22 Sep

Diabetes Management Goes Back to the Basics

Online Submission by Valentina Antonipillai

Patients walk instead of wait for their appointment at Toronto East General Hospital, where Dr. Rebecca Fine, endocrinologist and clinician educator of the Department of Endocrinology and Metabolism at U of T, established a Diabetes Walking Clinic for her patients with type -2 diabetes.

In her experience, a doctor’s appointment usually requires patients to sit and wait in the waiting room for quite a while before meeting the clinician. At the appointment, the patient sits next to the clinician to discuss his/her health and the clinician advises their patient to be physically active and ultimately, to exercise. Throughout the entire process of the doctor’s appointment, however, the patients are sitting.

Dr. Fine asks, “Why can’t we do the same thing while we’re all walking together?” That is, why can’t patients and clinicians conduct an appointment on the move, not only promoting physical activity, but putting it into practice?

This is what Dr. Fine has accomplished with the Diabetes Walking Clinic, what she describes as “a new model of care for ambulatory clinics – replacing the traditional doctor’s appointment with an appointment while on the move.”

At the Diabetes Walking Clinic, a group of patients undergo their routine health examination and once thier health status is recorded, such as their blood pressure and weight, they take a 30 minute walk in the outdoors, just outside the hospital, while discussing diabetes management individually with Dr. Fine. “We typically see them every three months and we do a number of things. It’s their same doctor’s appointment but in this group walking setting.”

The clinic not only improves the health of patients with type-2 diabetes, but aims to overcome the obstacles they face in their daily lives. “Things like access to time or to exercise are barriers for them because they are working multiple jobs, they may not have the money to buy a gym membership and a lot of them are from cultural groups where exercise isn’t necessarily encouraged,” explains Fine.

Fine’s research focuses on improving patient care. From exploring barriers to physical activity to examining patient blood sugar and cholesterol levels, Fine intends to explore the benefits of exercise in this particular setting for patients with type-2 diabetes and observe how their attitudes change towards exercise.

“It’s just a matter of showing people that 30 minutes a day, which is basically what’s recommended, is easy to achieve. People are amazed at how quickly time goes by when they’re with other people and they’re busy. That’s really what we’ve been trying to promote,” she says.

Fine’s research has completed its first year and the results are currently being analyzed. “We’re just in the process of collecting their post surveys looking at whether they feel that their level of activity has improved,” explains Fine. “When the question ‘do you do more physical activity now?’ was asked, in their heads they say ‘no, I’m not doing more,’ but if you actually look at the numbers, they are.”

A couple of observational trends of the data being collected show that patients have smaller waist sizes, a potential indication of cardiovascular improvement and their HDL (“good” cholesterol) levels have slightly risen. “It’s a bit early and we haven’t analyzed it formally yet,” cautions Fine about the data.

“In informal conversations with patients, they say that they really like [the Diabetes Walking Clinic] and they enjoy coming,” says Dr. Fine, “I think that has improved their attitude towards diabetes care.”

The Diabetes Walking Clinic is an innovative approach to diabetes management, providing sustainable healthcare and patient engagement. Dr. Fine hopes that in the years to come, her research will be able to better assess and solve the problems associated with type-2 diabetes.

“A lot of diabetes research and management is looking towards innovative new drugs, expensive treatments and things like pancreatic transplants, which are really important and essential, but I think what we’ve done here is we’re going back to the basics”.

You don’t necessarily have to have a new idea,” she says. “Walking is nothing new, it’s just thinking about an old idea in a new way.”