Centres for Complex Diabetes Care – How they can help you

What They Do
Centres for Complex Diabetes Care (CCDC) provide expert short-term case management to diabetic patients over the age of 18 with cumulative, complex problems requiring more intensive treatment measures. The CCDC uses a coordinated approach to diabetes management from a single access point, connecting patients to various services and programs the patient may require for their health needs.
Specialized teams of endocrinologists, nurse practitioners, registered nurses, registered dietitians, social workers, pharmacists and chiropodists (foot care specialists) help patients manage their diabetes through:

• Specialized medical interventions
• Management and stabilization of blood sugar
• Diet planning and nutritional counselling
• Insulin administration and monitoring
• Eye/retinal monitoring
• Counselling and mental health support
• Management and monitoring of related cardiovascular health concerns
• Foot and wound care

The CCDC team works closely with the patients’ primary care provider (a family physician)  to ensure additional support for diabetes management through education, specialized training and mentoring. The patient-centred, goal-specific model links patients with the necessary services across the health care and social service systems to effectively manage their condition.
Who Can Be Referred?
To be referred, the client must be 18 years of age or older with Type 1 or Type 2 diabetes and have one or more of the following:

• Multiple episodes of inadequate glycemic control and/or significant co-morbidities impacting glycemic control;
• Barriers in accessing healthcare, serious mental health issues, mobility issues, frail or elderly, and other issues compromising determinants of health;
• Recurrent emergency department visits or hospitalizations; and
• Individuals with diabetes complexities that would benefit from an inter-professional team who is able to provide collaborative client care between multiple healthcare providers.

Diabetes and Chronic Pain
Allevio is very pleased to be able to work together with CCDCs across the province, and specifically with the North York General CCDC to be able to support patients with both diabetes and chronic pain. Allevio Pain Management helps many patients that have diabetic neuropathy, also known as diabetic neuropathic pain, through various treatments and our team works with CCDCs to meet the needs of diabetic patients.
Ontario has six CCDCs in the following regions:

1. Central West : William Osler Health System – (Phone) 905-494-2260 (Fax) 905-595-2863
2. Northeastern Ontario : Health Sciences North/Horizon Santé-Nord – (Phone) 705-671-6601 Ext. 2971 (Fax) 705-671-5634
3. Northwestern Ontario : Thunder Bay Regional Health Sciences Centre – (Phone) 807-684-6663 (Fax) 807-684-5928
4. Central : North York General Hospital – (Phone) 416-635-2575 (Fax) 416-635-2601 *Referral forms can be downloaded by visiting the CCDC’s website at www.nygh.on.ca/diabetes or clients can use the e-referral process.
5. Mississauga Halton : Trillium Health Centre – (Phone) 905-848-7545 (Fax) 905-804-7955
6. Central East : Central East Community Care Access Centre – (Phone) 905-430-3308 x.5458 (Fax) 905-430-8682

The ministry of health and long-term care also provides multiple resources and helpful guides online at their website. For more information please visit: http://www.health.gov.on.ca/en/public/programs/diabetes/.
For more information on living with diabetes make sure to visit the Canadian Diabetes Association.