Canadian Diabetes & Endocrinology Today

Optimizing the Use of Automated Insulin Delivery (AID) Systems in Routine Clinical Care of People with Type 1 Diabetes

Alanna Chambers — 2025-11-18

With the updated Diabetes Canada Clinical Practice Guidelines recognizing automated insulin delivery (AID) as the standard of care for people with type 1 diabetes (PwT1D), clinicians play a vital role in supporting individuals to adopt and optimize use of this technology.

AID systems integrate insulin pump therapy (IPT) and real-time continuous glucose monitors (rtCGM) in conjunction with a control algorithm to automate various aspects of insulin delivery. The recommendation to adopt AID is supported by robust evidence from both randomized-controlled trials and real-world studies across diverse populations, including all ages, previous experience with technology, baseline glycemia, and self-management behaviours. Glycemic benefits include consistent improvements in time in range (TIR) (often by >10%), and reductions in A1C, mean glucose levels, and hypoglycemia. Additionally, AID use has shown important improvements in person-reported outcomes, including reduced diabetes distress, reduced fear of hypoglycemia, improved quality of life, and improved sleep.

Youth-Onset Type 2 Diabetes: A Review

M. Constantine Samaan — 2025-11-18

Type 2 diabetes (T2D) was once considered a disease of adults. However, the obesity pandemic has helped its transition to the pediatric population. While type 1 diabetes remains the most common type of pediatric diabetes in Canada, the incidence of youth-onset T2D has increased by 60% in recent years. Canada has one of the highest prevalences of youth-onset T2D in the world, with approximately 50% of new cases annually occurring in Indigenous children, with the remaining 50% of cases occurring in other ethnic groups, including Caucasians.

As a relatively new disease in youth, there is a lack of natural history data for youth-onset T2D to predict long-term outcomes. However, its aggressive nature in youth suggests that these patients will likely have a significant burden of disease related to cardiometabolic risk, comorbidities, and complications.

In this paper, we highlight current knowledge on the pathophysiology of youth-onset T2D, diagnostic criteria, the impact of obesity on diabetes risk, comorbidities and complications, and current treatments.

Running a Trans-Welcoming Clinical Practice

Irena Druce — 2025-11-18

A wide range of terms are used to describe gender-diverse people, including transgender, gender-fluid, gender-queer, non-binary, and two‑spirit, reflecting the diversity of the community itself. Transgender and gender-diverse patients (TGDP) may experience gender dysphoria—the distress that arises when their gender identity does not align with the sex assigned at birth. TGDP are estimated to represent between 0.1% and 2% of the global population; in Canada, the 2019 census reported a prevalence of 0.35%.

Access to gender-affirming care is strongly linked to improved health outcomes. One study found that suicidal ideation decreased from 67% prior to transition to just 3% afterward. Yet, despite the clear benefits, TGDP continue to face major barriers to care. According to the Trans PULSE survey, as of 2019, only 35% of respondents had completed their medical transition. Even in general healthcare, access remains inequitable: while 81% of respondents reported having a primary care provider (PCP), only 52% felt comfortable discussing trans‑related health issues with their PCP, and over 40% reported having an unmet healthcare need. These disparities reflect the ongoing impact of transphobia and prior trauma within healthcare systems, and as a result, TGDP face disproportionate health burdens compared to the general population, including lower rates of cancer screening, higher rates of mental health disorders, and sexually transmitted infections (Figure 1).

Addressing these inequities requires urgent action to expand access to gender-affirming hormone therapy, surgery, and mental health care. Equally important, healthcare systems must adopt inclusive policies and practices that improve access to all forms of care for TGDP. This article outlines practical measures that any healthcare practice can implement to create a more welcoming and affirming environment.

Novel Treatment Options For Menopausal Symptoms

Nathalie Gamache — 2025-11-18

The world of menopause is undergoing a renaissance. In recent years, medical experts have taken to social media, igniting a long overdue surge of information on the subject that helps debunk the fear of menopausal hormone therapy (MHT), which stems from the 2002 Women’s Health Initiative (WHI) study.¹ The devastating consequences on health and wellness were profound: an entire generation of women was suddenly deprived of symptom relief and quality of life (QOL) due to the marked decline in hormone prescriptions in North America. These effects continue to echo today. The near extinction of medical education on mature women’s health and wellness in our academic institutions since 2002 has left healthcare professionals ill-equipped to guide the next generation of menopausal women who seek contemporary medical advice and refuse to “live their mothers’ menopause.” The creation of the Menopause Foundation of Canada in 2022, recent sold-out menopause conferences, and renewed interest from pharmaceutical companies is convincing evidence that menopause is finally receiving the recognition and attention it deserves.