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Avis Favaro

40 amputations a day being performed in hospitals across the country. Canadians who lose a toe, a foot, an entire leg. And the single biggest culprit is diabetes. High sugar levels from both type 1 and type 2 can build up, triggering inflammation and damage to blood vessels and nerves. 

Calgary resident Harry Rangan paid a hard price, as he lost part of one foot and another leg.

Harish Rangan

Yeah. When I see my leg, 52 stiches on it, oh, and the total leg below the knee is gone. It’s desperate. That time I was crying actually. Yeah. 

And if you give up, give your leg, basically your life’s totally gone.

Avis Favaro

A new report by the Canadian Institute for ������ϱ� Information shows that diabetes is not only one of the most common chronic diseases in Canada, with numbers rising. There are also troubling signs that amputations are happening more often in people living in lower-income areas, among those with lower educational status and in rural/remote areas.

We’ll hear from Calgary’s Dr. Karim Manji, director of the Zivot Limb Preservation Centre, who says far too many people are being diagnosed too late in the disease process.

Karim Manji

So almost the entire foot can become numb to the point where you could step on something and not know. For example, a needle.

One time a piece of a chicken wing bone was also in a patient’s foot who had diabetes that had no idea that they had stepped on something. They just noticed their cat chewing the other end of the chicken wing, which led them to believe that part of the bone was in their foot.

Avis Favaro

That is a disturbing picture for sure, and that’s why this episode is so important.

Hello and welcome to the Canadian ������ϱ� Information Podcast. We call it the CHIP for short.

I’m Avis Favaro, the host of this conversation.

A note: the opinions expressed here don’t necessarily reflect those of CIHI, but it is an open discussion. And this one is about a disturbing picture of how doctors estimate there are up to a million Canadians out there at risk of complications that could cause them to lose an arm or a leg or their lives. 

Joining us now from Calgary is Harish Rangan. Nice to meet you.

Harish Rangan

Nice to meet you, Avis.

Avis Favaro

Thanks for coming and talking about a very difficult subject, because it’s amputation, and you know this because you’ve lived it.

Harish Rangan

I know. Yeah. I’ve been there and go through it last 3 years, almost 4 years now.

Avis Favaro

Yeah. I was talking to someone who said amputation changes everything.

Harish Rangan

Oh, yeah. It changes your whole life. Yeah. Exactly.

Avis Favaro

One of the reasons we’re doing this is because we’re looking at the number of amputations, especially those linked to diabetes. And I was looking at the numbers that ������ϱ�has put together, and it’s 40 amputations a day.

Harish Rangan

Oh, wow. I didn’t know that. Yeah.

Avis Favaro

Yeah. So that’s 2 an hour somewhere in Canada, people are losing a toe —

Harish Rangan

Somebody got amputated. Yeah. Wow.

Avis Favaro

A leg. Does that surprise you?

Harish Rangan

Oh, totally. Yeah. Like, I didn’t know the numbers are that big. Yeah.

Avis Favaro

Mm-hmm. When did you realize that you had developed type 2 diabetes?

Harish Rangan

I have diabetes for the last 15 years, but the real time actually I find out after 10. After the first 5 years, I didn’t even know, like, I have diabetes, because I have some symptoms, urination, sudden thirstiness, tired and everything. But I was working, too, that time, so I didn’t notice that then. I thought it’s normal. Right?

Avis Favaro

And so when you were diagnosed, then your blood sugar levels were very high.

Harish Rangan

Very high. Yeah. Because sometimes, like, I just totally fainted sometime, a couple times.

Avis Favaro

You fainted?

Harish Rangan

Exactly.

Avis Favaro

At work?

Harish Rangan

Not at work. At the house. Early morning when I would get up, my blood pressure is, like, really low, and my blood sugar level is high. I get up, and I’m just like totally fainted, like just fell down with 2 minutes, and then I get up. So I thought, what’s going on?

Then I just go to the doctor, and then he just did all my tests and everything. So then I realized I have diabetes. Yeah. So then he put me on medication and everything, and I’m taking medication since that. Yeah.

Avis Favaro

And you were managing a convenience store?

Harish Rangan

I was managing Mac’s convenience store. Yeah. It’s called Circle K these days, so I was a dealer and manager there. Yeah.

Avis Favaro

So long hours. Lots of stress?

Harish Rangan

Long hours. Oh yeah. Long hours. Stores are 24 hours. If you don’t have any employees, so you’re stuck working, even doesn’t matter night or day.

Avis Favaro

Right. So let’s go to the diagnosis. One of the things about the high sugar levels is that it ends up causing inflammation, it damages blood vessels, it damages the nerves. So some people don’t even feel —

Harish Rangan

Right.

Avis Favaro

— the damage in their limbs that might be happening.

Harish Rangan

Yeah.

Avis Favaro

Did you have that?

Harish Rangan

Actually, yeah. That’s true. It happened to me. Because I don’t feel any tingling or anything. Like if anything’s just pinched me or something, so I don’t feel any pain.

Avis Favaro

When did you notice there was a problem with the toe?

Harish Rangan

I see just like in section, like small — like I was going to the bath and I just come out. So I just have — like the rock actually just hit me, my toes. And it just basically like a small knife — like small cutter. And that cuts start getting bigger and bigger, and it’s getting infected. So the one hole too, it’s so big and it tracks to the side toes, too. Yeah.

And when it’s getting too much pain, it’s hard to walk and everything, so it’s getting worse. So then I just go to the emergency. Yeah.

Avis Favaro

And you went?

Harish Rangan

And I went to the —

Avis Favaro

And what happened?

Harish Rangan

After that, they say, “it’s got infected. Yeah. So this one has to go. Because if it’s not, we don’t cut it, then it’s going to go over to the bones and then it’s going to be, like, really hard.” Yeah.

Avis Favaro

How did you feel?

Harish Rangan

I feel like that time really bad. I said, “no, no, no, I don’t want to cut it. You have to just do something. Give me some antibiotic or something.” But there’s no other option. There’s nothing.

Avis Favaro

Save your life by losing a toe.

Harish Rangan

Yeah. So that’s what he said, it’s better to do it now. Otherwise, more you wait, it’s going to get bigger and bigger, and then it’s going to go to the bones and keep going over your body.

Avis Favaro

And then a year and a half later —

Harish Rangan

A year and a half.

Avis Favaro

— not very long much afterward —

Harish Rangan

Yeah.

Avis Favaro

— there’s a problem with your leg. Where did that start? And what — why —

Harish Rangan

— starts on my feet, too.

Avis Favaro

Yeah.

Harish Rangan

And that same thing, like it’s just got little pimple, and then the pimple getting bigger. And it gets swollen so big, my feet look like almost times 4 size. Eh? Go to the hospital.

Avis Favaro

Emergency.

Harish Rangan

I go to the hospital, and they say, “yeah, it’s infected.” Exact same story again. And they say, “no, this time we cannot do anything; you have to cut the leg.”

Avis Favaro

Oh my.

Harish Rangan

So I waited for at least 5 days to just keep saying “no, no, no.” And they keep sending me to different doctors.

Avis Favaro

Why did you say no? Why did you say no?

Harish Rangan

Because actually I thought, “it’s my leg,” because living without is so hard. And if you give up, give your leg, basically your life’s totally gone. Basically, like, you cannot do anything, you cannot walk. Your totally whole lifestyle change.

Avis Favaro

When you woke up from the operation and you had to feel your leg.

Harish Rangan

Oh yeah. That’s the worst scene. Yeah. When I see my leg, 52 stitches on it, oh, and the total leg below the knee is gone. It’s desperate. That time I was crying actually. Yeah.

Avis Favaro

I bet.

Harish Rangan

Yeah.

Avis Favaro

I’m sympathizing with you at this moment. I can feel it.

Harish Rangan

I know. That’s the worst moment for my whole life. Yeah.

Avis Favaro

Have you accepted that this was the price to save your life from diabetes and the damage that it caused?

Harish Rangan

Yeah. I accept it. You just want to live, or you want to die. Basically, if you want to live, so that’s the option. You have to do it. So whatever the doctors say, you have to do it. And then I accept it.

Avis Favaro

Do you think it’s changed the way that people look at you?

Harish Rangan

Yes. Totally.

Avis Favaro

In what way?

Harish Rangan

The same people, actually, they just feel, like, a little bit sorry for me, and then try to help me more. It’s not like the same when we just — like the friends, just do whatever you want and let’s go there. But now they just kind of, like, slow down and don’t tell me, “let’s go on holiday,” or do this, do that. Like it’s going to be hard for them to just handle with me because now I’m slow and everything.

Avis Favaro

So the other question that I had, Harish, is how has it affected your ability to work? Are you able to work? Can you do that job? Or are you on disability?

Harish Rangan

No.

Avis Favaro

What was the economic consequence of what happened?

Harish Rangan

So the economic is bad. Yeah. Because working the job that when I was doing it same thing, it’s hard. You cannot do the same job. And it’s, basically, you cannot stand too long, you cannot walk and you get tired too much.

Avis Favaro

So are you working?

Harish Rangan

So you are like, basically, really — no. I’m not working right now. No.

Avis Favaro

That’s hard. It must be really hard.

Harish Rangan

Yeah. It’s really hard. Yeah. Because it’s pretty hard. I tried so many places, but it’s hard. Everybody just say, yeah, this is our requirement, so if you can’t do it. So it’s hard.

Avis Favaro

Do you worry that you might end up having another amputation?

Harish Rangan

I hope not, but it still worries. Yeah. I’m worried. Yeah. But I actually take really good precautions right now, wash my feet all the time, do my medication, watch my sugar, watch my blood sugar level all the time.

If you don’t do that, it’s no chance you’re going to lose it again. Yeah. So you have to be, like, on the top all the time. Yeah.

Avis Favaro

I can’t thank you enough, Harish, for talking about this.

Harish Rangan

Oh, no problem. Anytime.

Avis Favaro

It’s a hard topic because you’ve lost part of your body to this disease.

Harish Rangan

I know. Yeah. That’s right. But life goes on. Yeah.

Avis Favaro

Doctors tell us that about 80% of these amputations related to diabetes are actually preventable with regular foot checks to catch wounds early, and then fast access to medical care if an infection sets in.

Our next guest, Dr. Manji, heads the Zivot Limb Preservation Centre at the Peter Lougheed Centre in Calgary. And he’s going to talk about how his team is trying to save limbs, literally 1 toe at a time.

We’re now joined by Dr. Karim Manji in Calgary as well. Welcome to the show.

Karim Manji

Thank you for having me.

Avis Favaro

So we just finished talking to Harish, who is one of your patients. What we learned is that he seems to be one of the many Canadians who are getting diagnosed with diabetes late, as a delayed diagnosis. And is he an example of what’s happening across the country?

Karim Manji

He is. Harish is a patient who has diabetes, who’s lost feeling in their feet, and sometimes patients with loss of feeling would develop a wound, and in his specific case, developed a pretty bad infection, and it resulted in a major amputation on one side.

Prior to that, he had actually developed an infection in his other foot — in his right foot — where we were able to save his limb by just removing the toes. And so, maintaining that ankle joint was a huge success from our standpoint in that it allowed him to maintain some independence, his ability to continue driving and his quality of life.

Avis Favaro

So if someone has a foot infection, how long usually has the diabetes been there, not well controlled?

Karim Manji

I would say many years. Many years.

Avis Favaro

So what is it that’s happening when someone has diabetes that’s not recognized or treated? What’s going on in the body that leads to this?

Karim Manji

Ultimately, the diabetes and the elevated blood sugar is causing some type of damage to the nerve, resulting in numbness. And it’s what we would call peripheral neuropathy. So almost the entire foot can become numb to the point where you could step on something and not know. For example, a needle. I’ve taken out a number of needles from patients’ feet over the years who stepped on a sewing needle at home and didn’t know but just noticed the blood on their floor.

One time a piece of a chicken wing bone was also in a patient’s foot who had diabetes that had no idea that they had stepped on something. They just noticed their cat chewing the other end of the chicken wing, which led them to believe that part of the bone was in their foot. So the numbness is profound.

Avis Favaro

You know, Harish was 51. You normally think of amputations going into the 60s and 70s, older people. What’s the age range?

Karim Manji

I think it’s that 50-to-65 age group that we’re seeing more and more in our clinic. One, they’re continuing to work. They’re unable to potentially offload their foot in order to help it heal, so the ulcer remains open.

We’re seeing these patients sometimes having difficulty getting the medications they need to help control their diabetes. So it does affect a certain demographic in terms of socio-economic status in our society.

Avis Favaro

Data was showing 3 times more men who are ending up with amputations than women.

Karim Manji

I think part of it is, how often maybe men would go see the doctor to say, “hey, I don’t feel good; perhaps something is going on.” Or the stigma around having someone look at your foot to see why it’s bleeding, or there’s a blister, or why there’s an open sore.

Avis Favaro

You also brought up that it’s 3 times higher among those living in lower-income communities and people with lower levels of schooling. Those were 2 other findings in the report by CIHI.

Have you noticed that trend, too?

Karim Manji

Yep. I would agree. Perhaps the occupations that these patients would have to be doing would be more physically demanding, perhaps putting more pressure and force on their lower extremities, resulting in a wound.

So we see a lot of patients who are truck drivers, a lot of people in construction, a lot of people in the trades who are working on their feet. We’re fighting the fact that every step they take on that wound prevents it from healing and perhaps ultimately could potentially get infected.

So how do we maintain the patient’s quality of life, their ability to work, help them heal? If they undergo an amputation, how do we save as much of the limb to allow them to function back into society and into that occupation?

Avis Favaro

One of the things I’ve been hearing through sort of the medical community is that there seem to be more amputations being done. It’s reflected certainly in the ������ϱ�data. We’re up to total 14,000 in the last year, which I calculated to 40 a day across the country. Right?

There may be more amputations being done because there are fewer family doctors catching it early, not enough ways of monitoring people who might have injuries or wounds on their feet.

Do you get the impression that some people are doing the amputations because it’s easier and faster?

Karim Manji

I think the rise in amputations is partly due to the fact that there’s less surveillance from family doctors. I think part of it is due to the fact that access to care is limited. So perhaps someone living in a rural part of Alberta, let’s say, for example, by the time they end up at a tertiary centre in Edmonton or in Calgary, the only option that remains is an amputation and perhaps a major amputation.

But I think the other part is — what we’ve noticed here in Calgary is that our amputation rates have continued to climb over the last decade, but the ratio at which type of amputation is different. We have started to do much more toe amputations and partial foot amputations. And as a result, it has reduced the need for a major amputation, which is below the knee or above the knee.

And that’s a drastic — there’s a huge difference in quality of life, mobility, complications and even life expectancy for someone who’s had a minor amputation versus a major amputation.

Avis Favaro

Amputations are costly. So the data is showing that it’s between $25,000 and $45,000 per patient who has something amputated. But it’s also got to be costly emotionally for the patients. Harish was talking about depression, how he can’t do things.

What do you see is the effect of all these amputations on people?

Karim Manji

I think that one of the biggest things patients will say to me is that they’ve lost their independence. Some of the researchers who study amputation prevention feel as though losing a limb is so profound because they feel that, when we evolved, before we came out of the trees, our brains were developing, so the limb was such an important part of our evolutionary process.

And so people feel that they can’t actually wake up in the middle of the night and walk to the bathroom because they have to find their prosthesis to put on in order to get there. They may not be able to drive or perhaps wear a pair of shorts without that stigma.

So the feeling is that there’s a loss of independence. There’s a loss of losing a part of your body that you were born with. So feelings and things like depression do set in, and hopelessness sets in.

Avis Favaro

Okay. There’s also a higher risk that these patients who have the amputation will die. We filmed a story a while ago and the patient had a limb, one of his legs, taken off. And I heard that about 3 weeks later, he died. There’s a risk.

Karim Manji

Huge. After having a major amputation, the life expectancy drops drastically. Having a diabetic foot ulcer — just a wound on your foot — your life expectancy is 50% in 5 years. And it’s not the ulcer that’s potentially the cause of death, but it’s the sign that the diabetes has taken a toll on the human body.

Avis Favaro

And before we leave the stats, one of the other findings that is very troubling is that among the homeless, there was almost a 4- or 5-time increase in the number of homeless people and those with frostbite who are having amputations. And I know Alberta has been quite hard-hit by this.

Are you seeing it?

Karim Manji

Huge. The challenge with patients who generally have suffered frostbite is that they don’t have the neuropathy that a patient with diabetes would have. So now the tissue loss and infection is very, very painful. Even being in the hospital, it’s very hard to control their pain because their nerves are still working.

So this population, we’ve seen a dramatic increase in the number of amputations from frostbite over the last 2 years here in Calgary.

Avis Favaro

You’re trying an approach to save the limbs. You’re trying to say, okay, if someone has a wound, how do we make it the safest possible for their limbs?

What is it that you’re trying to do? And what are you finding with your team?

Karim Manji

So what we have done here in Calgary is developed a team based on the global guidelines around the diabetic foot. And that includes a foot surgeon and a vascular surgeon as the backbone of that team. And our goal is to detect, early on, the ulceration or wound and get it to heal as soon as possible.

Unfortunately, sometimes patients will come in with an infection that is too far gone, perhaps gone to the bone, has caused a lot of damage in the foot. And so at that point, our goal would be to remove the infected tissue and provide the patient a functional foot to walk on.

Avis Favaro

So what does that mean? Not amputate, but take away just the infected part?

Karim Manji

Just the infected part, but to leave them with a functional foot.

So there is an understanding the mechanics of the foot, and where the tendons are, and where the bones are, and how they function provides the ability for the foot surgeon to determine how a foot would function with part of it gone. So, in some cases, that would require removing all of the toes or removing the metatarsal heads, which is a transmetatarsal amputation.

Avis Favaro

You would take off the front half of the foot?

Karim Manji

The front half of the foot. And that’s what Harish has. And he still has his ankle joint. He still has his major hind foot joints. And he’s able to walk and he’s able to walk in a regular shoe with an insole that has a little bit of cushion at the end of his foot. It allows him to walk with less strain on his heart.

Once we’ve removed the leg below the knee, your cardiac demand rises. Our goal at our centre is, how do we preserve the limb and make sure that it continues to have a function for the patient so that it maintains their independence, reduces the strain on their heart and improves their quality of life.

Sometimes it’s not removing all of the toes. Sometimes it’s just removing 1 or 2 toes. There’s a lot of different surgical options to help save the diabetic foot, depending on the specific scenario.

Avis Favaro

Yeah. You called it “toe and flow.”

Karim Manji

Yes. So “toe and flow” is a term that was coined by David Armstrong, who is one of the global leaders in the diabetic foot. And they found that the toe and flow model was one of the most effective teams. And the toe stands for the podiatric surgeon, which is the foot surgeon; and the flow is the vascular surgeon, or the one who helps reestablish blood flow. And so the toe and flow model is what our clinic is based on.

Avis Favaro

And you’re the podiatric surgeon —

Karim Manji

Correct.

Avis Favaro

— which a lot of Canadians probably have never heard about. What is that? You’re a physician. You’re a surgeon. And it’s a unique specialty.

Karim Manji

Yeah. So I’m a podiatric surgeon. I pursued my podiatric training in the United States. And so this is a unique profession. It’s not something that exists throughout Canada. It really does only formally exist in places like British Columbia and Alberta. Alberta has a publicly funded model that allows for that access to care, and we’re showing that an investment in this specific specialty has shown to improve outcomes for patients with diabetes.

Avis Favaro

So tell me what the results are, because you’ve been testing out this team approach.

Karim Manji

So what we found is, we looked back about 10 years into the number of amputations that were done in the Alberta ������ϱ� Services system. And so we looked province wide, and we found that in Calgary, with the toe and flow model, we were able to reduce major amputation rates by 45%. That’s huge.

Avis Favaro

It’s huge.

Karim Manji

Our most recent study showed that, along with reducing major amputations, we were also able to reduce the number of hospitalizations that patients with diabetes would have. So a 30% reduction in hospitalizations.
If you did get admitted to the hospital, your length of stay would be reduced by 21%. Not only are we saving the limb, but they actually stay in the hospital for a shorter period of time compared to other places in Alberta.

Avis Favaro

What about other places — compared to other places in Canada?

Karim Manji

It’s difficult to —

Avis Favaro

Because there are different programs that are being tested out with slightly different approaches in Toronto and Quebec.

Karim Manji

Right. I think the difficulty from my experience has been we don’t really have a clear way of collecting the data across the country. And I think that’s what ������ϱ�has really helped us clarify.

If we compare our delivery of care, our model, to other places in Canada, I would argue that the best way to do that would be to check our Hi-Lo ratios.

Avis Favaro

What is high and low amputations?

Karim Manji

So the Hi-Lo ratio is basically the number of high amputations, which would be above the ankle, divided by the number of low amputations, which would be below the ankle. That number will show or demonstrate how often a patient is undergoing a major amputation compared to a minor amputation.

Avis Favaro

Are other jurisdictions interested in following what you’re doing?

Karim Manji

Very interested. So right now, there’s the development of a toe and flow centre in Edmonton. So it’s expected that they’ll open their centre in Q1 of 2025.

We’ve had discussions with the University of Toronto, some of the vascular surgeons at the University of Toronto. We’ve talked with the vascular surgery department at the University of Ottawa, and looking at ways in which we can create toe and flow teams throughout the country. I think the realization is, this is what we can do to help reduce major amputations.

Avis Favaro

And how are we doing right now based on what you see? Not so good.

Karim Manji

Not so good. I think we can do better here in Canada.

Avis Favaro

I think Canada scored 14th out of 24 countries with universal health care in terms of the rate of amputations. We were sort of in the bottom half of that.

Are we missing the ball? Are we not taking this seriously?

Karim Manji

I think the seriousness is there. I think that the solutions that are available have been, I think, maybe not investigated to the fullest extent. I think we have a solution here in Calgary that needs to translate throughout the country. Why is it that Edmonton and Calgary have such a drastic difference in amputation rates? I think the toe and flow model speaks for that.

Avis Favaro

So let me just delve into that. Your amputation rate is what? And what is it in Edmonton?

Karim Manji

So Calgary has a 45% lower major amputation rate than Edmonton. So, if you have diabetes and you live in the Edmonton Zone, you’re 45% more likely to lose your limb to diabetes below the knee. Like you’re going to have a major amputation below the knee, not save your limb.

So Calgary is speaking for what can be done. Edmonton is the standard of care. And that’s kind of what we talked about in our study, is that the Canadian standard is what Edmonton’s doing. Edmonton is providing all of the access points to vascular surgeons, to pharmacists, to family doctors, to medications. They have the same demographic. So why is it that in Calgary our amputation rates are lower?

Avis Favaro

And you say it’s the toe and flow.

Karim Manji

And I say it’s the toe and flow. And particularly the toe portion of it.

Avis Favaro

So some might play devil’s advocate and say, “well you’re promoting your profession.” Not everybody has one of you. Not everyone has a podiatric surgeon on team, for whatever reason.

Karim Manji

That’s a good question. And so the Alberta ������ϱ� said that they would like to study now, once creating a toe and flow model, if it does have an impact on the reduction. So that will be even a stronger case, or dispel the rumour, that we are actually making a difference.

Avis Favaro

Just I guess to wrap up, you are proposing another way of dealing with this and you have the platform in Alberta to proceed with it. Right?

Karim Manji

So we’ve been looking at this problem for a while and we understand that there’s different barriers to provide access to the care we provide. And so we’re trying to find solutions to help different places start toe and flow teams.
What we found is that the biggest gap from our side is, where do you find a podiatric surgeon? You can’t just go get one. So we’ve started a fellowship. So the fellowship allows for American-trained podiatric surgeons to come back to Calgary, train for a year, learn how the toe and flow model works, and hopefully take that to another place in Canada.
So we just graduated our first fellow. We have a second fellow that’s currently in his training, and hopefully he’ll be part of the team that goes to Edmonton.

So there’s a lot of interest around recruitment of our fellows to different parts of Canada. That’s part of how we’re hoping to contribute to the solution around the toe and flow model teams.

And then continuing to build bridges with all the different partners involved in limb preservation: Wounds Canada, Diabetes Canada, the Canadian Podiatric Medical Association, CIHI, all the universities. I think all of these people are stakeholders that can help share the message around limb preservation.

Avis Favaro

Okay. I guess my last question is, where do you get your payoff? At the end of the day, what gives you the greatest sense of satisfaction? In a very hard profession. Because you’re talking about people losing their body parts here. What gives you the most satisfaction?

Karim Manji

Some of the most happy moments are where a patient heals a wound that’s been struggling for months and is able to get back into a normal pair of shoes. This patient was on the edge of potentially getting an infection and an amputation, and we were able to prevent that. And now they can return back to their normal life with more information and more tools to prevent this from happening in the future. It makes me feel very satisfied with the work I do.

Avis Favaro

Good.

Karim Manji

I’m very honoured to be part of that patient’s life.

Avis Favaro

All right. We’ll leave it there. Thank you so much, Dr. Manji. Appreciate it.

Karim Manji

Thank you.

Avis Favaro

You’ll recall in his interview, Dr. Manji noted about patients he sees who can’t afford those diabetes medication to keep the disease in check. And that’s one of the reasons why the federal government says it’s working to make essential diabetes medications free as part of its first phase of a national universal pharmacare program.

And remember, diabetes doesn’t just lead to lost limbs. It also causes blindness, kidney failure and heart disease.

If you want to learn more about the Advancing equity in diabetes care report, you’ll find the entire document online at C-I-H-I.ca, along with much more information on the work ������ϱ�is doing on equity in health care.

Thank you for listening to this important episode, and please subscribe to the CHIP wherever you get your podcasts.

I’m Avis Favaro. Talk to you next time.

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