Healthy Eating and Active Living for Diabetes (HEALD)
Whereas strong evidence supports the role of lifestyle modification in the prevention and management of T2D, we lack a clear understanding of best strategies for dietary and physical activity behaviour promotion among adults with T2D within primary care. Current clinical practice guidelines are based on resource laden, one-to-one individual and clinically-based approaches to lifestyle modification, with limited theoretical grounding for recommended health behaviour change. Furthermore, numerous barriers exist for the primary care physicians to direct counselling for lifestyle modification. Consequently, little guidance is available for practical, sustainable, economically viable solutions, with limited evidence of long-term efficacy and efficiency.
The Healthy Eating and Active Living for Diabetes (HEALD) will serve to establish effectiveness of a prescribed, and ongoing, theory-based lifestyle modification program for those with recently diagnosed diabetes in a community-based setting primary care setting. We plan to evaluate HEALD through a non-randomized controlled study, using a previously successful “on-off” group assignment method. Patients will be assigned to a control group (i.e., usual care) or the HEALD group on a monthly basis, over a 12 month period (i.e., in the first month patients would be assigned to control, the second month to HEALD-PCN, and so on, for a total of 6 months of enrolment for each group). We will use a combination of metrics to determine the effectiveness of the HEALD-PCN. In all subjects we will measure behavioural, clinical and psychosocial variables at 3, 6 and 12 months. We will also collect information on cost of the enhanced lifestyle program in the PCN environment, as well as subsequent health care utilization, through linkage with administrative data in the Alberta Diabetes Surveillance System (ADSS) (www.albertadiabetes.ca). Such information will be used to estimate the cost-effectiveness of the lifestyle program, using previously developed diabetes economic forecasting model for Alberta.
Steve Johnson, Jeffrey Johnson, Ronald Plotnikoff, Clark Mundt, Diane Bray,
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