PATHWAYS: Personalized Approaches To improving Health outcomes of diabetes With standardized Assessment and risk Stratification
About PATHWAYS
Young adults diagnosed with Type 2 diabetes before age 40 often referred to as young-onset type 2 diabetes (YOD), face a particularly aggressive form of the disease and have a higher lifetime risk of complications compared to those diagnosed later in life. Managing diabetes requires ongoing self-management, but many young adults report that existing diabetes education programs do not adequately address their needs.
In most healthcare settings, diabetes self-management education is delivered through one-on-one visits with a certified diabetes educator, typically a nurse or dietitian. These sessions aim to help individuals understand their health risks and develop strategies to manage their condition.
PATHWAYS is a multi-component intervention to improve self-management education for YOD designed to improve how diabetes self-management education is delivered to young adults by developing tools that help educators provide clear, personalized, and engaging information about health risks and diabetes management.
Pathways is inspired by the Joint Asia Diabetes Evaluation (JADE) program developed in Hong Kong, a a large-scale digital diabetes management system that integrates standardized assessments, risk prediction, and personalized visualizations to support diabetes care. Research involving more than 26,000 individuals with diabetes has shown that participation in JADE was associated with significantly lower rates of diabetes complications and mortality compared with usual care.
Thus, PATHWAYS is a net-new tool that uses the JADE concept as a guide, with unique features built for the Canadian healthcare context.
PATHWAYS FRAMEWORK
Pathways is a multi-component intervention developed through several stages of research to support diabetes educators in delivering more personalized self-management education.
Understanding Barriers
The first step in developing PATHWAYS was to understand the challenges young adults face when managing diabetes.
A concept mapping study involving young adults with diabetes and healthcare providers identified major barriers to effective self-management, including limited awareness of long-term risks, difficulty understanding health information, and gaps in current education programs.
Publication:
Shah V, Senga J, Yu C, Zenlea I, Tang T, Barnet C, et al. Barriers and Facilitators to Self- Management of Young-Onset Type 2 Diabetes (YOD). Abstract accepted to be presented at: Diabetes Canada and Canadian Society of Endocrinology and Metabolism Professional Conference 2025 (forthcoming); 2025 Nov; Toronto.
Standardized Assessments
PATHWAYS includes a structured assessment tool that collects important clinical and background information needed to support personalized diabetes education. The tool gathers key indicators such as laboratory results and other health information and was developed through a multi-disciplinary consensus process involving clinicians and patients. The tool was developed through a Delphi consensus process involving clinicians and patients and has been integrated into the Epic electronic medical record system to support consistent information collection during diabetes education visits.
Risk Prediction and Visualization
PATHWAYS also includes tools to help patients understand their personal risk of diabetes complications.
Risk prediction models were developed using data from over 450,000 individuals with type 2 diabetes in Ontario, estimating the likelihood of future cardiovascular events based on clinical characteristics and laboratory results.
These risks are displayed using visual formats designed to make complex health information easier to understand.
Publication:
Abraha M, Senga J, Vallis M, Lipscombe LL, Yu CH, Zenlea I, et al. Impact of cardiovascular risk visualization on motivation to self-manage young-onset type 2 diabetes. Diabetes Research and Clinical Practice [Internet]. 2025 June 25 [cited 2025 June 25]; Available from: https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(25)00357-2/fulltext
Visualizing Key Risk Factors
The current phase of PATHWAYS focuses on the development and refinement of personal risk factor visualizations designed to support diabetes self-management education. This work follows an iterative co-design process with young adults living with young-onset type 2 diabetes (YOD) to ensure that the visualizations are clear, meaningful, and useful in clinical discussions with diabetes educators.
These tools focus on key modifiable risk factors, including HbA1c (blood sugar), blood pressure, and LDL cholesterol, which play a central role in determining the risk of long-term diabetes complications. By presenting these indicators in clear visual formats, PATHWAYS aims to help patients better understand their current health status and support more informed conversations about strategies to improve risk factor control.