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View Arun Garg's Presentation Slides Population Based Solutions TYPE 2 DIABETES DIALOGUE 2020 Arun K Garg Ph.D., MD, FRCPC CONFLICT OF INTEREST None Disclaimer - This is not medical advice for specific person; Consult your physician for medical advice. This is a presentation for conversation WELCOME PERSONAL JOURNEY . A PhD level Scientist with MD and FRCP training- 40 years of Clinical and Lab Medicine Service . Evidence- Science- Cellular- Subcellular- Reductive pathways daily bread . Mind boggling numbers on CDM - there is a GAP and a missing LINK . Laboratory Medicine and understanding of SYSTEM and role of PRE and POST parameters . Fusion of Reductive and Integrative, linear and Circular;- Illness and Health are sum of total BODY; MIND and Intellect . Personally Fusion of best of EAST and WEST-Canada young India . Like Symphony of Music- Role of Players, Conductor and Producer/Director DIABETES MELLITUS 2 AND POPULATION Canada 3.8 million (10%) have DM , expected to increase 4.9 million (12%) by 2030- Diabetes Canada- Policy paper Population prevalence varies- India with 16% of world population has 20% of DM population (200 million +) curve is getting steeper (eJIFCC- Mithu Banerjee Sept 2020) South Asians between 40 and 79 years - USA - DM was 23% prevalence- Clin Cardiology 2013 Estimated that Diabetes is 2 to 4 times more prevalent amongst South Asians in Canada In Surrey with a population of 500,000 and 25% South Asian, the number of people with diabetes may be the same as general population. The South Asian rate for diabetes is 54% higher than in the general population. HOUSTON, WE HAVE A PROBLEM But….. there is opportunity in crisis STRENGTHS AND GAPS OF CARE - CANADA Strengths Gaps Excellent Acute Care Model o Community and Chronic Care Between Pre and Post GP Office Excellent Pharma Model o o Self-Management Excellent Medical Model o Lifestyle Interventions – diet/food, stress, Excellent Advocacy Model integrative health Excellent Academic Model o Role of diet not emphasized – food thy medicine o Cultural Effectiveness and Efficiency CULTURAL EFFECTIVENESS Culture Matters - The South Asian Context! . Individual and Heterogeneity within communities . Over 10,000 years of Social Epigenetics . Religious -Geographical – Linguistic- Cuisine – Social- Ethnic- Demographic-Canadian Time and Influence . Influencer and Line of Authority and understanding . Example from India divide of North-South-East and West . Hindu, Sikh, Christian, Muslim, Jain, Buddhist, Agnostics and subsets with very different health and LIFESTYLE followings BARRIERS System Cultural . System driven by fragmentation of experts . Denial . DOTS are not CONNECTED but SCATTERED - what happens between office Visits PRE and POST of . Stigma the office VISIT- NO LINK to DIET and HEALTH . Empowerment and education of the patient is . Fatalism minimal . Major incentives and resources are primarily in acute care – important but some shift required Leads to passive-aggressive approach to illness OPPORTUNITIES COVID and SELF ENGAGEMENT Tools Models must build on TRUST and . Engagement EMPOWERMENT Guidelines recognize the importance of . Empowerment behaviour modifications Role of Family, Community, Congregation, Priest . Education and Physician are critical . Energy Our work for last 10 years with the community shows deep interest amongst members of the . community; Culturally effective interventions are Entertainment required HOW TO BRIDGE THE GAP COMMUNITY CAPACITY CLINIC CULTURALLY EFFECTIVE and EFFICIENT Intervention of NUDGING; SUPPORT- EMPOWERMENT- INTEGRATIVE THINKING LINKED to SOCIAL ACTIVITY - COMPREHENSIVE and Support as PRE and POST GP VISIT- WORSHIP PLACES- BANQUETS and COMMUNITY GATHERINGS-NIMBLE and FLEXIBLE Full USE of MOBILE Technology, MONITORING and FEEDBACK FAMILY and PEER BUDDY APPROACH HEAVY emphasis on Diet and 5 Ks of Healthy Eating and 5 Ps of Lifestyle Intervention 5K OF HEALTHY EATING KAB – when you eat KIYO – why you eat KITNA – how much you eat KESE – how you eat KIYA – what you eat Note “what” is last YouTube and face book videos - www. thecins.org Canada India Network Society 5P OF LIFESTYLE INTERVENTION Culturally Effective Intervention PROMOTION of HEALTH and healthy lifestyle, including food, yoga & pranayama PREVENTION and delay of ILLNESS PROTECTION from DISEASE PRAYERS to declutter the MIND PHILANTHROPY of CARE; TRUST and we are in it together FROM YOU – THINGS TO CONSIDER YOUR EXPERIENCE and any LESSONS to SHARE OPPORTUNITY TO INNOVATE and be part of PRIMARY CARE TRANSFORMATION What are your solutions for bridging the gap? ACKNOWLEDGMENT - 2010-2020 IT TAKES A VILLAGE TO RAISE A CHILD Family (Lori and Davin and my Parents ) Dr Rogers Prize Minnie Downey British Columbia Institute of Technology Medtronic Canada Dr Tricia Tang Institute for Health System Transformation and Sustainability Dr Simon Sutcliff GAPIO Marc Pelletier C-PISA-BC Fraser Health Authority Doctors of BC Royal Columbian Hospital Foundation Hindu Temple of Burnaby and several others places of worships in lower mainland Simon Fraser University Canada India Network Society Kwantlen Polytechnic University Dr Victoria Lee Dr Karen Davison Dr Joanne Curry Drishti and other SA Media Partners THANKS AND QUESTIONS [email protected].
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