M. Carolina Archundia-Herrera | ALES Graduate Seminar

Date(s) - 11/12/2020
1:00 pm - 2:00 pm

A graduate exam seminar is a presentation of the student’s final research project for their degree.
This is an ALES PhD Final Exam Seminar by M. Carolina Archundia-Herrera. This seminar is open to the general public to attend.

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Meeting ID: 959 0166 1390
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Meeting ID: 959 0166 1390
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Thesis Topic: The Pure Prairie Living Program for Type 2 Diabetes: Evaluation and Steps to Optimize and Enhance Participant Success

PhD with Dr. Catherine Chan

Seminar Abstract:

Background: Given the etiology of T2D, a multidisciplinary approach is recommended for its management, in which self-management education and support, nutrition therapy, physical activity and pharmaceutical therapy play a major role. However, people with T2D phase difficulties in meeting the Canadian Diabetes Guidelines, especially in regards to nutrition therapy. The rational of the work presented in this thesis is to enhance participants’ successful adherence to the guidelines through the evaluation and optimization of the Pure Prairie Living Program (PPLP). Thus, the primary objective of this thesis was to evaluate the effectiveness of the PPLP in a primary care setting. Guided by results obtain from this RCT study, two additional objectives were researched: i) analyze to what extent lifestyle interventions align with the cornerstones of type 2 diabetes treatments and to compare their effect sizes when moving through the scale-up process (efficacy trials to effectiveness trials), ii) understand the lived experience of people with T2D when managing their disease, to identify optimization strategies for the PPLP and other lifestyle interventions.

Methods: Within the RCT adults with type 2 diabetes were randomized into intervention (PPLP, n = 25) and wait-listed controls (CON, n = 24). The PPLP group participated in six education sessions and were followed for six months. For the analysis of lifestyle intervention alignment with the guidelines, a systematic review methodology was adopted guided by PRISMA guidelines. To understand the live experience of people with T2D a Qualitative study design was followed guided by COREQ checklist.

Results: The RCT intervention yielded no significant within-group changes in HbA1c at three-month (-0.04 (-0.27 to 0.17) and -0.15 (-0.38 to 0.08)) or six-month (-0.09 (-0.41 to 0.22) and 0.06 (-0.26 to 0.38)) follow ups in either CON or PPLP groups, respectively. Dietary adherence scores improved in the PPLP group (p < 0.05) at three and six months but were not different in the between-group comparison. No changes in diabetes self-efficacy scores were detected. Participants described the program as clear and easy to understand. Knowledge acquired influenced their everyday decision-making but participants faced barriers that prevented them from fully applying what they learned. Healthcare professionals enjoyed delivering the program but described the “back-stage” workload as detrimental. The main results of the systematic review found that all the studies analyzed reported a decrease in HbA1c values in the intervention group and that a scale up penalty was detected ranging from 0 to 35%. The main results of the qualitative study indicate that participants’ knowledge regarding DM and nutrition is considerable but experienced health behavior cycles which are influenced by many factors. Participants provided valuable information about what they would like to see in a program

Conclusion: While some positive effects of the PPLP intervention were observed, they were not comparable to those previously attained by our group in an academic setting or to what the guidelines recommend, which reflects the challenge of translating lifestyle intervention to real-world settings. However, the finding of a modest scale-up penalty does not negate that real-world application of lifestyle interventions can result in clinically relevant improvements in diabetes outcomes, specially if interventions provide and include the same importance to each cornerstone of diabetes management and increase or maintain its intensity over the long term. Including input from participants’ context, experiences and needs, would provide more sustainable and realistic lifestyle intervention programs. People living with DM request a more extensive and comprehensive treatment to address participants’ needs and mirror the multifaceted aetiology of type 2 diabetes.