisional needs of people with adult-onset type 1 diabetes. Objective The aim of this study was to explore the diabetes-related decision-making needs of people diagnosed with adult-onset type 1 diabetes. Methods An interpretive descriptive qualitative study was conducted. Participants who self-identified as having adult-onset type 1 diabetes were interviewed using a semistructured interview guide. Transcripts were coded to identify needs, supports and barriers using thematic analysis. Results Participating in the study were 8 adults (2 men, 6 women), ages 33 to 57, with type 1 diabetes for durations of 1 to 20 or more years. Their decision-making needs are summarized in 6 broad themes: 1) people diagnosed with type 1 diabetes are launched into a process of decision-making; 2) being diagnosed with type 1 diabetes means you will always have to make decisions; 3) knowledge is crucial; 4) personal preferences matter; 5) support is critical for decisions about self-care in type 1 diabetes; 6) living with type 1 diabetes means making very individualized decisions about daily life. Conclusions The findings describe the sudden and ubiquitous nature of type 1 diabetes decision-making and the need to tailor approaches for making care decisions in type 1 diabetes. People diagnosed with adult-onset type 1 diabetes require access to reliable information, support and opportunities for participation in decision-making.