Could screening high-risk populations for pre-diabetes and setting them up with culturally preferred fitness regimes prevent people from developing Type 2 diabetes and the secondary complications of heart and kidney disease, blindness and stroke?
That’s what several York researchers are hoping to find out. If successful, their Pre-Diabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) Program could become the model for provincewide intervention.
York Professors Michael Riddell, Norman Gledhill, Veronica Jamnik, Chris Ardern, Jennifer Kuk and Paul Ritvo in the School of Kinesiology & Health Science’s Physical Activity & Chronic Disease Unit in the Faculty of Health, along with York PhD candidate Chip Rowan, PRE-PAID project coordinator, are now deep into Phase 2 of their study and so far the results are promising. They have found there is an overwhelming need for programs such as PRE-PAID, as a high percentage of the participants tested already had pre-diabetes. In addition, there is a real lack of close and affordable fitness programs.
Right: From left, Michael Riddell, Veronica Jamnik, Chip Rowan and York students and certified exercise physiologists Ajay Rampersad and Thomas Bok
The researchers also found that to reach people in high-risk areas they need to tap into existing social networks and make community contacts, as traditional media campaigns are not that helpful. With community engagement, they were able to increase their visibility and build partnerships to fight diabetes.
The goal of the PRE-PAID program is to identify those individuals from the highest risk populations, including Chinese, South Asian, African and African-Caribbean, who have pre-diabetes, and to provide them with targeted, accessible and monitored fitness programs, and hopefully prevent them from developing Type 2 diabetes.
It could save lives and millions of health-care dollars. Health-care costs for the treatment of persons with diabetes in Canada amounts to $9 billion annually. In recognition of this burden, the Ontario Ministry of Health & Long-Term Care has made the treatment and management of diabetes a priority.
“The costs are anywhere between $2,000 and $15,000 a year per person with diabetes in direct and indirect costs, but if we can get that down to around $200 a year in investment for those with pre-diabetes to prevent the disease, that would save a lot. Not only that, but we can probably prevent six cases out of 10,” says Riddell. “We have to show this model will work and will save money in the long run over the health-care costs caused by the complications of diabetes. If we invest now in treating pre-diabetes, it will cost less in the future.”
Left: A participant undergoes a finger prick blood test to check sugar levels
The PRE-PAID Program has screened some 428 people, aged 35 to 64, from the communities of York University, Jane and Finch, Malvern in Scarborough, and Agincourt for high risk, and are looking for more participants. A further 350 were given a finger-prick blood test, which measures the amount of sugar coating on red blood cells as a measure of average blood sugar control over the last three months. Of these, 238 were found to be pre-diabetic – all of whom were previously undiagnosed.
Right now, there is no outreach screening or treatment program in the province for people with pre-diabetes. This study, funded by the Ontario Ministry of Health Promotion and the Ontario Trillium Foundation, is an important step toward changing that, say Riddell and Rowan.
Through community partnerships, all of those screened through the PRE-PAID Program with pre-diabetes are being given educational training on diabetes prevention and are provided with accessible and culturally preferred exercise sessions for six months.
Right: PRE-PAID participants in a bollyfit class
“The advantage of having the study at York is they can use the students from the School of Kinesiology to hold the classes and many of them are of the same ethnicity as the participants, so we’re breaking down some of the cultural and language barriers,” says Rowan. “Because we are so multicultural here, that really works.”
So instead of expecting study participants to join a gym and run on the treadmill for half an hour a day, the project offers things like bollyfit, socasize, reggaerobics, line dancing and tai chi in easily accessible community centres with certified exercise physiologists, for free. The participants are also asked to incorporate walking into their weekly routine.
Through the PRE-PAID Program, participants who have been identified as pre-diabetic are “provided with the opportunity and the encouragement. Then we track them to see how they comply,” says Rowan. “If it’s going to be sustainable, they really have to make that decision and that commitment.” The participants are assessed at the beginning, at three months and again at six months.
Some of the factors that stand in the way of participating in fitness programs are cost, time and priorities. “People are busy and have other pressing priorities, priorities we can’t even imagine,” says Riddell. “We’re trying to alleviate some of these barriers.”
By looking at studies done in the United States, India and China, “we know that by doing 150 minutes of moderate intensity exercise per week, about 30 minutes a day, five days a week, we can lower the risk of developing diabetes from a state of pre-diabetes by about 50 per cent,” says Riddell. “What is novel about this approach is we want to give them physical exercise that taps into culturally preferred activities. This is the first study I’m aware of that has done that.”
The incidence of pre-diabetes and Type 2 diabetes continues to rise in Canada. It is estimated that about seven per cent (two million) of Canadians have diabetes with about half of them undiagnosed, while another five to seven per cent have pre-diabetes.
“All the research has shown that exercise is the most effective preventative tool, even independent of dietary change,” says Riddell. So it makes sense that people at the highest risk of becoming pre-diabetic would be caught early on.
The researchers are currently seeking funding for Phase 3 of the project. In Phase 3, the team will recruit an additional 500 to 1,000 subjects and will extend the eligible age range to 18 to 64, as recent findings have shown there is an increasing incidence of diabetes in young people.
The group is presenting some of their preliminary results at the International Congress on Physical Activity & Public Health, May 5 to 8 in Toronto.
For more information, visit the Diabetes Prevention Program Web site or contact Chip Rowan at 647-378-6777 or stopdiab@yorku.ca. For more information about diabetes, visit the Canadian Diabetes Association Web site.
By Sandra McLean, YFile writer