Practical health advice for patients with diabetes
There is strong evidence that people with type 2 diabetes can improve control of their disease and reduce the risk of complications such as heart attack and stroke by eating well-balanced diets and staying physically active. But unfortunately, most of them do not follow lifestyle recommendations.
An innovative research initiative is aiming to help by developing a practical toolbox of physical activity and diet guidelines tailored specifically for people with type 2 diabetes. The study is called PANDA (Physical Activity and Nutrition for Diabetes in Alberta). PANDA's large multidisciplinary research team is led by University of Alberta professor Dr. Catherine Chan.
The time is right for PANDA, she notes. More than 2 million Canadians have type 2 diabetes, and the number of people with the disease continues to rise. The cost of treating diabetes and its related conditions is estimated at up to $9 million annually. "It is important to find out why it is so difficult for people to follow diet and lifestyle recommendations," says Dr. Chan. "We want to make a real difference by finding ways to assist people with diabetes to live fuller lives."
The team uses a "4A framework" approach to developing its recommendations, meaning that all the elements of the toolbox should be adequate (meet current guidelines), acceptable (something that people will actually do), accessible (include elements of cost and ease of use or preparation), and available (something that everyone can do regardless of where they live). The project involves research on Alberta food products, recommendations of reasonably priced foods that are appropriate and accessible for those with diabetes, a nutritional guideline that can be easily used by those with diabetes, and physical activity options suitable for those with diabetes.
The plan is to develop a set of practical options for physical activity and nutrition that would be tested in pilot studies and, if proven effective, distributed to public health and medical clinics throughout Alberta. Dr. Chan believes the framework will be flexible enough to be used in other provinces and even other countries. The team has already had meetings with researchers in China, where the prevalence of diabetes is also rising.
One of PANDA's co-principal investigators is Dr. Ron Sigal, an endocrinologist at the University of Calgary. His work in PANDA is related to his main research, which is centered around clinical trials on physical activity, obesity, diabetes, and cardiovascular disease. He is the principal investigator of four randomized trials evaluating exercise programs for people with, or at risk of, diabetes.
"It's no secret that exercise is beneficial for people with diabetes, just like it is for anyone," says Dr. Sigal. "The question isn't whether to exercise or not; it's about what kind of exercise will be most effective to reduce the risk of cardiovascular disease in people with diabetes. My research group is carrying out clinical trials and systematic reviews in this area."
His first large trial was DARE (Diabetes Aerobic and Resistance Exercise), which ended in 2005. DARE was a ground-breaking study; it provided the strongest evidence for the value of both aerobic (walking, cycling, or jogging) and resistance exercise (weight training) for most people with diabetes. Results showed that aerobic exercise and resistance exercise were each effective in improving blood glucose control in type 2 diabetes, but the combination of both types of exercise was at least twice as effective as either type alone. Both the Canadian and the American Diabetes Associations changed their clinical practice guidelines regarding exercise in response to these results.
Since DARE, Dr. Sigal has gone on to study exercise effectiveness in people with type 1 diabetes and adolescents who are overweight or obese (which puts them at risk for type 2 diabetes). These clinical trials are currently underway. Dr. Sigal's team is also investigating ways to enhance the long-term sustainability of exercise programs.
"Assuming that what we found out about the benefits of the exercise for people with type 2 diabetes holds in people with type 1 diabetes, I would like to see this as a widely available treatment for diabetes—one that is funded publicly in the same way drugs are funded now. Our study in adolescents who are overweight highlights the potential to incorporate these exercises into school programs. To have a broad public-health impact, we're going to have to change behaviour over the long term."
PANDA (Physical Activity and Nutrition for Diabetes in Alberta)
The PANDA project takes a multidisciplinary team approach to developing practical physical activity and nutrition guidelines for people with type 2 diabetes. The project is provincial (focusing on Edmonton and Calgary) and will involve researching Alberta food products, assessing cost-friendly foods that are appropriate and accessible for those with diabetes, developing a nutritional guideline (an Alberta Diet) that can be easily used by those with diabetes, and developing a physical activity "toolbox" suitable for those with diabetes.
Source: University of Alberta Department of Agricultural, Food and Nutritional Science