DIABETES REVERSAL PROGRAM
The Diabetes Reversal Program (DRP) is targeting patients with type 2 diabetes who will be enrolled in a 6-month lifestyle management programme. This intervention focuses on encouraging patients with type 2 diabetes to achieve changes in their lifestyle that address not only carbohydrate intake but also focus on healthy fats and proteins, as well as incorporating increased physical activity into their daily routine. The program is structured into 3 Phases.
Initial consultation and evaluation by a Doctor
Patients are seen following a specific protocol, current health status is accessed, including diabetes and comorbidities, medications and physical and metabolic parameters (blood pressure, BMI, Self-monitored Blood Glucose/random blood sugar, HbA1c, lipids, liver function, thyroid function and renal function) are documented. The laboratory tests provided should be done not more than a month before this consult.
Patients readiness to make lifestyle changes is assessed and those that indicate that they are ready will be invited to attend the Diabetes Reversal Programme. Their medications are adjusted where appropriate to reduce hyperinsulinemia and the risk of hypoglycemia and to facilitate weight loss. Patients are advised to undertake limited structured self-monitoring of blood glucose (about 6 tests per week).
Lifestyle management programme (Six weeks during months 1-3)
Patients are invited to attend a weekly lifestyle management programme for six weeks that will reinforce dietary messages, provide peer support and encourage increased physical activity within their lifestyles. The programme is developed according to the principles of social learning theory, whereby individuals learn from their own experiences and observations, particularly in a group setting. The programme will run several times a year. Each session runs weekly for 2hrs 30mins.
Each session follows a detailed written curriculum, backed up by written material for participants. Sessions are facilitated to encourage active engagement and discussion between participants. Each week focuses on a specific theme and participants are asked to complete related tasks during the following week, adapted to meet their own goals. Each session is facilitated by a qualified clinician and nutritionist in a group setting and is facilitated by staff with expertise in nutrition, behaviour change and psychology, as well as diabetes management. The doctor reviews the participants and makes any necessary adjustments to medication as needed.
Lifestyle update groups (Month 5)
Having completed the above programme, patients are enrolled in a follow-up group update to help them consolidate lifestyle changes, review their goals and seek additional support in achieving them as required. Each participant is invited for the session, and each one will recap part of the content of sessions 1-4 above, with extended time to review the progress to date of each participant and supporting them in overcoming any obstacles to achieving their goals.
Follow-up consultation with Doctor (Month 4 and 6)
The aim is to review progress in changing diet and physical activity, reducing body weight and improving blood glucose levels. Blood is taken for HbA1c at month 4 and 6. Medication (for diabetes, blood pressure and lipids) are adjusted as appropriate.
In patients who are able to come off all diabetes medication and whose HbA1c is <6% (42mmol/L), a glucose tolerance test will be performed as part of the final assessment at one year to document the extent of reversal (e.g. to IGT or normal).
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