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Meet the passionate team behind the T2D Network, including staff, consultants, and contractors working together to improve T2D support across British Columbia. The T2D Network Team Our dedicated team brings diverse expertise and lived experience to advance innovative solutions for T2D across British Columbia Kathleen Chouinor Chief Executive Officer Kathleen Chouinor is a seasoned healthcare executive with over 30 years of leadership experience, specializing in system transformation, primary care, chronic disease management, and home health and long-term care. She has worked extensively within BC health authorities to improve patient outcomes through innovative, community-driven models of care. Kathleen also served as a strategic advisor for Community Care at the BC Ministry of Health, where she helped shape policies to enhance community care services for individuals with chronic conditions. In addition to her practical expertise, Kathleen holds an MBA and an MHA, along with certifications as a Certified Health Executive (CHE), Certified in Risk Management (CRM), and Certified Management Consultant (CMC). Her career is marked by strategic planning, team leadership, and a focus on sustainability and high-quality care delivery. She is committed to developing future healthcare leaders and driving healthcare system improvements to ensure better access and outcomes for patients, particularly those living with chronic diseases. 📩 Contact Kathleen: kathleenchouinor@ihsts.ca Edward Smith Griffiths Director Having joined the T2D Network team as a coordinator in 2024, Ed has now stepped into the network director role. As well as his previous network coordinator role, Ed has worked stints in the motorsport industry as a technical liaison, and the high-performance marine industry as an operations manager. His transition to healthcare comes with an enthusiastic drive to make a change in the lives of British Columbians. Ed has well established experience in project management, strategic development, and administrative process. He holds a degree in Physics and Mathematics from the University of British Columbia Okanagan, and is currently pursuing a Master of Business Administration at Royal Roads University in his spare time – when not finding new gravel cycling routes around his home in Kelowna, BC. As the T2D Network director, Ed will continue to develop novel initiatives to address gaps in community care for those with type 2 diabetes or at risk of developing the disease. He will also contribute to the strategic direction of the T2D Network to ensure its mission is being carried out effectively. Examples of projects that Ed and the T2D Network team already have underway are the development of culturally tailored management and prevention initiatives for communities, establishing pathways between diabetes care resources and mental health resources, and improving the access and dissemination of diabetes related data within community health care. 📩 Contact Ed: edwardsmithgriffiths@ihsts.ca Rana Madani Senior Project Coordinator Rana joined the T2D Network as a Project Coordinator in October 2024, bringing a strong academic background and a passion for improving community health. She holds a Master of Science in Pharmaceutical Sciences and a Bachelor of Science in Nutritional Sciences from the University of British Columbia. Her research has focused on social connections and central obesity in aging populations, as well as dietary strategies for diabetes remission. With extensive experience leading projects during her graduate studies and engaging with various nonprofit organizations, Rana aims to bring her expertise in research and project management to her role. As the T2D Network project coordinator, Rana supports and advances initiatives aimed at closing gaps in community care for individuals at risk of, or living with, type 2 diabetes. She works closely with the team to promote prevention, build partnerships, enhance engagement, and increase awareness through strategic communications and educational efforts, all contributing to the T2D Network’s overarching mission. Outside of work, Rana enjoys embroidery, photography, and pottery. 📩 Contact Rana: ranamadani@ihsts.ca Stephanie Altenhof Program Coordinator Stephanie joined the T2D Network in early 2026 as a program coordinator, focusing on collaborative, person-centered approaches to chronic disease support and system-level care improvement. She previously worked as a Support and Education Coordinator with the Alzheimer Society of BC and Yukon, where she provided psychosocial support, facilitated workshops and support groups, supervised volunteers, and supported interdisciplinary memory clinic collaboration. Her experience also includes serving as a board director with the BC Association of Social Workers, and research and teaching assistant roles at Vancouver Island University and the University of Windsor. She holds a Master of Social Work from the University of Montana and a Bachelor’s degree in Environmental Studies from the University of Windsor, and is a Registered Social Worker with the Ontario College of Social Workers and Social Service Workers. After work, she may be on the golf course, at the chess board, singing, or playing piano. 📩 Contact Stephanie: stephaniealtenhof@ihsts.ca We gratefully acknowledge the advisors who generously contribute their time, expertise, and guidance to support the Network’s mission on an ongoing basis. We also thank the Clinical and Patient Advisory Committees for their valuable insights and contributions to the co-design and development of this website.

Explore the T2Dnetwork partners page to discover trusted collaborations, industry leaders, and organizations working together to advance innovation, research, and solutions in Type 2 Diabetes care and prevention. Our Partners The T2Dnetwork brings together a diverse group of partners committed to improving the understanding, prevention, and treatment of Type 2 Diabetes. Through collaboration across research, healthcare, industry, and innovation, our partners help drive meaningful progress toward better outcomes for patients and communities worldwide. Funding Partners Strategic & Implementation Partners

Explore the T2D Network dedicated to type 2 diabetes support through education, resources, and community engagement in British Columbia. #T2DNetwork Uniting communities, healthcare providers, and partners across British Columbia to support type 2 diabetes Type 2 Diabetes Network Patients & Caregivers Healthcare Professionals Create Your Journey Join Our T2D Network Diabetes by Numbers The statistics are alarming. Diabetes has become a widespread issue, affecting over 11 million Canadians. % Percentage of British Columbians living with diabetes or prediabetes % Percentage of British Columbians living with diagnosed diabetes % Percentage expected increase in diabetes in British Columbia (2023-2033) 20 0 20 Our Resources Blog Articles Books Care Centres Caregiver Support Clinical Guidelines Diabetes News Diabetes Stigma East Asian Resources Healthy Eating Healthy Lifestyle Indigenous Resources Interactive Tools Knowledge Hub Monitoring & Medication Patient Education Professional Education Referrals & Support South Asian Resources Vodcasts & Webinars What's New This Week NEWS B.C. opens 65 new nurse practitioner training seats across 3 universities New additions bring total number of nurse practitioner training seats in B.C. to 165. The University of British Columbia is adding 30 seats, University of Northern British Columbia, 20, and the University of Victoria, 15. Read More PROFESSIONAL DEVELOPMENT Indigenous Education Series - Rural Reach Webinar: Indigenous Women’s Determinants of Health and Illness in Medicine. Join Dr. Terri Aldred for a powerful session on Indigenous women’s wellness exploring strength, the impacts of colonialism, and paths toward equity in medicine. 📅 Thursday, Sept 25, 2025. ⏲️ 8 PM ET | Online (Zoom) Free Admission – Everyone Welcome Read More EVENTS Virtual Open House: Family Physician Job Opportunities at UPCCs Event by Fraser Health Authority Tue, Oct 7, 2025, 7:00 PM - 8:00 PM (your local time) Read More RESOURCES Diabetes Canada Clinical Practice Guidelines VIDEOS If you prefer to watch the Diabetes Canada Clinical Practice Guidelines in video format, this series of 38 videos covers it all. Read More Unique Visitors 0 Website Sessions 0 Desktop Visitors 0 Mobile Visitors 0 Our Website Statistics for April 2024 - April 2025 Unique visitors refer to the number of individual users who visit a website, while site sessions count the total number of visits, including repeat visits by the same user. Upcoming Events Dr. David Campbell is an Internal Medicine and Endocrinology specialist at the University of Calgary whose research focuses on health equity and improving diabetes care for socially disadvantaged populations. Video Podcast: Diabetes and the Social Determinants of Health We’ve got an exciting event coming up! Dr. David Campbell , a clinician-scientist from the University of Calgary, joins host Krista Lamb to discuss his work studying diabetes in those experiencing homelessness or food insecurity. Dr. Campbell's research considers the importance of strategies that remove structural barriers to needed healthcare. His team also looks at how to provide solutions that are empathetic and foster mutual respect. In addition, Dr. Campbell will discuss his out-of-the-box knowledge mobilization strategies, including his team's short film, Low , and the photo voice exhibit, Home Sweet Homeless. During the recording, Dr. Campbell will answer the audience’s questions, so be sure to join us live to participate! 👉 Post your questions ahead of time in our Forum 👉 Date: June 3, 2025 (12:00-1:00 PM PST) Register Here IDEA Diabetes Stepping Stones Workshop: Spark Interest, Build Trust, and Inspire Hope This three-day virtual workshop will ignite interest in a different way to thinking, talk and do diabetes, based upon a foundation of hope, empowerment, and equity. Participants will consider the opportunities for better outcomes and a better future for people with diabetes and how each one of us can make a difference. This workshop is for people who are involved in healthcare and health leadership, including in Indigenous communities, and have the interest, energy, and influence to shape the community approach to diabetes. 👉 Date: May 6 -7, 2025 👉 Find out more information, the cost, and how to register here Register Here Testimonials “This is outstanding! Great compilation of what is out there in one stop shopping!” Diabetes Clinical Nurse Specialist "This website is truly a wealth of information where people can find everything they need to help them sort out this difficult health issue." Patient Partner “The culturally relevant resources, especially for Indigenous communities, makes this website feel truly inclusive.” Diabetes Practice Advisor Recent Posts Become a patient partner Sign up here Your voice matters. Join the T2D Network as a patient partner and help shape diabetes education, research, and care. Share your lived experience, collaborate with healthcare teams, and make a real difference in the lives of others. 1 2 3 4 5 FAQ What is T2D Network? T2D Network is a community-based organization in Canada that supports people living with type 2 diabetes through education, peer connection, and practical health resources, primarily in British Columbia. Who is T2D Network for? T2D Network is for people living with type 2 diabetes, their caregivers, and healthcare providers seeking accessible education, community support, and practical tools for diabetes management. What support does T2D Network provide? T2D Network provides support across multiple areas including healthy eating, lifestyle management, community connection, caregiver resources, and healthcare provider education. Where can I find diabetes support resources in British Columbia? You can access diabetes support resources through T2D Network, including education programs, community-based support, and practical tools for managing type 2 diabetes. How can I get started with T2D Network? You can get started by exploring educational resources, joining community programs, or accessing support materials through the official website. Does T2D Network provide resources for caregivers and healthcare providers? Yes. T2D Network provides dedicated resources for patients, caregivers, the public, and healthcare providers to support better understanding and management of type 2 diabetes. 👉 Patients, caregivers, and the public 👉 Healthcare providers What topics does T2D Network cover? T2D Network covers key areas of diabetes management including healthy eating, lifestyle habits, stigma reduction, education, and community-based support. Where can I learn more about healthy eating and lifestyle support? You can explore dedicated resources on healthy eating and healthy lifestyle management through T2D Network’s educational pages. 👉 Healthy eating 👉 Healthy lifestyle Stay tuned for upcoming events and sign up for your Network newsletter or follow us on social media. You can also access past event recordings, webinars, and resources on our T2D Resource Archive and Blog page . Blog Articles Check out our latest articles to stay updated on the newest insights, trends, and information in diabetes care.

Written by Clare Koning, RN, PhD June 2026 5 min read Key Highlights ✅ Diabetic kidney disease affects approximately 1 in 4 people with T2D ✅ It is largely silent until significant damage has occurred ✅ SGLT2 inhibitors have revolutionized kidney disease treatment ✅ Guidelines recommend earlier initiation of kidney-protective medications ✅ A simple urine test and blood creatinine check can detect early kidney involvement Of all the complications of type 2 diabetes, diabetic kidney disease is perhaps the quietest. It produces no pain, no visible signs, and often no symptoms at all until kidney function has declined substantially. Yet it is the single leading cause of kidney failure requiring dialysis in Canada, and it affects approximately one in four people with T2D. The clinical landscape around diabetic kidney disease has changed dramatically in the past five years, with new medications, updated guidelines, and a fundamental shift in how providers approach kidney protection in T2D. Here is what you need to know. How Diabetes Damages the Kidneys The kidneys contain millions of tiny filtering units called glomeruli, each fed by a network of capillaries. Chronic high blood sugar damages these capillaries in two ways: first, by causing direct glycation damage to the capillary walls; second, by increasing pressure within the glomeruli (hyperfiltration), which forces the filters to work harder and accelerates their deterioration. The first detectable sign of this damage is usually microalbuminuria, the appearance of small amounts of the protein albumin in the urine, indicating that the kidney filter is becoming leaky. As damage progresses, protein loss increases, blood pressure typically rises, and the estimated glomerular filtration rate (eGFR), which measures how efficiently the kidneys are filtering blood, begins to fall. The 2026 ADA Standards of Care recommend annual screening for all people with T2D, beginning at diagnosis, using both a urine albumin-to-creatinine ratio (uACR) and an eGFR blood test. The combination of these two simple tests provides an early warning system that most people with T2D are entitled to but not all routinely receive. The SGLT2 Revolution The most significant development in diabetic kidney disease management in recent years has been the emergence of SGLT2 inhibitors, including dapagliflozin (Forxiga) and empagliflozin (Jardiance), originally approved as glucose-lowering medications, as kidney-protective agents in their own right. Landmark randomized trials including DAPA-CKD and EMPA-Kidney demonstrated that SGLT2 inhibitors significantly reduce the risk of kidney disease progression and kidney failure in people with chronic kidney disease, with benefits seen whether or not participants had diabetes. In trials specifically focused on diabetic kidney disease, SGLT2 inhibitors reduced the risk of a sustained decline in kidney function by approximately 50% compared with placebo, a magnitude that has prompted a fundamental reassignment of these drugs from glucose-lowering agents to cardiorenal-protective agents. The mechanism goes beyond glucose control. SGLT2 inhibitors reduce intraglomerular pressure, the harmful elevated filtration pressure that drives chronic kidney disease (CKD) progression in diabetes, through a hemodynamic effect on the glomerular afferent arteriole. They also reduce inflammation, reduce body weight, lower blood pressure, and appear to protect kidney tubular cells directly from metabolic stress. Let's pause on that... SGLT2 inhibitors reduce kidney disease progression by approximately 50% in people with diabetic CKD. That is a remarkable clinical result for a class of drugs that was originally approved purely for blood sugar. This Harvard Medical School Continuing Education video examines these key questions: How do SGLT2 inhibitors provide kidney protection? What key findings in CREDENCE and DAPA-CKD, two landmark kidney outcomes trials, have led to new SGLT2i guidelines for patients with CKD? Updated 2026 Guidelines The 2026 ADA Standards of Care include new guidance on glucose-lowering therapies in people with chronic kidney disease, including use by those on dialysis, reflecting a continued expansion of the kidney-protective treatment framework. Importantly, the guidelines now support initiating SGLT2 inhibitors at earlier stages of CKD than previously recommended, extending kidney protection to more people with T2D. The 2026 guidelines also highlight finerenone, a novel nonsteroidal mineralocorticoid receptor antagonist, as an additional kidney and heart-protective agent in T2D-associated CKD, based on the FIDELIO and FIGARO trials showing reduced risk of kidney failure and cardiovascular events. What People with T2D Should Ask Their Provider If you have T2D and have not recently had your kidneys checked, ask for both a urine albumin test and a blood creatinine/eGFR at your next appointment. These are standard of care and should be done annually. If you are already on an SGLT2 inhibitor for blood sugar control, your kidneys are likely already benefiting. If you are not, and have any degree of kidney involvement, ask your provider whether you are a candidate. Early detection and treatment is the difference between slowing this condition and arresting it before serious harm occurs. For more on managing diabetes complications, visit the T2D Network's Monitoring & Medication and Learn More pages.

Written by Clare Koning, RN, PhD June 2026 5 min read Key Highlights ✅ A 2025 meta-analysis of 8 RCTs found time-restricted eating (TRE) significantly improved fasting glucose, HbA1c, and time in range in people with T2D ✅ A head-to-head trial at ENDO 2025 found intermittent fasting (two days per week) outperformed continuous calorie restriction on insulin sensitivity and adherence ✅ A January 2026 study found TRE without calorie reduction produced no metabolic benefit, complicating the picture ✅ When does matter: early TRE aligned with morning eating windows shows stronger effects than late-night eating windows ✅ Medication timing and hypoglycaemia risk require careful planning before starting any fasting protocol Intermittent fasting is one of the most searched dietary topics in health right now, and for people with type 2 diabetes, the question of whether it helps, hinders, or simply does not matter is both practically urgent and genuinely unsettled. The evidence in 2026 is richer than it was two years ago, but also more nuanced, and that nuance is worth communicating clearly. What Time-Restricted (fasting) Eating Shows Time-restricted eating (TRE) limits daily food intake to a defined window, typically six to ten hours, leaving a fasting period of fourteen to eighteen hours, usually overnight. A systematic review and meta-analysis published in the International Journal of Molecular Sciences in July 2025 analysed eight randomized controlled trials involving 312 participants with T2D or impaired fasting glucose. The pooled results were meaningfully positive: TRE significantly reduced fasting glucose (mean difference: -0.74 mmol/L), reduced HbA1c, and increased time in range by an average of 10.51%. A separate trial presented at ENDO 2025, the Endocrine Society's annual meeting, directly compared three dietary approaches in people with T2D and obesity: intermittent energy restriction (IER, fasting two days per week), time-restricted eating, and continuous energy restriction. All three improved HbA1c. But the IER group showed the greatest advantages in reducing fasting blood glucose, improving insulin sensitivity, reducing triglycerides, and crucially, maintaining adherence over time. Across trials, intermittent fasting approaches consistently improved blood sugar metrics in people with T2D. The two-day fasting model also produced better adherence than continuous dieting, which is a clinically meaningful distinction. A study published in Science Translational Medicine in October 2025 added a significant caveat. Researchers in Germany tested TRE under strictly isocaloric conditions, meaning participants ate the same total number of calories whether fasting or not. The result: no clinically meaningful improvement in insulin sensitivity, blood sugar, blood fats, or inflammatory markers. The conclusion: when TRE produces metabolic benefits, it appears to be largely through reduced caloric intake, not through fasting itself as a metabolic trigger. The circadian timing shift was confirmed, but metabolic improvement was not. This does not invalidate TRE as a strategy. It clarifies the mechanism. TRE works in practice partly because restricting the eating window tends to reduce overall calorie consumption naturally and sustainably for many people, particularly those who previously ate from morning until late at night. The fasting itself may not be the active ingredient. A Case Study Fasting is one of the oldest dietary practices known to humanity. Physician, researcher, and author Jason Fung explains the physiological changes that occur during fasting and describes its role in helping a 69-year-old patient reverse type 2 diabetes. Intermittent fasting works by shifting the body's primary fuel source from glucose to stored fat. Its potential benefits include simplicity, convenience, flexibility, low cost, and compatibility with a wide range of dietary approaches. Timing Matters: Earlier Is Better One consistently emerging finding across TRE studies is that early eating windows, finishing the final meal by early evening, produce stronger metabolic effects than late or unrestricted windows. This aligns with circadian biology: insulin sensitivity is highest in the morning and declines through the day. Eating in alignment with this rhythm, front-loading calories earlier and fasting from late afternoon onward, amplifies the benefit. Research supports the idea that circadian misalignment caused by late-night eating is itself a contributor to metabolic risk. Shifting the eating window earlier, even without reducing total calories, may carry circadian benefits beyond simple caloric arithmetic. What This Means If You Have T2D Fasting protocols are not without risk for people with T2D, particularly those on insulin or sulfonylurea medications that can cause hypoglycaemia during fasting periods. Before starting any fasting protocol, it is essential to discuss medication adjustment with your care team. With appropriate medical oversight, the evidence now supports TRE and intermittent energy restriction as viable, evidence-based dietary strategies for people with T2D seeking non-pharmacological approaches to improving blood sugar, weight, and metabolic health. They are not magic, they work primarily through caloric reduction and circadian alignment, but they may be more sustainable for many people than conventional continuous dieting. For guidance on eating strategies and T2D, visit the T2D Network's Healthy Eating page or sign up for our weekly insights.

Written by Clare Koning, RN, PhD June 2026 5 min read Key Highlights ✅ People with T2D have a 3-fold higher risk of muscle loss compared to those without diabetes ✅ Muscle is the body's primary glucose disposal organ, so losing it directly worsens insulin resistance ✅ T2D causes a distinct type of muscle loss that differs from normal aging ✅ Resistance training slows muscle loss, and may be more important than cardio for people with T2D ✅ GLP-1 medications, while effective for weight loss, may accelerate muscle loss without adequate protein and resistance training When people think about the complications of type 2 diabetes (T2D), they typically think about the eyes, the kidneys, the heart, and the feet. Muscle rarely makes the list. But skeletal muscle is the largest glucose disposal organ in the human body, responsible for absorbing up to 70-80% of insulin-stimulated glucose uptake during a meal. When you lose muscle, that capacity shrinks, and blood sugar control gets harder. This relationship between T2D and muscle loss, increasingly referred to as diabetic sarcopenia, is one of the most underrecognized and clinically important aspects of living with the condition. What Diabetic Muscle Loss (Sarcopenia) Actually Is Sarcopenia is defined as the progressive loss of skeletal muscle mass, strength, and function. It is classically associated with aging. But research published in Frontiers in Endocrinology has demonstrated that T2D-related muscle loss is a distinct entity, with a different pathological pattern than age-related sarcopenia. Where normal sarcopenia primarily affects fast-twitch Type II muscle fibres, T2D targets the slow-twitch, oxidative Type I fibres that are most important for sustained, endurance-type activity and metabolic regulation. A 2025 review published in Diseases identified key risk factors for diabetic sarcopenia: poor glycemic control (HbA1c above 8%), longer diabetes duration over five years, low BMI, and reduced levels of vitamin D and insulin-like growth factor-1 (IGF-1). Importantly, the review found that people with T2D have a 3-fold higher risk of sarcopenia compared to those without, and that 8.2% of people with newly diagnosed T2D already have sarcopenia at the time of diagnosis. The mechanisms are multiple and reinforcing. Chronic elevated blood sugar promotes the accumulation of advanced glycation end-products (AGEs) in muscle tissue, impairing contractile function. Insulin resistance itself impairs the anabolic signalling pathways, particularly the mTOR pathway, that drive muscle protein synthesis. And elevated cortisol, common in people with poorly managed T2D, directly accelerates muscle protein breakdown. More muscle mass, and not just less body fat, is critical to lowering your risk for type 2 diabetes, a study by UCLA's Dr Preethi Srikanthan and colleagues suggests. T2D causes muscle loss through at least four distinct biological mechanisms: glycation of muscle proteins, impaired anabolic signalling, inflammation, and elevated cortisol. This is not just aging. It is disease-driven. The GLP-1 Weight Loss Warning One timely dimension of this issue relates to the extraordinary popularity of GLP-1 receptor agonists for weight loss. These medications are effective, and their benefits for glycemic control, cardiovascular health, and kidney protection are well-documented. But rapid weight loss from any cause, including GLP-1 therapy, carries a risk of significant muscle loss alongside fat loss. A 2025 review in Nutrients specifically examining creatine supplementation, exercise, and T2D noted that for people with pre-existing insulin resistance and sarcopenic risk, losing weight rapidly without concurrent resistance training and adequate protein intake may worsen the muscle-mass deficit even as metabolic markers improve. This is not an argument against GLP-1 therapy. It is an argument for pairing it with structured resistance exercise and protein-focused nutrition, a combination that evidence strongly supports for preserving muscle during weight loss. What the Exercise Evidence Shows A 2025 systematic review and meta-analysis published in Diabetes Research and Clinical Practice, examining 19 randomized controlled trials in older adults with T2D, found that resistance exercise training significantly improved HbA1c (mean difference: -0.51%, p < 0.0001) and fasting blood glucose, alongside meaningful improvements in muscle mass, strength, and body composition. A 2025 review in Metabolites comparing aerobic, resistance, HIIT, and combined training protocols concluded that combined aerobic and resistance training produced the best overall metabolic outcomes, with resistance training showing particular advantages for muscle preservation and insulin sensitivity in people with T2D. The key finding from the meta-regression work is that training effect matters: the greater the strength gain, the greater the HbA1c reduction. This points toward progressive overload, gradually increasing weight or resistance, as the mechanism behind blood sugar benefits, not simply moving the body. Practical Targets For people with T2D, the current evidence supports at least two resistance training sessions per week targeting major muscle groups, combined with adequate dietary protein (generally 1.2 to 1.6g per kg body weight daily, adjusted for kidney function). Both are underutilized in standard T2D care. Talk to your diabetes education team about incorporating resistance training, even if it is bodyweight exercise at home, into your management plan. This is not supplementary to your diabetes care. For many people, it may be one of the most impactful interventions available. For more on exercise and T2D, visit the T2D Network's Healthy Lifestyle page or join our network for weekly insights.