St. Joseph’s prescribes lifestyle as medicine
Through a novel program, patients living with type 2 diabetes will receive coaching and confidence to make food and activity central to self-care, with wearable technology providing real-time motivation.
For years, 58-year-old Mark Alfieri had missed all the signs of type 2 diabetes. The ones he did notice – numbness and pain in his hands and feet – he dismissed as part of a long-standing back injury.
He also admits to abusing his body with less than stellar eating habits and an addiction to sugar. But with no family doctor, his diabetes wasn’t detected until he received care for a broken shoulder in 2020.
“The day I broke my shoulder, breakfast was a box of Cheese Nibs, Brisk lemonade and a KitKat bar. I wish I was kidding. I kept M&M’s chocolate-covered almonds in my pocket at all times and would finish a two litre bottle of regular Coke at one go – filling my glass until it was empty. I lived on starches and carbs for dinner and would be in the bakery a couple of times a week buying pies and cannolis. I was being horrible to myself.”
That all changed when Mark was referred to the Primary Care Diabetes Support Program (PCDSP) of St. Joseph’s Health Care London. It wasn’t the diabetes medications he was prescribed that turned his life around. It was what he learned about the connection between food, lifestyle and health.
For those living with type 2 diabetes, good understanding of the benefits of food and activity is essential to self-management, and ensuring patients have the knowledge they need is central to effective diabetes education. But the PCDSP is going further. In an innovative step, the PCDSP will be launching a powerful, new approach to lifestyle as medicine and inviting anyone living with type 2 diabetes in London to participate.
Called LIBERATE (LIBre Enabled Reduction of A1c Through Effective Eating and Exercise), the approach focuses on empowering and encouraging those living with type 2 diabetes to use food and activity to support blood sugar (glycemic) control and improve overall health, explains Amanda Mikalachki, registered nurse with the PCDSP and LIBERATE co-investigator.
“It was live or die. I had a choice. St. Joseph’s saved my life.”
All new patients referred to the PCDSP will be invited to attend a one-hour introductory lifestyle medicine group class, which is designed to motivate and build awareness of the opportunity to make small, sustainable lifestyle changes that can translate into improved diabetes management and overall health, explains Amanda. Patients will then have the option to take part in LIBERATE – a virtual bi-weekly group education class with six to eight patients per group for three months, followed by a monthly class for an additional three months.
Those living with type 2 diabetes who are not patients of the PCDSP will also be able to participate. In the coming weeks, recruitment will get underway through family physician offices and corporations in the city, or individuals will be able to call directly if they are interested in taking part.
Making the program unique is its virtual format as well as the use of wearable technology to provide biofeedback to support lifestyle changes aligned to the glycemic and health goals set by each patient. The technology, which will be provided to participants, includes both a flash glucose monitor, which measures, displays and stores glucose readings, and a wrist activity tracker.
The program builds upon an earlier 12-week PCDSP program that found the wearable technology and virtual class format – initiated when the pandemic swept in – contributed to a powerful and meaningful learning experience for patients.
For Mark, the 12-week program was not only eye-opening, it was life-saving.
“I learned how my body processes food and the wearable technology was critical in seeing just how my body was reacting to my food choices.”
Through lifestyle medicine, Mark has been able to transform his diet and go off all diabetes medications. He’s proud to report that he has eliminated processed sugar and slashed his carb intake.
“I lost a sister to type 1 diabetes and I was on the same path with my health, says Mark. “It was live or die. I had a choice. St. Joseph’s saved my life.”
"Patients living with type 2 diabetes need strong and innovative support to adopt and sustain healthy lifestyle patterns."
St. Joseph’s introduction on how to use lifestyle medicine to improve health “is sometimes the first time a patient has attended a diabetes appointment where they were offered self-management treatment options that move beyond the typical approach to care, which often only focuses on medication intensification,” says Betty Harvey, nurse practitioner with the PCDSP and LIBERATE co-investigator.
Since the PCDSP was created in 2008 at St. Joseph’s Family Medical and Dental Centre, the team has become a leader in evidence-based lifestyle intervention for those living with type 2 diabetes. The program’s approach has been a model for community physicians and other centres.
“Our team has always recognized that patients living with type 2 diabetes need strong and innovative support to adopt and sustain healthy lifestyle patterns,” says Dr. Sonja Reichert, a physician with the PCDSP and Principle Investigator of the LIBERATE trial. “With each successive year, our program has grown and evolved, benefitting our patients and providing leadership to other Canadian diabetes centres looking to operationalize effective, feasible ways to incorporate lifestyle as medicine.”
LIBERATE, a Lawson Health Research Institute study, will be a two-year, multi-site clinical trial that will begin soon at the PCDSP. A launch at Hamilton Health Sciences’ Boris Clinic in Diabetes Care and Research Program is also planned.
“We know lifestyle medicine can have a profound impact on the health and wellbeing of people living with type 2 diabetes,” says Dr. Reichert. “Ultimately, we would like to create a health care practitioner coaching guide and see the LIBERATE approach available and easily accessible across the country."
Interested in joining LIBERATE?
If you are living with type 2 diabetes and interested in participating in a novel education program, you may be eligible for LIBERATE. Now available, LIBERATE is a virtual bi-weekly group coaching class with six to eight patients per group for three months, followed by a monthly class for an additional three months. The purpose is to empower those living with type 2 diabetes to use food and activity to support blood sugar control and improve overall health, guided by the latest activity and diabetes blood sugar monitoring technology.
Participants should….
- have an HbA1c above 8.0 per cent
- own a smartphone. Smartphone compatibility will be confirmed - for example, iPhone 7 (iOS13.2 or higher) or Android operating system of 7 or higher.
- have a computer and Internet connection
- have not yet used an intermittently-scanned or continuous glucose monitor
If you fit these criteria and are interested, contact the Primary Care Diabetes Support Program of St. Joseph’s Health Care London at 519 646-6000 ext. 67230.