Building Competency in Diabetes Education THE ESSENTIALS

5-30 | CHAPTER 5

healthy eating, physical activity and weight loss (126). Frequent follow-up (i.e. every three months) with a registered dietitian has been associated with better dietary adherence in people with type 2 diabetes (127). Culturally sensitive peer education has been shown to improve A1C, nutrition knowledge and self-management (128) in people with type 2 diabetes. Programs dedicated to weight management may be beneficial. Figure 4 describes important criteria to consider when choosing a weight management program.

Figure 4. Checklist for weight management programs

Checklist for weight management programs

1. The program assesses and treats comorbid conditions. 2. The program recommends healthy behaviour modifications, and pharmacotherapy or surgery for those who qualify. 3. The program provides individualized nutritional, physical activity and behavioural programs and counselling. 4. Reasonable weight loss goals are set at 1– 2 kg/month. 5. Cost is not prohibitive. 6. There is no requirement to buy products, supplements, vitamins or injections. 7. The program does not make unsubstantiated claims. 8. The program provides access to a weight maintenance program.

Reprinted from Diabetes Canada 2018 Clinical Practice Guidelines (11).

Large, randomized, clinical trials of intensive lifestyle interventions using different lifestyle approaches have shown benefits in people with diabetes (129-132). These programs, led by a multidisciplinary team (registered dietitians, nurses and kinesiologists), usually consist of behavioural interventions using dietary modification and increased physical activity. However, the feasibility of implementing an intensive lifestyle intervention will depend on the availability of resources, including a multidisciplinary team. Generally, people with type 2 diabetes are treated initially with nutritional therapy and physical activity. If A1C <1.5% above the person's individualized target, antihyperglycemic pharmacotherapy should be added if glycemic targets are not achieved within three months of initiating healthy behaviour interventions. If A1C ≥1.5% above target, antihyperglycemic agents