Globally, 346 million people have diabetes and the prevalence of type 2 diabetes mellitus (T2DM) is expected to increase to an estimated 440 million in the next 20
]. Consequently, treating and managing this population will be a substantial burden to health care systems [3
]. There is, however, sufficient evidence to suggest that drug treatment, physical activity (PA), medical nutrition therapy, and body weight management can mitigate longer-term complications of diabetes [2
] and thus potentially lessen the impending public health burden. Healthy eating and active living are two main ingredients of T2DM self-management. Attention to both nutrition and physical activity (exercise) has repeatedly and consistently been shown to be associated with improvements in metabolic risk [4
]. As such, guidelines for healthy eating and active living have been developed for use in clinical practice [2
]. Despite the availability of evidence-based guidelines, the majority of adults with T2DM follow unhealthy dietary patterns and are insufficiently active [9
] suggesting current frontline approaches to promoting and supporting healthy self-management may not be effective or efficient. Several community-based or ‘real world’ interventions have demonstrated that self-management programs can be effective in improving behavioral and clinical outcomes [11
]. Although these real world examples have shown success, questions still remain around the longer-term impacts of these interventions at the patient level and at the system level (i.e., primary care setting). More specifically, if patient exposure needs to be increased (i.e., program intensity) to sustain shifts towards positive self-management behaviours seen in what might be considered the early stages of adoption (e.g., 3
months), what are the longer-term costs within the context of sustainability for the patient and, at the same time, within the context of program delivery?
Acknowledging that gaps still exist in terms of our understanding of real world exemplars of diabetes self-management delivered in primary care, we designed the Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD-PCN) study to explore questions around the effectiveness and efficiency of delivering an evidence-based self-management program linked with community resources within in a newly emerging model of primary care. We intend to develop a comprehensive understanding of the system requirements for implementation, which will in turn provide supportive evidence to inform policy makers with respect to resource allocation and the potential for program sustainability.
The main objective of HEALD-PCN is to evaluate a novel implementation of an evidence- based self-management program for patients identified as having T2DM within an established Primary Care Network environment in Alberta, Canada. The primary study hypothesis is that those allocated to HEALD-PCN program will self-report higher levels of moderate and vigorous physical activity and objectively monitored daily pedometer steps. Secondary objectives are to complete a comprehensive evaluation to understand why the program did or did not have an impact, identify critical factors to successful implementation and to develop recommendations to mitigate barriers to successful implementation if the intervention proves effective.