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Effect of A Community-Based Lifestyle Intervention on Physical Activity and Diet in Pregnant Women
MON TRE AL 2008 ABST R AC TS
ORAL PRESENTATIONS
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Self-Monitoring of Blood Glucose in Type 2 Diabetes. BERNADETTE M GATlEN*', DIANA LAWLOR*', INGRID SKETRIS 3, EHUD UR', MICHAEL VALLIS 4 1. Saint Mary's University ' Department of Medicine QEII Health Sciences Centre. 3. College of Pharmacy, Dalhousie University 4Department of Psychology, QEII Health Sciences Centre The effectiveness of self blood glucose monitoring (SBGM) in Type 2 diabetes patients is debated. Self monitoring is costly, approximately 6 million dollars each year is spent by the Nova Scotia Pharmacare Program alone. At the Capital District Health Authority in Halifax, Nova Scotia, a study was developed to measure patient self monitoring knowledge and actions. A 42 item pilot survey was developed by a multidisciplinary team and sent to 400 patients with Type 2 diabetes who were followed by a Primary Care Diabetes Case Management team. Initial survey results (N ~ 116) revealed that 49% of participants test their blood glucose (BG) levels 7 days a week and 37 % of participants test 2 times per day. When asked why they test, 94% indicated that they test to know if their diabetes is under control. 69% indicated they test because their care provider requested them to. When asked about the number of times they were told to test BG 21 % stated 4 times every day and 28% stated 2 times every day. Other frequencies were less common. Of those surveyed, 59.9% identified were aware of their last A I c result while 36% were not Sixty-nine percent knew the appropriate postprandial glycaemic targets. However, 36% did not know their postprandial BG target. Forty percent had high BG readings 3-4 times weekly and 23% had high readings every day. Results from our patients followed by diabetes case managers will be compared to those in other jurisdictions and using other models of care.
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Stages of Change for Ph ys ical Activity in Elderl y People With Type2 Diabetes BOWMAN A. School of Health Studi es. Brandon Uni ve rsity, Brandon, MB Exercise consultati on provided by Canadi an diabetes educati on centres considers clients' readiness for ph ysical activity CPA), but the use of a structured, indi viduali zed approach such as the Stages of Change (SoC), and reg ul ar follow -up are not the nann. This stud y examined readiness for PA among indi viduals ~ 65 years, selfreported METs per day, and correlates of PA in this population. A random sample ofparticipallts returned 438 useable mailed surveys concerning PA participation , physical characteristics, demographics, knowledge , and attitudes. SoC among 426 of the respondents were: 20.1 % (n=88) precontemplation , 4.3% (n=19) contemplation, 23.5% (n=I03) preparation, 2.1 % (n=9) action, and 47.3 % (207) maintenance. PA SoC was significantly positively correlated with METs expended daily , rp=.398, (p< .OOI ) . Regression analysis revealed 21 % of the variance in METs of PA is explained by PA Soc. Mean METs were 2946.15 (SD=1237. 12). Significant correlations were found fOf SoC and: age rp=-.241 , education rp=. 198 , income rp= .201 , life history of being physically active fp= .227 , exercise self-efficacy r p=.511, exercise beliefs rp=.567 , physical function rp=.488, total comorbid diseases rp=-.292, long-term diabetes complications rp=-.218 (p<.OO I for all) , and for gender rp=-.137 (p=.005), diabetes duration r,=-.I64 (p=.OOI), and BM! r, =-. 128 (p=.OIO) , but not for knowledge of diabetes care regarding physical activity participation rp=.063 (p=.233). The assumption and improvement in diabetes self-care behaviours , including PA could likely be enhanced through diabetes education centres and outreach programs through consultation using Stages of Change staging and processes, even among elderly individuals. Attention to exercise self-efficacy and beliefs would appear relevant.
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Implementation of Diabetic Foot Screening into Primary Care. IRIS R. NOlAND', Department of Community Medicine, Quinte Health Care Corporalion, Trenton, ON Foot screening is advocated in the prevention of Lower Extremity Ampt.tations (LEA). This is poorly implemented in primary care settings. An audit of my practice of all diabetic patient visits in Sept. 2007was conducted. 58 charts were audited yielding a screening rate of only 12%. In Jan. 2008 a toot screening protocol was introduced. 84 patients were screened from Jan.-March 31, 2008. 30 palients or 35 %had findings indicative of increased risk of ulceration and LEA. 12 patients or 14 % had University of Texas Foot Classification score of 6 indicating a very high risk of LEA. A fOllOW-UP audit was conducted in March, 2008. There were 64 visits by diabetic patients. 94 %had been screened. This observalional study confirmed the need for diabetic toot screening in primary care, an effective intervention and an opportunity to reduce LEAs. Barriers to screening and strategies to encourage translation of knowledge into praclice are discussed. Results Jan,l · March 31.2008 12
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Effect of A Community-Based Lifestyle Intervention on Physical Activity and Di et in Pregnant Women. Amy HUI', SORA LUDWIG, PHILLIP GARDINER, GUSTAAF SEVENHUYSEN, HEATHER DEAN, MARGARET MORRIS, SHARON BRUCE, GARRY SHEN. Univ. of Manitoba, Winnipeg , MB Obesity is a modifiable risk factor for type 2 diabetes. Maternal obesity is associated with future obesity and type 2 diabetes in mothers and their offspring. We conducted a community-based lifestyle intervention for pregnant women lin Winnipeg. Pregnant women «20 weeks of pregnancy) were recruited with an assistance from the Healthy Start for Mom & Me Prenatal and Postnatal Program, and randomized into Intervention (I G) and Control Groups (CG). Participants in the IG received instructed group and home exercises for 3-5 times/week, and computerized Food Choice Map dietary counseling. Participants in both groups received 2 surveys for activity and diet at base line and 2 months after enrolment (post-intervention), and a post-parium visit. A total of 110 women completed the program (58 in the IG, 52 in the CG). No significant difference was detected in age, ethnicity, family income, pre-pregnant weight, baseline physical activity index and nutritional intakes betwee n the groups. Self-reported physical activity at post-intervention was greater than that of IG at baseline (p
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ORAL PRESENTATIONS
69
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70
Self-Monitoring of Blood Glucose in Type 2 Diabetes. BERNADETTE M GATlEN*', DIANA LAWLOR*', INGRID SKETRIS 3, EHUD UR', MICHAEL VALLIS 4 1. Saint Mary's University ' Department of Medicine QEII Health Sciences Centre. 3. College of Pharmacy, Dalhousie University 4Department of Psychology, QEII Health Sciences Centre The effectiveness of self blood glucose monitoring (SBGM) in Type 2 diabetes patients is debated. Self monitoring is costly, approximately 6 million dollars each year is spent by the Nova Scotia Pharmacare Program alone. At the Capital District Health Authority in Halifax, Nova Scotia, a study was developed to measure patient self monitoring knowledge and actions. A 42 item pilot survey was developed by a multidisciplinary team and sent to 400 patients with Type 2 diabetes who were followed by a Primary Care Diabetes Case Management team. Initial survey results (N ~ 116) revealed that 49% of participants test their blood glucose (BG) levels 7 days a week and 37 % of participants test 2 times per day. When asked why they test, 94% indicated that they test to know if their diabetes is under control. 69% indicated they test because their care provider requested them to. When asked about the number of times they were told to test BG 21 % stated 4 times every day and 28% stated 2 times every day. Other frequencies were less common. Of those surveyed, 59.9% identified were aware of their last A I c result while 36% were not Sixty-nine percent knew the appropriate postprandial glycaemic targets. However, 36% did not know their postprandial BG target. Forty percent had high BG readings 3-4 times weekly and 23% had high readings every day. Results from our patients followed by diabetes case managers will be compared to those in other jurisdictions and using other models of care.
71
Stages of Change for Ph ys ical Activity in Elderl y People With Type2 Diabetes BOWMAN A. School of Health Studi es. Brandon Uni ve rsity, Brandon, MB Exercise consultati on provided by Canadi an diabetes educati on centres considers clients' readiness for ph ysical activity CPA), but the use of a structured, indi viduali zed approach such as the Stages of Change (SoC), and reg ul ar follow -up are not the nann. This stud y examined readiness for PA among indi viduals ~ 65 years, selfreported METs per day, and correlates of PA in this population. A random sample ofparticipallts returned 438 useable mailed surveys concerning PA participation , physical characteristics, demographics, knowledge , and attitudes. SoC among 426 of the respondents were: 20.1 % (n=88) precontemplation , 4.3% (n=19) contemplation, 23.5% (n=I03) preparation, 2.1 % (n=9) action, and 47.3 % (207) maintenance. PA SoC was significantly positively correlated with METs expended daily , rp=.398, (p< .OOI ) . Regression analysis revealed 21 % of the variance in METs of PA is explained by PA Soc. Mean METs were 2946.15 (SD=1237. 12). Significant correlations were found fOf SoC and: age rp=-.241 , education rp=. 198 , income rp= .201 , life history of being physically active fp= .227 , exercise self-efficacy r p=.511, exercise beliefs rp=.567 , physical function rp=.488, total comorbid diseases rp=-.292, long-term diabetes complications rp=-.218 (p<.OO I for all) , and for gender rp=-.137 (p=.005), diabetes duration r,=-.I64 (p=.OOI), and BM! r, =-. 128 (p=.OIO) , but not for knowledge of diabetes care regarding physical activity participation rp=.063 (p=.233). The assumption and improvement in diabetes self-care behaviours , including PA could likely be enhanced through diabetes education centres and outreach programs through consultation using Stages of Change staging and processes, even among elderly individuals. Attention to exercise self-efficacy and beliefs would appear relevant.
72
I
Implementation of Diabetic Foot Screening into Primary Care. IRIS R. NOlAND', Department of Community Medicine, Quinte Health Care Corporalion, Trenton, ON Foot screening is advocated in the prevention of Lower Extremity Ampt.tations (LEA). This is poorly implemented in primary care settings. An audit of my practice of all diabetic patient visits in Sept. 2007was conducted. 58 charts were audited yielding a screening rate of only 12%. In Jan. 2008 a toot screening protocol was introduced. 84 patients were screened from Jan.-March 31, 2008. 30 palients or 35 %had findings indicative of increased risk of ulceration and LEA. 12 patients or 14 % had University of Texas Foot Classification score of 6 indicating a very high risk of LEA. A fOllOW-UP audit was conducted in March, 2008. There were 64 visits by diabetic patients. 94 %had been screened. This observalional study confirmed the need for diabetic toot screening in primary care, an effective intervention and an opportunity to reduce LEAs. Barriers to screening and strategies to encourage translation of knowledge into praclice are discussed. Results Jan,l · March 31.2008 12
_6
o o
5 .4b
Un/w,lslyol .4. Te . . Fool
1
1
~l<>o3
Vl 1
t-J19
_ _ _ _ 54
.0 o
lO
40
Numb.rot patjents
60
I
I
Effect of A Community-Based Lifestyle Intervention on Physical Activity and Di et in Pregnant Women. Amy HUI', SORA LUDWIG, PHILLIP GARDINER, GUSTAAF SEVENHUYSEN, HEATHER DEAN, MARGARET MORRIS, SHARON BRUCE, GARRY SHEN. Univ. of Manitoba, Winnipeg , MB Obesity is a modifiable risk factor for type 2 diabetes. Maternal obesity is associated with future obesity and type 2 diabetes in mothers and their offspring. We conducted a community-based lifestyle intervention for pregnant women lin Winnipeg. Pregnant women «20 weeks of pregnancy) were recruited with an assistance from the Healthy Start for Mom & Me Prenatal and Postnatal Program, and randomized into Intervention (I G) and Control Groups (CG). Participants in the IG received instructed group and home exercises for 3-5 times/week, and computerized Food Choice Map dietary counseling. Participants in both groups received 2 surveys for activity and diet at base line and 2 months after enrolment (post-intervention), and a post-parium visit. A total of 110 women completed the program (58 in the IG, 52 in the CG). No significant difference was detected in age, ethnicity, family income, pre-pregnant weight, baseline physical activity index and nutritional intakes betwee n the groups. Self-reported physical activity at post-intervention was greater than that of IG at baseline (p
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