Review of recent research into Prediabetes and Diabetes Type 2- testing and lifestyle programs for older adults.
Provided by Diana Dibblee, RD
This study was completed in rural Ontario among 26 older adults (average age was 60). The Stratford community based health center and Ottawa University students worked with these individuals to support their education and understanding around diabetes, particularly in relation to nutrition education. The identified prediabetic adults were given support to enable them to make lifestyle changes, to their diet and their health. The findings from the study concluded that "based on preliminary results, the 6-month lifestyle education program helped those rural adults improve some of their dietary behaviors, such as reducing their total sugar intake". The research noted that these changes may help to prevent or delay the risk of developing diabetes. It was also noted that the study supported the reduction of their consumption of carbohydrates, specifically sugars, as well as fats. More research is needed to determine if these results would continue beyond the 6 month time frame with a larger study, particularly in relation to these adult. Some questions that arose include: were they able to control their sugar levels, could they prevent diabetes type 2 with their lifestyle changes and what supports did they receive (from dietitians and other health professionals that led them to make these changes).
In another recent article from the American Diabetic Association, adults with prediabetes are strongly recommended to be tested for hyperglycemia. In this Diabetes Care article (Venkat Narayan & Gujral, 2015), "Evidence Tips the Scale Toward Screening for Hyperglycemia", sites the many research studies that suggest that "type 2 diabetes prevention among people with prediabetes, screening for hyperglycemia is the first step toward delivering interventions to this subpopulation (over 90% of whom remain undetected)". Once the individuals have been determined to either have prediabetes or type 2, then the health care system needs to combine efforts to support lifestyle interventions and nutrition education to provide the best care possible (to prevent or delay the onset of diabetes type 2). What do you think? Do we have these supports currently in place in Canada? What can we do in our own practices to support those who may come to us with prediabetes or type 2?
The American Diabetes Association recommends glucose testing in all people aged 45 years and over or those at high risk for type 2 diabetes. The Canadian Diabetes Association recommends that individuals at or over the age of 40 be screened every 3 years. They also recommend to screen individuals more often who have additional risk factors for diabetes or those who are at very high risk (using the diabetes calculator- see the CDA site for the chart used to determine sugar levels). Overall, from the many research articles I read, the key to promoting and preventing diabetes type 2, is the support that adults need. This can include but is not limited to: working with health care individuals such as a registered dietitian who educate and guide patients in their care re: their diet, exercise and lifestyle changes that can impact their blood sugar levels.
I once interned in the Diabetes Care Program at a local hospital. I remember the short amount of time I had to spend with each patient in order to educate them on best practices re: their diabetes. There was an incredibly long wait list for those who had been newly diagnosed with diabetes type 2. In conclusion from all of the research, it is imperative that we continue to support adults with prediabetes and those newly diagnosed with type 2 with timely, informative and clear/concise education. As noted in Aging Well, "Diabetes Prevention, The best medicine" (Palmer, 2009) as quoted by another RD, "the evidence is clear—older adults' lifestyle choices dramatically influence the risk for developing type 2 diabetes. With such compelling information, promoting preventive lifestyle strategies should be part of routine healthcare for older adults". Let's continue to work at promoting, preventing and supporting education of this disease with all of our clients/patients and other health care practitioners. Prevention and nutrition education are essential!
An article from the Canadian Dietetic Conference held recently in June caught my attention. One of the papers presented at the conference was entitled "The effect of a 6-month lifestyle education program on dietary behaviors in rural adults with prediabetes". I read the abstract though could not find the details conducted by a group of researchers in Ontario (I. Giroux et al, 2015).
Given the epic proportions of prediabetes and diabetes, type 2 in our North American society today and the fact that most of us probably have a relative (or a client) that currently has prediabetes (identified or not as yet identified), I thought this was a good article to review this month.