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 support 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 counseling for lifestyle modification. Consequently, little guidance is available for practical, sustainable, economically viable solutions, with limited evidence of long-term efficacy and efficiency. Like other aspects of PCNs models of care, incorporating an exercise specialist, as a member of the health care team, is vital, with responsibility for supporting patients adopt healthier behaviours to self-manage their diabetes.

The Healthy Eating and Active Living for Diabetes (HEALD-PCN) is an exercise specialist-led lifestyle modification program that targeted daily ambulatory activity and dietary glycemic index recommendations, in a community-based setting. Newly diagnosed diabetes patients are usually referred to a “one-time” group education workshop. However, it is recognized, that this one-time workshop is insufficient to support lifestyle modification in the longer term in this patient population. The ABCD intervention enrolled patients who have completed some basic diabetes education after their diagnosis, and were provided enhanced follow-up through HEALD-PCN in four PCNs [St. Albert Sturgeon, Leduc Beaumont Devon, Camrose, and Alberta Heartland].

Photo courtesy of The St. Albert Gazette

Those assigned to the HEALD intervention participated in a 24-week supervised walking program, lead by a trained exercise specialist (with certification). The program targeted increased daily walking for the first 12 weeks, followed by brisk walking speed target and increased substitution of low- relative to high- glycemic index foods over the next 12 weeks.

We used a combination of metrics to determine the effectiveness of the HEALD-PCN. Behavioural, clinical and psychosocial variables were measured at baseline 3, 6 months. We also collected information on cost of the enhanced lifestyle program in the PCN environment, as well as subsequent health care utilization, through linkage with administrative data from Alberta Health. Such information will be used to estimate the cost-effectiveness of the lifestyle program, using previously developed diabetes economic forecasting model for Alberta. In addition to these outcome measures, the HEALD-PCN intervention is contributing to the ABCD project’s comprehensive evaluation framework. This evaluation component is critical understanding the full impact of HEALD-PCN. We anticipate the results to be published sometime this year.

For a detailed description of the HEALD-PCN intervention design, please click here.

For more information about the ABCD project evaluation, please click here.

Related Papers

Avedzi HM, Storey K, Johnson JA, Johnson ST.  Healthy Eating and Active Living for Diabetes-Glycemic Index (HEALD-GI): Protocol for a Pragmatic Randomized Controlled Trial. [PMID: 30839283] JMIR Res Protoc 2019 8(3):e11707.

Johnson ST, Mladenovic AB, Mathe N, Davenport MH, Butalia S, Qiu W, Johnson JA. Healthy eating and active living after gestational diabetes mellitus (HEALD-GDM):  Rationale, design, and proposed evaluation of a randomized controlled trial  [PMID: 28700892] Contemporary Clinical Trials.  2017 Oct;61:23-28

Johnson ST, Lubans D, Mladenovic A, Plotnikoff R, Karunamuni N, Johnson JA. Testing social-cognitive mediators for objective estimates of physical activity from the Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN) Study. [PMID: 26899570] Psychology, Health & Medicine. 2016 Dec;21(8):945-53

Mladenovic A, Wozniak L, Plotnikiff RC, Johnson JA, Johnson ST.  Social support, self-efficacy and motivation: a qualitative study of the journey through the Healthy Eating and Active Living for Diabetes (HEALD) program.  [PMID: N/A] Practical Diabetes 2014 31(9);370-374

Johnson ST, Bell GJ, McCargar LJ, Welsh RS, Bell RC.  Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. [PMID: 19614943] Diabetes, Obesity & Metabolism, 2009 11(9):836-43

Johnson ST, Bell GJ, Harber VJ, McCargar LJ, Tudor-Locke C, Bell RC.  Walking faster: Distilling a complex prescription for type 2 diabetes management through pedometry. [PMID:16801594] Diabetes Care 2006 29(7): 1564-1655

Johnson ST, McCargar LJ, Tudor-Locke C, Bell RC.  Measuring habitual walking speed of people with type 2 diabetes: Are they meeting recommendations? [PMID: 15920080] Diabetes Care 28(6): 1503-1504, 200