Advancing diabetes care and prevention
Nov 9, 2018
Photograph above: Dr. Diana Sherifali
November is Diabetes Month. Dr. Diana Sherifali, an associate professor in the School of Nursing and a researcher specializing in diabetes care, has just wrapped up a four-year trial involving diabetes patients. We recently sat down with her to discuss her work, along with the bigger question of what the future looks like for diabetes patients.
“Our CIHR funded trial randomized 365 participants living with type 2 diabetes from the community to diabetes coaching for one year, says Sherifali. “Half of the group received diabetes coaching by telephone and half received access to usual care; we are now in the process of analyzing the effect of diabetes coaching on clinical outcomes, patient reported outcomes and health service utilization.”
In describing diabetes coaching, Sherifali says it is a frequent, intensive intervention, based on short patient-centred interactions. Participants received 15 minutes of coaching once a week for the first six months by telephone, and 15 minutes/once a month for the last six months.
Sherifali and her team are now analysing and writing up the results. “They look very positive. My graduate student, Tharshika Sugumaran, is interviewing participants to explore their experience with diabetes coaching, and the interviews to date have been very insightful.”
The next step, Sherifali says, is to see if they can scale up this model of coaching by embedding technology. This would involve further trials. “We are looking at using a smart-phone app called Bant, which was developed by colleagues and co-investigators at the University of Toronto,” she notes. “With telephone coaching, one must take notes and cannot track data proactively, such as reviewing blood glucose levels. Technology can support some of that. It can also track healthy behaviours such as activity steps and photographs of meals to count carbohydrates and fat. In fact, I am a co-principal investigator on a CIHR grant application that seeks to understand and explore the use of Artificial Intelligence and diabetes coaching to assess, monitor and customize personal engagement for individuals living with diabetes.”
Diabetes coaching is one of several exciting innovations in managing type 2 diabetes. What about the bigger picture? What else are researchers in the field working on? One big trend Sherifali sees is the emphasis on the broader, societal aspect of treating and even preventing the disease in the first place. She points to Diabetes360 by Diabetes Canada. Diabetes360 is a call for a nation-wide diabetes strategy.
“The 360 approach is all encompassing,” says Sherifali. “It starts with acknowledging that we have a growing problem. What we are doing is not working, so that begs the question: What can we do to prevent, manage type 2 diabetes?” One of the report’s recommendations is educational programs to help people at risk of developing diabetes – before they become diagnosed.
While individual lifestyle change is crucial, Sherifali notes, “We know that it’s not that simple. We need to consider what policies can influence change and mitigate risk at a societal level. It’s about evoking change at government levels, across sectors to consider and reconceptualise how our environment and the social determinants of health influence one’s risk for type 2 diabetes. Consider immigration. Our immigration patterns reflect populations of individuals that are considered high-risk. Indigenous communities in Canada are also at great risk for type 2 diabetes. I believe the 360 approach is also a call for holistic approaches to diabetes care, including a great emphasis on support, particularly in relation to mental health and psychosocial issues. For example, we are now learning more about the relationship between distress and diabetes management. One of my graduate students, Holly Tschirhart, is seeking to establish the prevalence of distress during pregnancy in women with pre-existing diabetes.”
Funding for diabetes care is another big concern today. Diabetes Canada is calling for government support for coverage of essential medications. “We don’t want to have to worry that a patient isn’t taking their medication because they can’t afford it.”
Another promising trend is the possibility of type 2 diabetes remission, something that Sherifali has seen in her own research. “Now we can talk about diabetes remission as a treatment option. We are about to begin our fourth study related to diabetes remission, coordinated through the Population Health Research Institute. So if someone has type 2 diabetes for 3 years or less, we can potentially make their diabetes go away. We are learning more and more about: who is the ideal candidate for remission, what is the ideal pharmacotherapy treatment and what type of coaching support is needed? So it’s an exciting time. Researchers are hacking the Type 2 diabetes trajectory.”
Beating diabetes on a global level won’t be easy and won’t come in the near future. But we have a map, a vision and are taking steps, Sherifali says. If we can prevent the crisis from expanding, we can potentially avert other health problems as well because, at its core, “diabetes is about healthy lifestyle – healthy eating, physical activity, smoking cessation, and then alcohol use. Those are all four modifiable risk factors that may prevent, delay or better manage diabetes. But they also translate to other chronic conditions, such as cardiovascular disease and some forms of cancer. These risk factors are not unique to diabetes.”