314 I CANADIAN JOURNAL OF DIABETES

ORAL PRESENTATIONS

49 I

51

Do Group Education Classes Targeting Impaired Glucose Tolerance (IGT) Population Improve the 75 gram Oral Glucose Tolerance Test (OGTI)

SUSAN BONK".,SHERON PHILLIPS"., Markham Stouffville Hospital, Adult Diabetes Outpatient Education Centre, Markham, ON

The primary purpose of this study is to determine if the MSH IGT class can assist patients to make healthy lifestyle changes that will decrease their risk of developing type 2 diabetes. Outcome measures included: 2 hour 75 gram Oral Glucose Tolerance Test (OGTI), weight, waist circumference and increased activity. The two pioneering studies, (Diabetes Prevention Program and the Finnish Diabetes Prevention Study) in the area of lOT demonstrated that diabetes can be prevented/delayed if lifestyle changes occur, and the 75 gram OGTI results reverts back to normal value.

Individuals with Impaired Fasting Glucose (IFG) and impaired 2 hour 75 gram OGTI were eligible for the trial. The program consisted of attending two 3 hour educational classes six weeks apart. Classes were taught by Registered Nurses and Registered Dietititans. Class objectives: I) pathophysiology ofpre-diabetesIIGT, 2) importance of lifestyle changes, 3) healthy eating and label reading, 4) glucose selfmortitoring and interpreting blood glucose values.

30 people recruited from April 7/07 to April 15/08, data collected From 25 participants, 8-12 weeks after the second class. Results: 81 % lost weight, (24% losing >5% of their total body weight), average weight loss 3.3 kg. 92% had a decrease in waist circumference, 56% increased activity levels, both in duration and frequency. 48% showed nonnal OGTI, both fasting and 2 hour blood sugar values. Of those that normalized 50% had lost >5% of total body weight. All participants felt more confident and educated in making better choices.

A one year repeat OGTI is plarmed to determine if participants require a longer duration of lifestyle changes in order to revert !FG and OGTI to a nannal value. Future directions include: incorporate behavioral modification strategies to increase success in normalization of blood sugars values.

I Profiles of Smokers and Non-Smokers with Diabetes Attending Diabetes Education Centres.

REBECCA MATHEW'- , ENZA GUCCIARDI"', MARGARET DEMELO', SUSAN J.130NDY', 'Faculty of Arts and Science, University of Toronto, 'School of Nutrition, Ryerson University, ' Women 's Health Program, University Health Network, 'Allied lIealth, University Health Network, 'Public Health Sciences, University of Toronto, Toronto, Ontario.

Individuals with type 2 diabetes who smoke are at a higher risk of diabetes-related complications than non-smokers. The purpose of this study wa~ to examine differences in psychosocial, behavioural and clinical characteristics among smoking and non­smoking individuals with diabetes. A questionnaire was administered to 275 individuals diagnosed with type 2 diabetes attending one of two diabetes education centres between October 2003 and 2005. The characteristics of study participants were analyzed using a Pearson Chi-square Statistic, Independent T -test, or Mann-Whitney test. Multivariable linear and ordinal regressions were performed to adjust for sociodemographic variables thought to atlect smoking behaviours. After adjusting for sociodemographics in our multivariate analyses, smoking participants followed their recommended diet regime and tested their blood glucose levels less often than did their non-smoking counterparts, and smokers had lower diastolic blood pressure. Furthermore, smokers showed lower intentions to use diabetes­related resources both outside and within the DEC, and lower outcome expectations of the benefits ofperfonning self­management activities. Our findings suggest that smokers with diabetes tend to have lower anticipated benefits of performing self-management activities, are less adherent to self-management activities and less interested in using diabetes education rcsources. These results suggest cognitive and behavioural differences between smokers and non~smokcrs toward diabetes self­management. These findings may better direct strategies to identify and overcome barriers to self-management and use of diabetes educational resources among smokers with diabetes.

50

52

I Talking about Walking: Does Using a Motivational Tool such as a Pedometer increase Physical Activity in Individuals with Type 2

Diabetes? MANON LEMONDE", BARBARA W ALLACP, MARILYN SEALE", SUSAN CHANDLER, TRACY HOWSON, University of Ontario Institute of Technology, Lakeridge Health Corporation, Oshawa, ON. Physical activity is recognized as an essential component of an effective intensive treatment plan designed to normalize blood glucose and reduce weight gain in individuals with type 2 diabetes. The most commonly under taken physical activity for people with diabetes is walking. This randomized clinical trial based on the hypothesis that individuals with diabetes using a pedometer will be motivated to increase their daily physical activity (as defined by the number of minutes they exercise daily) which will improve their health indicators, and minimize their psychological distress. Subjects for the study were selected from Lakeridge Health Corporate Diabetes Program's "Healthy Beginnings" sessions from May 22, 2007 to August 9, 2007. Subjects were recruited on a volunteer basis. The study took place during existing educational sessions, and was not a separate program. Control and intervention groups received identical information, with the exception that the control group received a pedometer. Both groups received a physical activity record hooklet to record time spent exercising. Data collected at the irtitial and 3 month follow-up education sessions included AlC, weight, waist circumference, height, stages of change, and scoring on the Diabetes Distress Scale (DDS). Descriptive statistics were calculated for all variables and calculated separately for the control and experimental groups. A 2-group Mann-Whitney U was performed to compare the pedometer and non pedometer groups at baseline and at the 3 month follow-up. Although not able to demonstrate statistical significance due to recidivism which resulted in a decrease in sample size, the data clearly demonstrated a decreasing trend in weight, BMI, waist circumference and an increase of time exercising in the pedometer group.

I Implementation of Self-Management Support Techniques-A Model for Community Based Diabetes Education. JOANNE LEW1S* , SUSAN CHANDLER, Durham Region Diabetes Network, Bowmanville, ON

Effective self-care of diabetes requires knowledge; however the abil ity to self-manage involves the mastery of skill s and self efficacy. As a result , diabetes education programs have evolved dramatically over the years. From a more traditional didactic teaching style, diabetes education programs have emerged that embrace self-management and barrier-free accessible community­based programs. Integrating strategies of the chronic care model , ou r program, Living Well with Diabetes (LWWD) a self referred program, was designed to implement self-management support techniques for people living with prediabetes and type 2 diabetes in Durham Region. This 5 part dynamic program reflecting current evidence and guidelines consists of weekly 90-minute sessions and was piloted in three areas of Durham Region. Space for programming was donated by local grocery store chains. Programs were offered at various times of the day, including evenings. Each session was co-facilitated by an RN and RD. Goal-setting , action­planning and problem-solving skill s were taught and practiced. Each session consisted of participatory activities providing opportunities for interaction and practical learning. Evaluation of knowledge exchange was measured using "matching columns" type pre and post assessments. Although topics for each session were pre-determined by a curriculum , clients played a role in choosing what they wanted to learn . The program was modified to meet those needs , emphasizing the responsibility for their own health.

Post-program evaluation was very positive with all participants able to document a positive lifestyle change, reinforcing the need for self referred community based programs as part of a range of services and resources available to those clients with type 2 and pre diabetes.