St. Joseph’s health care schizophrenia services ‘going beyond’ with new diabetes research

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The prevention of diabetes among people with schizophrenia is the subject of new research being undertaken by clinicians at St. Joseph’s Healthcare Hamilton, with support from McMaster University. The focus of the research is to determine whether a program of intensive lifestyle modification can prevent or delay the onset of Type 2 Diabetes in a sample of 200 pre-diabetic individuals being treated for schizophrenia. It is known that Type 2 Diabetes has prevalence among people with schizophrenia that is two to five times greater than the general population. Schizophrenia is an independent risk factor for diabetes.

SJHH is in a unique position to be able to conduct original research on lifestyle interventions in those persons with a serious mental illness. This research is built on existing successful services. The Going Beyond program, an experiential adventure and recreation program offered by St. Joseph’s Community Schizophrenia Services (CSS) is recognized for its success at increasing activity levels and motivation among its clients.

Healthy Living and Running for Me are more recently developed therapeutic programs offered by CSS. Healthy Living offers a comprehensive, experiential program that helps clients modify their own lifestyles through a twenty-week series of modules that offer guidance on making healthy lifestyle choices. Areas covered include goal setting, meal preparation, budgeting, shopping, relaxation techniques, health teaching, exercise planning and recreational activities. Running for Me offers clients with no experience an introduction to running as a component of their regular routine. These two newer programs share the Going Beyond philosophy of being both a learning experience and fun.

A key element of each of these three programs’ success is that clients find themselves in a non-threatening, low-stress environment in which social relationships are fostered. Friendships with other clients, and trusting relationships with clinicians, are formed that last beyond the sessions.

Several large-scale international studies with obese individuals in the general population have shown that Type 2 Diabetes can be prevented, or at the very least, delayed by changing eating habits, increasing activity levels, and following a healthier life style. Existing Canadian Diabetes Association Diabetes Prevention Guidelines are being tailored to meet the needs of individuals with schizophrenia.

In the Diabetes Prevention Program (DPP), clients are assigned a lifestyle coach, and progress through a staged personalized diabetes prevention plan. This is packaged with an adventure based program (Going Beyond) and health education workshops (Healthy Living) based on principles of experiential learning, cognitive restructuring and behaviour modification. As well as a focus on the individual, the DPP focuses on the individual’s living environment. Family and caregiver education is provided, coupled with problem solving and support.

A randomized blind controlled trial design will enable the researchers to be confident that outcomes may be attributed to this initiative. The researchers hypothesize that by participating in the DPP, many clients will lose at least 7% of their body weight after 6 months and increase their activity level to at least 150 hours/week of moderate activity, e.g. brisk walking. After one year, if the hypothesis is correct, they expect to see clients’ blood sugar return to healthy levels, and after three years, a significantly lower proportion of individuals being newly diagnosed with Type 2 Diabetes.

The results from this research will provide a solid evidence-based foundation to the intuitive notion that preventative lifestyle decisions can result in a healthier life. This knowledge will offer hope to clients and families by demonstrating what positive steps they may take to preserve and improve quality of life in the longer term. Researchers hope their results will encourage mental health professionals to adopt the new program in various health-care facilities across the country.