Looking at the unique way that people from diverse communities experience diabetes has become increasingly important in recent years. Researchers like Dr. Baiju Shah, a clinician-scientist from Toronto’s Sunnybrook Research Institute and ICES, have spent years studying what the data shows about how your ethnicity, socioeconomic status or gender can impact your diabetes risk and outcomes. After seeing the impact that COVID-19 has had on those from marginalized communities, that work seems increasingly necessary and relevant when dealing with all chronic illness.
Shah was always interested in biology and health, knowing from an early age that he wanted a career in medicine. Originally, he thought he would become an ophthalmologist, but in medical school he realized he was actually quite squeamish about eyes—a fairly big barrier for an eye surgeon.
This loss to the eye health community has truly been a gain for the diabetes community. He describes his entry into research as “accidentally on purpose.” After his first year of internal medicine, he decided he wanted to look into doing research. He reached out to Dr. Bernard Zinman, then the head of Endocrinology at Mount Sinai Hospital in Toronto. Through that connection, he met Dr. Jan Hux, then at ICES.
ICES leads cutting-edge studies that evaluate health care delivery and population outcomes. They are the holders of a large array of Ontario’s demographic and health-related data, which their researchers can use in a way that is secure and respectful of privacy. This data allows data scientists to better understand trends and look for ways to improve the overall health of people in the province and across Canada.
Shah loved that this work incorporated so many different aspects of research and health care. He liked that he could mix these studies into his clinical practice, and in the process work on practical ways to better support his patients.
“What was exciting about this research was that it was directly relatable and connected. I could see how the questions that came up in clinical practice could be answered through research purposes. And similarly, the research I was doing could change the way we deliver care.”
Health services research, he explains, is less about new treatments and therapies and more about determining ways to improve elements of care, or to figure out why what is being done currently isn’t working for everyone.
Shah has gone on to lead multiple studies in the areas that he feels most connected to — in particular, diabetes in diverse communities. He realized quickly that despite the idea that Canada offers equal access to care, there were large differences in how communities were served. Universal health care did, however, provide a wealth of data to help understand these inequities.
“I thought it was an interesting and important area that needed attention. I think Toronto and Canada generally are a great laboratory for that kind of work, because we have such a multi-ethnic population. Everybody is covered under universal health care and, therefore, everybody has access. The strict financial access barriers are not necessarily there, but of course, we've learned that there's a lot more to it than that,” he says.
“What 2020 has really highlighted is how important ethnicity and the other social determinants are to health. I think the recognition that poverty has a huge role in health, that employment status and insurance status and all of these things I've been thinking about for decades, suddenly now the general public might recognize that these are important factors relating to how sick people get and how much care they get. Because people are talking about this and thinking about this, the importance of this kind of work has never been higher.”
One of Shah’s first big studies looked at diabetes complication rates in Chinese and South Asian people in Ontario. They showed that once people are diagnosed with diabetes, complication rates are similar to, or maybe even lower than they are in the general population, and mortality is also lower, a very different finding than what the general public might think. “A lot of what we perceive as this much higher risk of cardiovascular disease in patients, for example, is related to diabetes, getting diabetes and the risk for diabetes. But once you've got diabetes, that actually it's not that different. To me, that was interesting, because it challenged conventional wisdom a bit.”
Shah has also mentored some of Canada’s best and brightest scientists in this area, including Dr. Ananya Banerjee, who studies diabetes in the South Asian community, and Dr. Calvin Ke who looks at diabetes in the Chinese population. Their work continues to break down stereotypes and misconceptions about how and why different populations experience type 2 diabetes. It is also helping people see that there is not a one-size-fits-all solution to helping a community that is experiencing higher diabetes risk. For example, a person fleeing from the civil war in Sri Lanka under extreme stress and now living as a refugee in Toronto has a much different diabetes risk than a business person who immigrates to Canada from India. Their risk factors are unique and need to be looked at as such.
In addition, Shah recently worked with the Chiefs of Ontario on an in-depth study into diabetes in Ontario’s First Nations’ communities. This work showed deep inequities in access and in overall health outcomes. This work has helped to inform policymakers about the need to improve care and to look at culturally-appropriate and trauma-informed solutions.
When he started his career, Shah was hoping to find a way to make every day different. He had no idea that in his search for novelty, he would be able to make an indelible difference in Canada’s understanding of intersectionality in the diabetes experience.
— Written by Krista Lamb