This quality standard was created, and should be implemented, according to the Patient Declaration of Values for Ontario. This declaration “is a vision that articulates a path toward patient partnership across the health care system in Ontario. It describes a set of foundational principles that are considered from the perspective of Ontario patients, and serves as a guidance document for those involved in our health care system.”
These values are:
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Respect and dignity
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Empathy and compassion
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Accountability
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Transparency
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Equity and engagement
People with diabetes in pregnancy benefit from care providers or care teams with the knowledge, skills, and judgment to provide evidence-based treatment for diabetes in pregnancy while also addressing all health care needs. The goal of management is to improve symptoms, function, quality of life, and prognosis.
People with diabetes in pregnancy also benefit from relationships with care providers who respect their priorities and recognize their diversity and specific needs, and who have the support necessary to address social determinants of health, including access to transportation, safe housing, and sufficient income.
Care providers should consider that many of the lifestyle factors that put people with diabetes at risk of complications, such as diet, physical activity levels, and stress, are driven by the social determinants of health—a person’s income, employment, physical and geographical ability to access healthy and affordable food, and experiences of discrimination. Care providers can better support people with diabetes in pregnancy by acknowledging that some of these barriers may make it harder for some people than others to follow a healthy diet, lose weight, or increase physical activity levels.
Management of diabetes in pregnancy in Indigenous populations should follow the same guidance as those for the general population. However, care providers should be aware of the historical context of the lives of Indigenous Peoples throughout Canada and be sensitive to the impacts of intergenerational trauma and the physical, mental, emotional, and social harms experienced by Indigenous people, families, and communities, as well as recognizing their strength and resilience. Approaches to care can include holistic healing and healers for people and communities and should be tailored to address these needs.
The residential school experience, Indian hospitals, the Sixties Scoop, and other policies of colonization have had negative effects on the health of survivors and their descendants. Some residual health effects include stunted growth, greater insulin sensitivity, lowered metabolic rate, increased gestational complications in people who are pregnant, and lowered immune system development and function. Accumulatively, these physical effects, combined with trauma and ongoing discrimination, have led to increased rates of obesity and made Indigenous people more prone to developing type 2 diabetes and diabetes in pregnancy.