That鈥檚 what several 91亚色 researchers are hoping to find out. If successful, their Pre-Diabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) Program could become the model for provincewide intervention.

91亚色 Professors Michael Riddell, Norman Gledhill, Veronica Jamnik, Chris Ardern, Jennifer Kuk and Paul Ritvo in the School of Kinesiology & Health Science鈥檚 Physical Activity & Chronic Disease Unit in the Faculty of Health, along with 91亚色聽PhD candidate Chip Rowan, PRE-PAID project coordinator, are now deep into Phase聽2 of their study and so far the results are promising. They have found there is an overwhelming need for programs such as PRE-PAID, as a high percentage of the participants tested already had pre-diabetes. In addition, there is a real lack of close and聽affordable fitness programs.

Right: From left, Michael Riddell, Veronica Jamnik, Chip Rowan and 91亚色 students and certified exercise physiologists Ajay Rampersad and Thomas Bok

The聽researchers also found that to reach people in high-risk areas聽they need to tap into existing social networks and聽make community contacts, as traditional media campaigns are not that helpful. With community engagement, they were able to increase their visibility and build partnerships to fight diabetes.

The goal of the PRE-PAID program is to identify those individuals from the highest risk populations, including Chinese, South Asian, African and African-Caribbean, who have pre-diabetes, and to provide them with targeted, accessible and monitored fitness programs, and hopefully prevent them from developing Type 2 diabetes.

It could save lives and millions of health-care dollars. Health-care costs for the treatment of persons with diabetes in Canada amounts to聽$9 billion annually. In recognition of this burden, the Ontario Ministry of Health & Long-Term Care has made the treatment and management of diabetes a priority.

鈥淭he costs are聽anywhere between聽$2,000 and $15,000聽a year per person with diabetes in direct and indirect costs, but if we can get that down to around $200 a year in investment for those with pre-diabetes to prevent the disease, that would save a lot. Not only that, but we can probably prevent six cases out of 10,鈥� says Riddell. 鈥淲e have to show this model will work and will save money in the long run over the health-care costs caused by the complications of diabetes. If we invest now in treating pre-diabetes, it will cost less in the future.鈥�

Left: A participant undergoes a聽finger prick blood test to check sugar levels

The PRE-PAID Program has screened some 428 people, aged 35 to 64, from the communities of 91亚色, Jane and Finch, Malvern in Scarborough,聽and Agincourt for high risk, and are looking for more participants. A further 350 were given a finger-prick blood test, which measures the amount of sugar coating on red blood cells as a measure of average blood sugar control over the last three months. Of these, 238 were found to be pre-diabetic 鈥� all of whom were previously undiagnosed.

Right now, there is no outreach screening or treatment program in the province for people with pre-diabetes. This study, funded by the Ontario Ministry of Health Promotion and the Ontario Trillium Foundation, is an important step toward changing that, say Riddell and Rowan.

Through community partnerships, all of those screened through the PRE-PAID Program with pre-diabetes are being given educational training on diabetes prevention and are聽provided with accessible and culturally preferred exercise sessions for six months.

Right:聽PRE-PAID participants聽in a聽bollyfit class

鈥淭he advantage of having the study at 91亚色 is they can use the students from the School of Kinesiology to hold the classes and many of them are of the same ethnicity as the participants, so we鈥檙e breaking down some of the cultural and language barriers,鈥� says Rowan. 鈥淏ecause we are so multicultural here, that really works.鈥�

So instead of expecting study participants to join a gym and run on the treadmill for half an hour a day, the project聽offers things like bollyfit, socasize, reggaerobics, line dancing and tai chi in easily accessible community centres with certified exercise physiologists, for free. The participants are also asked to incorporate walking into their weekly routine.

Through the PRE-PAID Program, participants who have been identified as pre-diabetic are 鈥減rovided with the opportunity and the encouragement. Then we track them to see how they comply,鈥� says Rowan. 鈥淚f it鈥檚 going to be sustainable, they really have to make that decision and that commitment.鈥� The participants are assessed at the beginning, at three months and again at six months.

Some of the factors that stand in the way of participating in fitness programs are cost, time and priorities. 鈥淧eople are busy and have other pressing priorities, priorities we can鈥檛 even imagine,鈥� says Riddell. 鈥淲e鈥檙e trying to alleviate some of these barriers.鈥�

By looking at studies done in the United States, India and China, 鈥渨e know that by doing 150 minutes of moderate intensity exercise per week, about 30 minutes a day, five days a week, we can lower the risk of developing diabetes from a state of pre-diabetes by about 50 per cent,鈥� says Riddell. 鈥淲hat is novel about this approach is we want to give them physical exercise that taps into culturally preferred activities. This is the first study I鈥檓 aware of that has done that.鈥�

The incidence of pre-diabetes and Type 2 diabetes continues to rise in Canada. It is estimated that about seven per cent (two million) of Canadians have diabetes with about half of them undiagnosed, while another five to seven per cent have pre-diabetes.

鈥淎ll the research has shown that exercise is the most effective preventative tool, even independent of dietary change,鈥� says Riddell. So it makes sense that people at the highest risk of becoming pre-diabetic would be caught early on.

The researchers are currently seeking funding for Phase聽3 of the project. In Phase聽3, the team will recruit an additional 500 to 1,000 subjects and will extend the eligible age range to 18 to 64, as recent findings have shown there is an increasing incidence of diabetes in young people.

The group is presenting some of their preliminary results at the International Congress聽on Physical Activity & Public Health, May 5 to 8 in Toronto.

For more information, visit the Diabetes Prevention Program Web site or contact Chip Rowan at 647-378-6777 or stopdiab@yorku.ca. For more information about diabetes, visit the Web site.

By Sandra McLean, YFile writer

Republished courtesy of YFile鈥� 91亚色鈥檚 daily e-bulletin.

The post New diabetes study on Type 2 diabetes, high-risk populations and fitness enters second phase appeared first on Research & Innovation.

shows why these factors are so important for health and documents the state of living conditions in Canada in an accessible manner for the Canadian public. The report finds these conditions are deteriorating, with serious ramifications for the quality and longevity of Canadians' lives, and outlines specific ways that the situation can be improved. The report is free to the public to read or download. Printed copies are also available to .

"Our key message is that the health of Canadians is much less determined by the health-care system than we typically think. Much more important are public policies that influence our living conditions," says Dennis Raphael, a professor in 91亚色's School of Health Policy & Management in the Faculty of Health and the report's co-author.

Raphael and Juha Mikkonen, a visiting scholar at 91亚色, explain in everyday language and with compelling graphics how Canadians' health is shaped by how much income and wealth they have, whether or not they are employed and, if so, the working conditions they experience. They pull together a wide range of research to show how health is powerfully influenced by Canadians' ability to obtain quality education, food and housing, among other factors.

Contrary to the popular belief that Canada is a caring nation with strong supports for its citizens, the report shows that Canada has one of the worst records among wealthy, developed nations in providing its citizens with the conditions necessary for health. These supports are eroding with significant effects on Canadians' health, says Raphael.

Left: Dennis Raphael

"This is not a storyline that's familiar to most Canadians. We're still stuck in those glory days where Canada really was one of the best places in the world to live. Sadly, that is no longer the case. What's frightening is that many of these aspects are completely beyond any one individual's control."

For example, new immigrants have difficulty getting accreditation for their skills, and are forced into service jobs where they can barely afford to feed their families. This leads to a host of problems that directly affect health and overall quality of life. "It's all interrelated. It's time to act on these issues," Raphael says.

Another striking example is found in maps that show a clear correspondence between poverty levels, prevalence of adult-onset diabetes and concentration of visible minorities in Toronto neighbourhoods.

Right: Juha Mikkonen

The report was inspired by the 2003 World Health Organization document Social Determinants of Health: The Solid Facts. Raphael hopes it will also spur the public into action. "It really is oriented toward building a social movement," he says.

The report provides concrete recommendations for improving the situation. For example, with regard to the increasing occurrence of hunger in Canada, it recommends increasing minimum wages and social assistance rates to the level where an adequate diet is affordable and that government assure healthy foods, such as milk, fruit and foods high in fibre, are affordable. It also recommends there be a provision of affordable housing and child care that would reduce other family expenses and leave more money for acquiring an adequate diet.

Sobering statistics cited by the report include:

• 15 per cent of Canadian children are living in poverty, putting Canada at a rank of 20th out of 30 of the world's wealthiest nations as defined by the Organisation for Economic Co-operation and Development (OECD).
• Only 17 per cent of Canadian families have access to regulated child care. Canada ranked last among 25 wealthy, developed nations in meeting various early childhood development objectives.
• Canada is amongst the lowest in its coverage of total health-care costs. Medicare covers only 70 per cent of total health-care costs, giving Canada a rank of 22nd of 30 OECD nations for public coverage of health-care costs.
• Canada is among the nations with the greatest gap between men's and women's earnings. Canada ranks 19th of 22 OECD nations in reducing the earnings gap between men and women.
• Over 40 per cent of Canadians with disabilities are not in the labour force, forcing many of them to rely upon social assistance benefits. Canada ranks 27th of 29 in public spending on disability-related issues.

Raphael, who teaches in 91亚色's Faculty of Health, has researched and written widely on these issues. His recent publications include , , and Health Promotion and Quality of Life in Canada: Essential Readings.

Mikkonen is a vice-president of the European Anti-Poverty Network (EAPN) Finland and a member of the executive committee of the EAPN. He has held positions in decision-making bodies at the University of Helsinki, the Finnish Student Health Services and the Finnish Youth Co-operation Allianssi, an umbrella organization for more than 100 Finnish youth non-governmental organizations.

Republished courtesy of YFile鈥� 91亚色鈥檚 daily e-bulletin.

The post Researchers' report details how living conditions determine health of Canadians appeared first on Research & Innovation.