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"All-hands-on-deck" approach could change diabetes care

Apr 24, 2017
Guylaine Spencer

One morning in March, McMaster Nursing Professor Dr. Diana Sherifali found her email in-box full of new messages. 

The reason? Overnight, international media outlets (Voice of America, the BBC, The National Post) had released stories about a research study promising a possible breakthrough in diabetes care. Sherifali is one of the investigators on the study, which was led by her colleagues in the Department of Medicine at McMaster, Drs. Natalia McInnes and Hertzel Gerstein. Suddenly everyone wanted to learn more.

The news splash followed the publication of their pilot study: “Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial”. It appeared in the Journal of Clinical Endocrinology & Metabolism on March 15. 

The study involved 83 patients. The intervention group of patients received oral medications, insulin and weekly coaching sessions from nurses to help them modify their eating and exercise habits. Researchers found complete or partial diabetes remission in approximately 40% of participants after receiving this treatment. 

Sherifali’s main role in the study involved “diabetes coaching”. What this means is that patients received a personalized exercise and meal plan and weekly coaching sessions from a nurse. “It’s education,” says Sherifali, “but it’s also behaviour modification and support. It was close follow-up once a week with a nurse to discuss knowledge, skills and behaviours they are gaining or working on.   There’s also a supportive accountability piece, where people are being monitored closely in a non-judgemental way, rather than coming in once every few months for a visit.”

Sherifali calls this approach a paradigm shift in how we could deliver diabetes care in the future. “The treatment needs to be intensive. It’s not just, oh, give yourself some time, work on your diet. This is very intensive, right after diagnosis. We’re trying to treat diabetes almost like cancer. When you get the diagnosis of cancer, it’s all-hands-on-deck to make it go away, to go into remission. And so with diabetes, we’re thinking of it through the same lens. Now we have some evidence that suggests -  ok, you’ve been diagnosed with diabetes, we’ll give you  several months of intensive pharmacotherapy and lifestyle modification, we may be able to make diabetes go away.” 

The initial results were encouraging – and exciting, notes Sherifali. “In this case, 40% of the participants were diabetes-free for up to three months. So now we’re doing larger studies to ask: can we prolong that remission period? what combinations of medications are most effective?  We have two multisite trials underway and a third about to start. There is also some suggestion that this type of intervention works better for some than for others, but we need to evaluate this systematically.”

In addition to her research and teaching roles at McMaster’s School of Nursing, Sherifali is on faculty at the Health Coach Institute at York University, an institute that trains new health coaches. She is leading a national stakeholder workshop with York University and McMaster University to develop core competencies and standards for a new health coach profession. 

The research for this pilot study was supported by a grant from Diabetes Canada and the Population Health Research Institute. 

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