At age 44 and tipping the scales at 315 pounds, Paul Dunn’s major food groups were “chips, candy, chocolate and ice cream.” When he needed milk from the corner store at the top of his street, he would drive his car there.
Paul’s wake-up call came last year when his doctor diagnosed type 2 diabetes and referred him to Toronto Rehab’s Diabetes Exercise and Healthy Lifestyle Service, a new offering of the hospital’s cardiac rehabilitation and secondary prevention program. Half way through his six months in the outpatient service, Paul has lost close to 35 pounds. His blood glucose level has dropped into the normal range, exercise has become a regular part of his life, and “anything with a trans fat in it, I’m not putting into my body,” he says. “Man, do I ever feel a lot healthier!”
The focus of the Diabetes Exercise and Healthy Lifestyle Service is to help adults living with diabetes to improve their strength, fitness, glycemic control and their overall quality of life.
“The literature tells us that people with diabetes may lose up to 13 years off their lives,” says Nicole Foster, Advance Practice Leader and Exercise Specialist, who helped to launch the new service. “If we can provide an intervention that helps improve their quality of life and hopefully get some of those years back, we’d like to do it.”
Diabetes increases a person’s risk of cardiovascular disease, according to Dr. Paul Oh, Medical Director of the cardiac rehab program. “A person with type 2 diabetes is two to four times more likely to develop coronary heart disease than a person who does not suffer from diabetes. Women with diabetes are five to seven times more likely to develop heart problems than women without diabetes of the same age.”
Although there has been a marked decline in the rate of death due to coronary heart disease in the overall population over the past 35 years, this has not been the case among people with diabetes. It is estimated that 80% of individuals with diabetes will die as a result of cardiovascular disease. More than two-million Canadians have diabetes, according to the Canadian Diabetes Association, and the cost to the country’s health care system is estimated at $13-billion each year. By the end of the decade, up to three-million Canadians could have diabetes.
“The Diabetes Exercise and Healthy Lifestyle Service helps people with diabetes to better manage their condition through personalized exercise programming, weight management and nutritional counselling,” explains Catherine Statton, Coordinator of Toronto Rehab’s new service. “Our interprofessional team provides the motivation and support needed to make the appropriate lifestyle changes necessary to help patients to get or keep their diabetes under control.”
The service accepts up to 250 patients a year on referral from a physician or other health professional. New patients undergo a cardiopulmonary assessment upon program entry and at discharge. Twice a week at the hospital’s Rumsey Centre, supervised exercise classes are conducted, including personalized aerobic and resistance training. A weight management support group, and individual and group nutritional counselling help patients improve their eating habits and achieve a healthy weight. Patients are educated about the primary prevention of coronary heart disease and risk factor profiles are developed for each participant. In addition, one-on-one counselling is available from a social worker or psychologist for those that need individualized support.
While there are many excellent diabetes education programs available in Toronto, the people who work in these programs helped Toronto Rehab to identify the need for a service that focused on the benefits of exercise. “There are very good studies that show a relationship between reduced mortality, fitness and activity in persons with diabetes,” says Dr. Oh.
For Paul Dunn, what really counts is the expertise of Toronto Rehab’s interprofessional team of physicians, exercise specialists, dietitians, social workers and psychologists, along with the sharing of experiences among program participants. “It takes a whole village to help a patientÑand that’s what it’s like here,” he says.
“The staff in this program have taught me the skills to be able to manage my diabetes for the rest of my life. Diabetes doesn’t scare me at all anymore.”