The PRE-PAID project, funded by the and , targets groups at high risk for diabetes and uses a community-based approach to engage them in the physical activities they enjoy. The 91亚色 study has been operational since November 2009, and several diverse ethnic neighbourhoods in the Toronto area have participated. The Sault College project will involve individuals of First Nations descent.

"The PRE-PAID team is very excited to partner with Sault College for this important initiative,鈥� states Chip Rowan, Researcher and Certified Exercise Physiologist at 91亚色. 鈥淭hrough this partnership, we hope to extend our program to a community that has a well documented risk for developing type 2 diabetes. Through the provision of free screening and targeting individuals with pre-diabetes, we hope that our physical activity intervention program will prevent or delay the development of type 2 diabetes for as many people as possible."

Canadian Diabetes Association Regional Branch Co-ordinator, Janie Bringleson, says the statistics involving those with diabetes are alarming. Nearly 1 in 4 Canadians either has diabetes or pre-diabetes and more than 20 people are diagnosed with the disease every hour of every day. The Health Council of Canada states that diabetes is much more common, and growing more quickly, among First Nations adults, who are two to eight times more likely to have diabetes than the overall Canadian population, depending on age group. Researchers hope to show participants the benefits of engaging in no cost, enjoyable physical activities. Second, it is hoped that the project will demonstrate the importance of investing in exercise to prevent diabetes. Through these interventions they expect to reduce diabetes by 60%.

The complete article is available on . More information about the is available through the Research website archives.

Posted by Elizabeth Monier-Williams, research communications officer, with files courtesy of YFile 鈥� 91亚色鈥檚 daily e-bulletin.

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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.

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