Dr. Tricia Tang Receives Funding Award through a JDRF – Michael Smith Health Research BC Partnership

This award will help Dr. Tang expand her pilot program REACHOUT, designed to provide greater mental health support to people living with type 1 diabetes in British Columbia.

JDRF Canada is thrilled to partner with Michael Smith Health Research BC to award type 1 diabetes (T1D) researcher Dr. Tricia Tang a Health Research BC Health Professional-Investigator (HP-I) award.

A key focus of JDRF is improving the mental health outcomes for people living with type 1 diabetes (T1D). Part of this is creating research partnerships that help extend and further our impact in addressing the gaps in Canadian mental healthcare for people with T1D.

As part of our goal to increase Canadian research capacity in mental health and T1D, JDRF has partnered with Michael Smith Health Research BC, British Columbia’s health research agency, to offer salary support to a researcher working in the T1D field through their HP-I award program. Health Research BC inspires and connects curious, creative, and passionate minds to drive discovery and innovation for better health and health care.,

Collaboration is key to both organizations, as partnership helps to support excellence in health research such as funding outstanding researchers like Dr. Tang; as well as help grow needed research talent and innovation.

The HP-I Program helps close the gap between health research and its implementation to improve health care. HP-I awards support health professionals who are actively involved in patient care to conduct and apply research relevant to health and/or the health system to ultimately improve health outcomes in BC and beyond.

Health Research BC is delighted JDRF are partnering with us to co-fund Dr. Tang’s HP-I award. We value strong partnerships that are integral to fostering world-class health research in BC. Co-funding on Dr. Tang’s award is particularly exciting as her research looks to address access to mental health support for people with T1D living in rural and remote communities,” says Dr. Danielle Lavallee, VP Research at Health Research BC.

These unique awards provide clinicians with protected time for research and as a result, these awards are highly competitive. These awards build research capacity, a goal of JDRF’s Mental Health Strategy, by helping established clinicians drive and grow important research. By receiving this salary support, Dr. Tang can devote more of her time and efforts to research.

Dr. Tricia Tang

Dr. Tricia Tang is an Associate Professor in the Department of Medicine, Division of Endocrinology at the University of British Columbia Faculty of Medicine. She is also a behavioral scientist and registered clinical psychologist with an expertise in diabetes research in high-risk and medically underserved populations. Over the past 22 years, she has focused on developing, implementing, and evaluating low-cost and sustainable peer support models for improving long-term diabetes-related health outcomes.

Living with T1D means a constant balancing act of measuring blood glucose levels and administering insulin to help try and stave off episodes of low and high blood sugars (hypo and hyperglycemic episodes) and knowing that there is a myriad of potential diabetes related complications, including blindness, kidney disease, amputation and even possible death, and while physical health is often addressed for people with T1D, emotional and mental health frequently is not.

It is also known that people living with T1D experience greater risk of mental health challenges, including chronic anxiety and eating disorders. Among the different psychosocial struggles that patients with diabetes experience, diabetes distress (DD), not depression, is most strongly associated with poor glycemic control.

Diabetes distress is defined as when people living with T1D experience a complex range of negative emotions such as stress, guilt, or denial that result from living with a chronic disease and the often-heavy burden of self-management.

In British Columbia, provincial health coverage does not reimburse for psychological services, so frequently a person in need of mental health support   cannot-afford counselling or find a qualified provider in their community. Add this onto the additional costs associated with living with T1D (for devices, insulins) and mental health needs simply may not get addressed. Dr. Tang seeks to use digital health strategies and peer support models to close this health care gap.

Dr. Tang’s research goal is to design and evaluate a virtual care platform (REACHOUT) for highly trained peer supporters to deliver psychosocial support to adults with type 1 diabetes (T1D) living in rural and remote communities of Interior British Columbia.

“REACHOUT uses technology to drive low-cost and sustainable mental health support to the doorstep of adults with type 1 diabetes (T1D). This digital health model will increase the availability, affordability, and accessibility of mental health support particularly for medically underserved and geographically marginalized communities. With the HP-I award, I have the opportunity to change the landscape of mental health care for the T1D community in British Columbia,” says Dr. Tang.

REACHOUT aims to be very innovative and highly personalized.  Support is delivered by peer supporters who have also experienced diabetes distress and depression; are between ages 19 right through to 90 and from diverse backgrounds; are at different stages of life; and have a wide range of life experiences.

Participants can select who they want to partner with –based on who they believe will best meet their unique support needs at that specific time in their life. And so, selection can change – for example, if a participant gets pregnant and wants to be paired with someone who has already experienced pregnancy with T1D, they can switch. Dr. Tang’s describes REACHOUT as a precision support model where participants, themselves, determine what type of support they want, how much they need, and who will deliver it. 

REACHOUT aims to step out of rigid and more traditional thinking to match people with whom they are optimally suited. This virtual model makes peer counselling accessible to everyone regardless of where they live. In many rural, remote areas in BC, people do not even have access to an endocrinologist, let alone access to specialized psychological care. REACHOUT draws on technology and peer support to reach the “hardly reached.”  

“I became a trained peer supporter to be connected to a T1D community, I have been living in the interior of BC for 16 years and during this time I have met no other person who has T1D,” says Allan Heel, Vernon, BC, who was diagnosed at the age of 25 and has been living with T1D for 32 years.

“It’s also helped me to have reassurance that the challenges I have with T1D are not unique to me, and to be able to share ideas for how to manage these challenges. I also wanted to participate to improve my insight into diabetes technology, drugs, and treatments that are available or being researched and potentially to participate in clinical trials,” he continues.

“I was excited to join REACHOUT for a couple of reasons. First, there is nothing like communicating with another person with diabetes at my own pace, one on one or in a group, about our common experiences with what can be an isolating disease. I was also excited to work with Dr. Tricia Tang and her team. They’re passionate and enthusiastic about helping people with T1D attend to their mental health in support of overall health and having a great life! I feel lucky to have great people in my corner and to give and receive support with my peers,” says Saffron Henderson, East Vancouver, who was diagnosed at 8-years-old and has been living with type 1 diabetes for 46 years.

Learn more about REACHOUT

More about these awards can be found here.

JDRF will continue to provide updates on REACHOUT, with the hopes that this may be tested in other provinces, and eventually rolled out across the country.

JDRF and Health Research BC looks forward to continuing working together in the future, sharing common priorities such as helping to build research capacity, filling strategic gaps in the health system, and optimizing investments in health research.

McGill University Health Centre designated provincial centre for islet transplantation for patients with type 1 diabetes

JDRF congratulates the McGill University Health Centre (MUHC) on its recent mandate to provide islet transplantation for persons with T1D in Quebec. This designation by Quebec’s Ministry of Health and Social Services recognizes the clinical and research teams at MUHC for their leadership and dedication in the field of islet transplantation. As one of only a dozen treatment centres in North America able to perform islet transplantation, this designation also means that the MUHC will be able to improve access to their services and treat more individuals.  

JDRF’s Global Research Strategy focuses on funding research that has a high likelihood of accelerating the development and availability of type 1 diabetes (T1D) treatments, as well as improving the lives of people who live with T1D. Cell therapy treatments in particular hold a lot of potential, as they may become a meaningful treatment option leading towards insulin independence.  JDRF is committed to funding research to make cell therapy safer and more accessible for people with T1D. JDRF is proud to have continually supported the development of cell therapies for decades. Over 20 years ago, JDRF funded both the team lead and the pre-clinical trials that lead to the Edmonton Protocol, which revolutionized the procedure for islet transplantation. Today, JDRF supports many projects that research cell therapies, including continuing research into refining islet transplantation. 

Currently, replacing damaged islets is the only treatment that is clinically proven to be able to achieve insulin independence in people with T1D. Even in cases when complete insulin independence is not achieved, islet transplants can be life changing for people with T1D who experience severe hypoglycemia and hypoglycemia unawareness, for example. The treatment is minimally invasive and much lower risk than pancreas transplantation.  

However, barriers to making islet replacement therapy more efficient and accessible remain. The transplant of donor islets requires recipients to take lifelong immunosuppressants, which can have risks and side effects.  There is also a limited supply of donor islets, which limits the amount of people who can receive this treatment. JDRF researcher Dr. Timothy Kieffer, PhD, is one of several JDRF-funded researchers who is currently examining ways to overcome these limitations through gene editing and stem cell technologies. Other factors, such as poor blood supply to the transplanted islets, can also affect the success of islet transplants. JDRF-funded work in Dr. Michael Sefton’s bioengineering lab is exploring solutions to this issue. Recipients may also need additional infusions of islets in the years after the initial treatment to maintain insulin independence, as transplanted islets may not be a lasting solution.  And so, although ongoing research and trials are promising, many hurdles remain before islet replacement therapy is widely accessible to people with T1D. 

Research at the MUHC facility is also exploring ways to overcome these challenges in islet transplantation. The MUHC team is led by Dr. Steven Paraskevas, a transplant surgeon, researcher, and Professor of Surgery at McGill. In addition to his role as Director of the Human Islet Transplantation Laboratory, he is Director of Pancreas and Islet Transplantation at the Royal Victoria Hospital and former President of the Canadian Society of Transplantation. His research focuses on beta cell injury and survival, as well as the way beta cell injury stimulates the immune system. Understanding beta cell injury is crucial in figuring out how to ensure transplanted islets survive longer and better, with less need for additional transfusions. Such research is essential for advancing knowledge to ensure that opportunities for islet replacement therapy increase in the future, as clinical trials are still at relatively early stages.   

The MUHC is also a site for collaboration, with industry partners as well as with other teams of scientists. The MUHC is currently the site of a clinical trial in conjunction with Vertex Pharmaceuticals. Vertex is conducting a clinical trial of VX-880, a new stem-cell derived therapy for T1D, at several sites in North America (of which the MUHC was the first Canadian site, and Toronto is now recruiting participants as well). The VX-880 product uses islets derived from stem cell cultures rather than from donated pancreases. By using stem-cell derived islets, VX-880 could make islet transplantation and insulin independence available to a greater number of people, if Vertex’s trial program goes on to show safety and efficacy. The clinical trial is still ongoing, but early results out of the US trial sites are promising. The patients who have so far received VX-880 have shown improved blood glucose time-in-range with fewer insulin injections.  

The MUHC further supports research by housing the McGill University Health Centre Human Islet Transplant Laboratory, which purifies islet cells from donated pancreases. These cells can then be transplanted into patients as well as being used in research to further our understanding of islet biology and the pathogenesis of T1D. The MUHC’s designation as a provincial centre for islet transplantation will help to ensure that cell therapy treatments will continue to develop.  

The Vertex trial is currently recruiting participants with T1D for their trial in Montreal and in Toronto. To see if you qualify, click here.  

JDRF ambassador Sébastien Sasseville takes on the Race Across America in latest of endurance races

Sébastien was diagnosed with type 1 diabetes (T1D) in 2002. He made a commitment to himself then that T1D would never keep him from living life to the fullest, and he has followed through on that promise to himself. Since then, Seb has run across Canada, climbed Mt Everest, and participated in a number of the world’s hardest endurance races. On June 28th, 2021, he started a ride across Canada Canada in support of universal access to diabetes devices for all Canadians living with the disease. And this past June, he took on The Race Across America, or RAAM, an ultra-distance road cycling race held across the United States known to be the toughest in the world.

JDRF had the chance to connect with Seb and ask about his experience with RAAM.

What made you decide to pursue this race, and so close after riding across Canada?

“When I came back from the ride across Canada, I was tired, but I was happy and proud about what I had accomplished. There is always a recovery phase, it’s part of the deal that there is some suffering involved, Before during and after. Just a very small part of it. I don’t like to suffer more than anyone else, but it’s not the part I focus on – it’s what I learn, the impact, how I grow, that is the appeal. When you look at it from that angle, it’s tough not to continue doing these things.

RAAM is a much tougher ride, physically and mentally. People get hung up on it being shorter than the ride across Canada, but the course is far more demanding. It’s a lot more climbing, and it has a cutoff, it’s a race. So, it has a different context. And you have twelve days maximum to complete it. There is no margin of error. You must be on your bike 20-22 hours a day. 12 days of 1-2 hours of sleep. It’s the toughest ultra-cycling event in the world.”

This is an extremely intensive undertaking for anyone but competing in race of this kind while managing your diabetes adds another layer of challenge and complexity. How did that impact the race for you?

“It had a huge impact, and a big issue was the lack of cell phone reception – that was a massive surprise. We thought we would lose reception every once in a while, but the course goes through very remote areas throughout the course. That’s a safety thing so you aren’t riding on highways, it’s a set course. We ended up days without coverage, or very spotty coverage. The impact was that I was planning on checking my blood glucose on my watch, but that goes through the internet.  I couldn’t get it on my phone -so my team couldn’t see my blood glucose readings in real-time. So, we didn’t expect not having the data. And this impacted how I controlled my diabetes.

And honestly – it was a big source of frustration. A lot of people who don’t understand T1D believe – oh you have a CGM (continuous glucose monitor), and insulin pump – so you’re fixed. And some people think I must be different. That diabetes must be easier for me because I do these kind of endurance events. I’m not. I’m like everybody. I go through the same challenges. And I hate it sometimes. I try and embrace it as much as I can. But I’m human like everyone else. And if it slows me down, I tell myself that this is my life and journey. But it takes up time and space in your head and body. And it impacts everything.

There was a pharmacist there (at the RAAM), who probably understood it the most. And he came up to me almost every day, to say how amazing he thought it was that I was competing in this race and have T1D. Although it felt good, it was a reminder that most people don’t have his knowledge and don’t understand what we have to go through every single day.

But I must say – it was still far better than last year (the ride across Canada). Because we learned a lot from last year. These types of races are never going to be easy. So, you have to adapt.

Type 1 diabetes is the one thing that slowed me down the most during this race. And I’m immensely proud that I was even on the starting line. It’s by qualification or invitation only.  I was the only Canadian. To race, to race strong, to finish, to finish 12 out of 33 who started, that’s a very strong performance.”

How would you describe your endurance sport as a metaphor for living with T1D?

“I hear a lot from people, when they learn about what I do that ‘It’s so out there, it’s hard to relate’ We were fully aware of it – a year ago when I started looking for sponsorship and funding, I did wonder how to connect this with the larger world outside of the T1D community, because it’s so outside the realm of most people’s experience (living with diabetes).

But for me, it’s such a parallel for life managing diabetes. One rider, a team of 10 people, working 24/7. It’s like with T1D, it’s the team that supports, the team that takes all the decisions. They prepare the bike and fix all the issues. It really is a collective effort and success. You can’t even get through day 1 without the team.

I relate this to how living with diabetes really takes a community too. None of us do this completely on our own.”

Do you see yourself continuing to pursue these types of high intensity endurance sports?

“I don’t plan on stopping. I don’t ask people when they play golf when they are going to stop. It’s something they love. I’m aware that isn’t a typical kind of life, but I have so much fun, I learn so much, I grow so much. I’m not an adrenaline chaser. I won’t jump out of a plane. But these I will keep doing as long as I can. They are life-enriching experiences. I finished, but at the end of the day – whether you finish or not, it’s a very rich experience. The team becomes like your family. We created something very special. I was a very magical and powerful experience. So, I plan to continue doing these things for a long time.”

Any final thoughts?

“We need a cure. There are people like me who live well with diabetes, and we all need to live a fulfilled life before there is a cure. We do need to live in the now. But the fact of the matter is that this is tough to live with. And there were bad diabetes days. And it slowed me down. I know a lot about type one and exercise, it’s my job and I keep it as well-managed as possible. And even still, I have highs, I have lows. I hate it sometimes. My reality is the same as others with this disease.

This is why I am an ambassador for JDRF. Because I want to be part of the cure.”

Follow his journey on Instagram