Diabetes is a metabolic condition leading to elevated glucose (sugar) levels in the blood. Insulin is a hormone that controls the amount of glucose in the blood. Type 1 diabetes is a chronic condition where the pancreas produces little or no insulin. Type 2 diabetes occurs when your body does not use insulin properly. We take a holistic approach to diabetes health as our multidisciplinary team includes: physician specialists (endocrinologists), advanced practice nurses, a registered dietitian and a social worker.
The Nurse Practitioner (also a Certified Diabetes Educator) works in collaboration with the endocrinologists and multidisciplinary health care team to help individuals living with Type 1 diabetes, Type 2 diabetes or polycystic ovary syndrome manage their condition. The Nurse Practitioner works in partnership with the individual to assess their health care goals and needs. They provide counselling, education, health promotion and revise treatment plans on an ongoing basis. The Nurse Practitioner is a registered nurse with addition education and an increased scope of practice.
NICOLA FARNELL –BSC, MN, CDE, NP-ADULT, CDE
Nicola obtained her Bachelor of Science in Nursing (Honours) degree in 2003 from University of Toronto and her Master of Nursing degree and Acute Care Nurse Practitioner certificate in 2007 from the University of Toronto. She holds a cross appointment with the University of Toronto as an Adjunct Lecturer at the Lawrence S. Bloomberg Faculty of Nursing. Working in her current role as a nurse practitioner in the Centre for Integrated Diabetes Care at Women’s College Hospital since 2007, Nicola is a Certified Diabetes Educator specializing in working with adults who have complex Type 2 diabetes and pregnant women with Type 2 diabetes or gestational diabetes. She has a particular interest in diabetes and pregnancy.
STEPHANIE GOMER BSC, MN, NP-PHC –
Stephanie obtained her Bachelor of Science in Nursing from the University of Toronto in 2011. She worked in pediatric inpatient transplant and medical specialties, including endocrinology, at the Hospital for Sick Children for 7 years. There she worked closely with the Good to Go program to help adolescents prepare for transition to adult care. She joined the Centre for Integrated Diabetes Care at Women’s College Hospital in January 2019 after completing her Masters of Nursing, Nurse practitioner Degree at the University of Toronto. In this role, she functions as a transition navigator for Young Adults living with Type 1 diabetes and specializes in supporting young adults to engage in their self-management of Type 1 diabetes. She is interested in new and innovative ways to provide in person and virtual care to young adults living with type 1 diabetes.
Advanced Practice Nurse
The Advanced Practice Nurse (also a Certified Diabetes Educator) works in consultation with the endocrinologist to improve the health and well-being of individuals living with diabetes. Through individual counselling, the Advanced Practice Nurse educates and facilitates self-management techniques to patients with Type 1 diabetes, Type 2 diabetes and those on insulin pump therapy.
LEAH DRAZEK – RN, BSCN, MN, CDE, ADVANCED PRACTICE NURSE AT WOMEN’S COLLEGE HOSPITAL
Leah obtained her Bachelor of Science in Nursing degree in 1999 from Dalhousie University in Halifax, NS and her Master of Nursing degree in Adult Clinical Care in 2008 from the University of Toronto, Toronto, ON. She holds a cross appointment with the University of Toronto as an Adjunct Lecturer at the Lawrence S. Bloomberg Faculty of Nursing. Working in her current role as an advanced practice nurse in the Endocrine Program at Women’s College Hospital since 2008, Leah is a Certified Diabetes Educator and Certified Pump Trainer specializing in the clinical education and self-care management of Young Adults with Type 1 diabetes and adults living with Type 1 and Type 2 diabetes. Living with Type 1 diabetes herself for 33 years, she has a particular interest in Type 1 diabetes, insulin pump therapy and continuous glucose monitoring.
The clinical social worker can help assist with psychosocial and behavioural issues of diabetes. They help a diverse population cope and adjust their lifestyle to be able to manage their diabetes. This can include: locating financial/compassionate programs to assist with the costs of diabetes medication and supplies; to developing coping strategies when managing life stressors (work, financial, family, extended family, other medical concerns and taking care of one’s diabetes as they manage their life).
NORETTE RENE-GOUGEON, MSW, RSW
Norette obtained her Bachelor of Social Work degree from the University of Sydney in 2008 and her Masters of Social Work degree from the University of Toronto in 2018. Norette has worked in various social work settings in Sydney, Australia and Toronto including early intervention, community mental health, children’s mental health and private practice.
Norette joined the Endocrinology Department at Women’s College Hospital in 2021. She has a keen interest in supporting diverse individuals in coping with diabetes management in addition to other challenges that are related to living with a chronic illness. Norette supports individuals with understanding and managing mental health symptoms, stress, life stage transitions and financial/system navigation.
The Registered Dietitian (RD), who is also a Certified Diabetes Educator, works in consultation with the endocrinologist and interprofessional health care team to provide nutritional assessment and education to individuals living with Type 1 Diabetes, Type 2 Diabetes, gestational diabetes and polycystic ovary syndrome. The dietitian works closely with patients to identify specific nutritional needs and design a care plan that works with the individuals’ lifestyle.
JANIS RUSEN MSC, RD, CDE
Janis has worked in clinical practice at Women’s College Hospital for the past 20 years, where she’s gained expertise in women’s health and transitional care. She joined the Endocrinology Program in 2010 and became a certified diabetes educator in 2011. Janis works closely with young adults diagnosed with Type 1 Diabetes and adults with complex Type 2 Diabetes, diabetes in pregnancy and gestational diabetes. Janis is a preceptor to dietetic interns and participates in the education of medical students, interns and residents.
Physician Specialists (Endocrinologist)
The Endocrinologists specialize in the treatment of hormone imbalances to help restore the normal levels of hormones in the body.
Dr. Eleni Dimaraki
Dr. Eleni Dimaraki graduated from the University of Athens Medical School and completed her endocrinology training at the University of Michigan. She also obtained a Masters of Science in clinical research design and statistical analysis from the University of Michigan. Prior to coming to Women’s College Hospital in 2016, she was on faculty at Northwestern University and the University of Michigan. Her clinical interests include type 1 diabetes mellitus in young adults, pituitary disorders and osteoporosis. She is the clinical director of the Centre for Integrated Diabetes Care at Women’s College Hospital. Dr. Dimaraki is also very active in the education of University of Toronto medical students, residents and fellows.
Dr. Arno Kumagai
Arno K. Kumagai, M.D. Arno Kumagai is Professor of Medicine and Vice Chair for Education, Department of Medicine at the University of Toronto. He also holds the F.M. Hill Chair in Humanism Education at Women’s College Hospital, where he has a clinical practice focused on working with individuals with type 1 diabetes mellitus.
Dr. Kumagai received his B.A. in Comparative Literature from U.C. Berkeley and his M.D. from UCLA School of Medicine. He completed postgraduate training and postdoc research fellowships at UCLA and in Tokyo, Japan. He was on faculty at the University of Michigan Medical School from 1996 to 2016 and joined the University of Toronto’s Department of Medicine as Vice Chair for Education in April 2016.
Dr. Kumagai’s scholarly interests are in the use of narratives and humanities in medical education, dialogical teaching, and teaching for equity and social justice. He is the recipient of numerous teaching awards in teaching, humanism, educational innovation, and diversity. He was most recently named as the 2018 Daniel C. Tosteson Visiting Professor in Medical Education at Harvard Medical School and is a member of the Editorial Board of Academic Medicine.
Dr. Lorraine Lipscombe
Dr. Lipscombe is an endocrinologist and director of the Division of Endocrinology at Women’s College Hospital, as well as a scientist at the Women’s College Research Institute, a senior adjunct scientist at the Institute for Clinical Evaluative Sciences, and an Associate Professor of Medicine at University of Toronto. She completed her MD from McGill University in 1998, followed by Internal Medicine and Endocrinology training and an MSc in Clinical Epidemiology from University of Toronto. Dr. Lipscombe’s research program focuses on the epidemiology, care and prevention of diabetes, with a specific focus on diabetes in women. She has extensive experience with the use of population-based databases to conduct diabetes research, and is currently leading a large clinical trial to evaluate a diabetes prevention program for women with gestational diabetes.
Dr. Geetha Mukerji
Clinician in Quality and Innovation, Assistant Professor, University of Toronto
Dr. Mukerji’s primary appointment is in the Division of Endocrinology at Women’s College Hospital with cross appointment to Division of Endocrinology at UHN/MSH. She has a Master’s degree in Quality Improvement and Patient Safety from the Institute of Health Policy and Management Evaluation at the University of Toronto and is the Clinician Lead in Quality at the Women’s College Institute of Health systems solutions and Virtual care. Her academic interests include: 1) system improvement efforts for those with complex chronic diseases such as diabetes 2) quality improvement in endocrinology in pregnancy care and transitional care populations, and 3) safety and quality care processes in the ambulatory setting. She is actively involved in the Young Adults Type 1 diabetes Transition Care program at WCH at the Endocrine in Pregnancy program at Mt Sinai and WCH. She has a special interest in the care of patients with chronic, complex diseases and examining innovative models of care delivery. She is an active clinical teacher in the endocrine division at WCH and also has a strong interest in teaching quality improvement and patient safety to undergraduate and post-graduate trainees.
Dr. Afshan Zahedi
Associate Professor of Medicine at the University of Toronto.
She is the Medical Director of the Thyroid Program and staff Endocrinologist at Women’s College Hospital with cross appointment to Division of Endocrinology at UHN/MSH. She is the Fellowship Program Director for the Division of Endocrinology at University of Toronto. Dr. Zahedi is a clinician teacher and is involved in both undergraduate and postgraduate education at the Faculty of Medicine. She has been the recipient of several education awards. Her research focuses on Quality Improvement with a multidisciplinary approach to delivery of health care. Her research focuses on implementing multidisciplinary (surgical and medical) team approach to Thyroid cancer management and improving the healthcare experience for patients with thyroid cancer. Other research includes impact of continuing education for primary care and allied health professionals to improve outcomes for chronic disease management including diabetes in geriatric populations.
Dr. Catherine Kelly
Dr. Kelly is a Clinical Educator and a Professor of Medicine at the University of Toronto. She is the former Division Head of Endocrinology at Women’s College Hospital, and the former U of T Endocrine Postgraduate Program Director from 1999 to 2007. She is the Peters Boyd Academy Director for the academic year 2009/2010 and is site director of the PB Academy at WCH since 2007-2013. She is a faculty member of the Institute for Healthcare Communication and is the University DOM Champion for the Communicator role. She has expertise in implementing Lean Management processes into clinical settings. Her clinical interest is in thyroid disease and she has created a Thyroid Cancer Program at WCH. She has won several teaching awards.
Dr. Iliana Lega
Dr. Iliana Lega is a scientist at Women’s College Research Institute, an endocrinologist at Women’s College Hospital, and an assistant professor at the University of Toronto. In addition, she is an adjunct scientist at the Institute for Clinical and Evaluative Sciences. She completed an internal medicine residency in 2007 and an endocrinology fellowship in 2009 both at McGill University. She obtained a Master’s degree in Clinical Epidemiology from the University of Toronto in 2013. Dr. Lega’s research program has focused on diabetes in complex populations. Her work to date has focused on the relationship between diabetes and cancer. While she evaluated the impact of diabetes and diabetes medications on cancer outcomes, she has also shown that young cancer survivors are at increased risk of developing diabetes. More recently, Dr. Lega’s research focus has been on diabetes management and potential overtreatment in older adults, with an emphasis on the adverse effects of intensive glycemic control in this population. In other research projects, Dr. Lega is evaluating ways to improve care delivery and to prevent cardiometabolic disease among women with Turner syndrome. Dr. Lega’s clinical interests lie in the area of diabetes, as well as reproductive endocrinology, including Premature Ovarian Insufficiency (POI), Turner syndrome, Polycystic Ovarian Syndrome (PCOS) and Menopause. Dr Lega has published over 20 peer-reviewed papers, and her research program is supported by the Canadian Institutes for Health Research.
Dr. Sandra Kim
Dr. Sandra Kim is an Assistant Professor and Clinician Teacher in Department of Medicine and Division of Endocrinology & Metabolism at the University of Toronto. She is Medical Director of the Centre for Osteoporosis & Bone Health at Women’s College Hospital, and she is the WCH co-lead with the Ontario Osteoporosis Strategy, in providing osteoporosis care outreach to underserviced communities, as well as inter-professional education, through the Ontario Telemedicine Network (OTN). Dr. Kim was appointed Chair of Osteoporosis Canada’s Scientific Advisory Council in 2018, and is involved in updating the Canadian Osteoporosis Clinical Practice Guidelines and is the co-chair of the guidelines’ pharmacotherapy working group. She also serves on the Canadian Panel for the International Society for Clinical Densitometry. Dr. Kim is actively involved in teaching at both the undergraduate and postgraduate levels, and is the recipient of several education awards. She is the co-chair of the Quality Operations Advisory Committee at Women’s College Hospital and her research activities include projects in evaluating outcomes of osteoporosis care delivered by telemedicine and transgender bone health.
Dr. Shoba Sujana Kumar
Dr. Sujana Kumar is an Assistant Professor in the Department of Medicine at the University of Toronto, and has an MSc in Community Health and Medical Education. She is an active teacher in both undergraduate and postgraduate education – she is director of the Internal Medicine Academic Half Day at the University of Toronto and site director for Endocrinology at Women’s College Hospital (WCH). She has been co-chair of the annual “Diabetes Week” course for incoming PGY4s in Endocrinology since 2010.
At the hospital level, she is also chair of Medical Grand Rounds and the Education Committee at WCH and director of the Endocrine Preconception and Pregnancy Program. Her clinical interests include diabetes, endocrinology of pregnancy, PCOS and thyroid cancer, and she also works in internal medicine in the Acute Ambulatory Care Unit.
Dr. Zoe Lysy
Zoë Lysy MDCM, MPH, FRCPC is an Adjunct Assistant Professor in the Department of Medicine. She completed her medical degree at McGill University and her postgraduate Internal Medicine and Endocrinology training at the University of Toronto. She has a Masters degree in Public Health from Harvard University and act primarily as a clinician within the division.
Her main areas of clinical interest include Osteoporosis, calcium disorders and general endocrinology such as type 2 diabetes. She is also actively involved in teaching both undergraduate and postgraduate trainees.
Dr. Adrian Lau
Dr. Adrian Lau is an Assistant Professor and Clinician Teacher in the Division of Endocrinology and Metabolism at Women’s College Hospital. He obtained his medical degree in 2007 at the University of Toronto, where he also completed his postgraduate training in Internal Medicine, and Endocrinology and Metabolism. In 2016, he obtained his Masters of Science in Community Health (Health Practitioner Teacher Education program) at the University of Toronto.
His particular clinical interests are in osteoporosis and metabolic bone diseases. He is actively involved in teaching at both the undergraduate and postgraduate levels. In research, he is currently involved in a study to better understand the genetic risk factors associated with atypical femur fractures. Dr. Lau is involved with the osteoporosis community nationally and internationally. He currently serves as a member of the Scientific Advisory Committee of The International Society For Clinical Densitometry (2017 to present), and a member of the Scientific Advisory Council of Osteoporosis Canada (2018 to present).
Dr. Rosario Briones
Dr. Rosario Briones-Urbina, MD, PhD, FRCPC
Assistant Professor of Medicine at the University of Toronto. PhD in Biochemistry
Dr. Briones-Urbina is an active teacher in undergraduate, postgraduate and continuing medical education. She has been the recipient of multiple education awards.
She fulfilled many leadership roles in education and is the former Chair of the Women’s College Department of Medicine Education Committee and the Chair of the Medical Grand Rounds Committee. She served in the Division of Endocrinology Postgraduate Education Committee. She was the Division of Endocrinology representative to the University of Toronto Department of Medicine task force on Continuing Education and Knowledge Translation & Exchange.
Her clinical interests are in thyroid disease, adrenal disease, and osteoporosis.
Dr. Olexandra Koshkina
Dr. Koshkina received her Honors Bachelor of Science and Master of Science degrees from the University of Toronto. She went on to receive her medical degree from the University College Dublin School of Medicine and Medical Sciences. She completed her postgraduate training in internal medicine at Lahey Hospital & Medical Center (Tuft’s University School of Medicine) and endocrinology training at the University of Toronto. Dr. Koshkina’s academic interest is in medical education and she is currently pursuing further training in this area from the University of Dundee Center for Medical Education. She is involved in undergraduate medical education at the University of Toronto as a clinical skills tutor for the second year medical students.
Her clinical interests are in general endocrinology as well as women’s health, which includes endocrine disorders in pregnancy, PCOS and reproductive endocrinology.
Dr. Sheila Laredo
Sheila Laredo, MD, PhD, FRCPC
Dr. Laredo is a Clinical Teacher and an Associate Professor of Medicine at the University of Toronto, in the Division of Endocrinology. She is the Chief Medical Advisor for The College of Physicians & Surgeons of Ontario. She has a PhD in Clinical Epidemiology. Her clinical focus is in polycystic ovary syndrome (PCOS), reproductive endocrinology, insulin resistance and lifestyle interventions. She has expertise in implementing ‘Lean Management’ processes into clinical settings. Dr. Laredo has extensive expertise in the Health Advocacy role in working with different levels of government to help develop health policy, training initiatives, and clinical practice guidelines, with a special interest in autism and developmental disabilities. She works with the endocrinology fellows every year on advocacy projects. She is teaching in undergraduate and postgraduate medicine in both endocrinology and advocacy, has mentored students clinically and in research, and is the recipient of several teaching awards. She is Chair of NeuroDevNet, a federally funded Network of Centres of Excellence, of over 300 scientists dedicated to early diagnosis, prevention and treatment of neurodevelopmental disabilities and support for families.
Centre for Integrated Diabetes Care
Women’s College Hospital
76 Grenville Street
Toronto, ON M5S 1B2
Hours of Service
Monday – Friday
8 a.m. to 4 p.m.
Note: some programs take place during evening hours.
We are all here to work with you, and to help you manage the different aspects of your diabetes care. The clinics in the Centre for Integrated Diabetes care include:
Integrated Diabetes Clinic
This Nurse Practitioner (NP) led clinic is for individuals with complex Type 2 diabetes whose A1C is 9.5% or higher at time of referral. The NP works closely with these individuals to help them adjust their diabetes medications and lifestyle to optimize their diabetes management.
Young Adult Program: The Young Adult program is dedicated to assisting young adults make a smooth transition to an adult diabetes clinic from their paediatric providers. The multidisciplinary diabetes team specializes in complex type 1 diabetes care for people 18-25 years old and works in partnership with paediatric endocrinology treatment centres to help improve the transition. The Young Adult Program is also supported by a Nurse Practitioner who functions as a transition navigator to assist young people in achieving their self-management goals and reduce patients becoming lost to follow up. Through this program, patients also have access to a social worker and dietitian at each appointment. The team provides counseling on living independently with diabetes, travelling, stress management, and how to navigate competing priorities on a young person’s time.
General Endocrinology Clinic
People living with diabetes who do not fit into the above clinics are seen in general endocrinology clinic by one of our endocrinologists. They continue to have access to the multidisciplinary team to provide integrated, holistic diabetes care.
Diabetes in Pregnancy
People living with type 1 or type 2 diabetes who are planning pregnancy, are currently pregnant, and people who develop diabetes during pregnancy (gestational diabetes) are seen in the OB-Endo clinic. Through this program, patients followed by an endocrinologist and/or a nurse practitioner. They will also have access to a dietitian to manage their glucose control or the social worker for support.
How to Refer a Patient
Due to capacity limits, our Diabetes Program is restricting referrals for the time being. We are temporarily closed to new referrals for diabetes in patients older than 25.
We continue to accept referrals for:
- Young Adult Diabetes program (patients 18-25 years old with diabetes)
- Diabetes in pregnancy
- Other endocrine conditions
Thank you for your understanding.
Patients are seen only by referral from a family doctor, other specialist or nurse practitioner.
Please send a referral to fax number 416-323-6534 with the following information
- Your name, billing number, contact information
- Preference for a specific program, endocrinologist if applicable.
- Patient demographic and contact information
- Reason, urgency for referral
- Past medical history/cumulative patient profile
- Medication list
- Relevant recent investigations, e.g.:
- HbA1c for diabetes
- TSH for thyroid disorder
- Thyroid ultrasound for thyroid nodule
- DEXA report for osteoporosis
Physician and Provider Resources
The following resources were compiled to assist medical professionals in providing the necessary resources to their patients who have limited financial coverage and/or are unable to locate the resources needed to help their situation.
- ADP Insulin Pump and Supplies for Adults Application (.pdf)
- ADP Insulin Pump and Supplies for Children Application (.pdf)
- ADP Insulin Pump Application Instructions (.pdf)
- ADP Insulin Syringes for Seniors Application Instructions (.pdf)
- ADP Insulin Syringes for Seniors Application (.pdf)
- Exceptional Access Program Application (.pdf)
- MedicAlert Membership Assistance Application (.pdf)
- Northern Health Travel Grant Application (.pdf)
- ODBP Co-Payment for Low-Income Seniors Application (.pdf)
- Trillium Drug Program Application
This program offers a team based, integrated approach for patients with Type 1 diabetes, young adults with Type 1 diabetes (ages 18 – 26), and complex patients with Type 2 diabetes. This program also provides support for patients who are using an insulin pump, or are interested in using an insulin pump. The multidisciplinary team offers tailored treatment plans for patients with complex diabetes care needs.
Once a completed referral has been received, you will be notified of an appointment date and time by a member of our administrative staff.
We would ask that you plan to arrive at least 10-15 minutes before your scheduled appointment time so that we can complete your registration.
Please remember to bring your Ontario Health Card with you to this appointment. Please Note: If you do not have a valid Ontario Health Card, you will be required to pay directly for the clinical service(s) provided at the time of your visit. Details are available from any of our program secretaries.
At your first appointment please bring:
• List of medications, supplements or herbal remedies
• Home glucose meter if you are using one
• Insulin pump printouts if able. You can also download at WCH
If you are unable to keep your appointment, please notify the program scheduling secretary at 416-323-6013 to cancel and/or re-schedule your appointment. Please try to ensure you give 48 hours’ notice of cancellation or rescheduling requests.
There are many resources available for both patients and health care professionals. The following are websites and resources that will provide answers to many questions you may have about diabetes: