INTRODUCTION Early identification of risk for type 1 diabetes (T1D) can reduce diabetic ketoacidosis at diagnosis and delay disease onset through disease-modifying therapies. While international population-based screening initiatives have demonstrated feasibility, Canadian efforts have focused on first-degree relatives, leaving uncertainty about broader implementation and capacity. As part of the Canadian Population Screening for Risk of Type 1 Diabetes (CanScreen T1D) initiative, this study assessed readiness across Canada to provide follow-up care, conduct clinical trials, and deliver immunotherapies to individuals identified through general population screening. METHODS We conducted a national needs assessment including a cross-sectional survey and follow-up qualitative interviews. The survey assessed institutional capacity for clinical care and research related to individuals at risk for or newly diagnosed with T1D. Interviews were conducted to contextualize survey findings. Quantitative data were analyzed descriptively, and qualitative data were analyzed using thematic content analysis. RESULTS Eighteen survey responses (39% response rate) revealed substantial variability in institutional capacity. While most institutions reported moderate to high capacity to care for individuals newly diagnosed with T1D, fewer reported sufficient capacity to support at-risk individuals or participate in prevention trials. Interviews highlighted broad support for population screening. However, participants identified major barriers, including limited space, staffing shortages, inadequate psychological supports, and challenges to equitable access for equity-deserving populations. CONCLUSION Canadian clinicians and researchers support population-based T1D screening in principle, but have reservations due to current healthcare and research infrastructure. Addressing capacity limitations and equity considerations will be critical to developing a coordinated national screening and follow-up strategy.
OBJECTIVE To assess the impact of sociocultural status on the risk of diabetes and diabetic complications among women from a large Canadian province. METHODS We conducted a longitudinal cohort study of sociocultural disparities in diabetes and diabetic complications among 681,875 women from Quebec, Canada with pregnancies between 2006 and 2023. We measured sociocultural disparities using linguistic status, comparing the anglophone minority of Quebec with the francophone majority. Outcomes included diabetic cardiovascular, renal, and metabolic complications that led to admissions anytime during follow-up. We accounted for patient characteristics and used Cox regression models to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for each diabetic complication, contrasting anglophones relative to francophones. RESULTS Compared with francophones, anglophones were 1.27 times more likely to develop diabetes in the long-term period following pregnancy (95% CI 1.15-1.39). Anglophones were more likely to be admitted for diabetic cardiovascular (HR 1.94, 95% CI 1.45-2.60), renal (HR 1.44, 95% CI 1.10-1.89), and metabolic complications (HR 1.50, 95% CI 1.13-1.99). Anglophones with gestational diabetes (HR 1.75, 95% CI 1.16-2.66) and preexisting morbidity (HR 2.17, 95% CI 1.11-4.27) were particularly at risk of developing cardiovascular complications. Anglophones who were socioeconomically disadvantaged were also at risk of diabetic cardiovascular, renal, and metabolic complications. CONCLUSIONS Sociocultural disparities in the development of diabetic complications are present in Quebec, Canada, with anglophone women having a greater risk of cardiovascular, renal, and metabolic complications than francophone women in the long term.
