This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

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Saturday, 25 February 2012

Lifestyle Redesign Diabetes Program

For the past 2 weeks we have had OTs who work in the USC Faculty Practice come to speak to the Lifestyle Redesign class about some of the programmes they are involved with.

Last week Dr Chantelle Rice (the OT who runs the weight management group I have been attending) spoke about the Lifestyle Redesign Diabetes Program. Chantelle developed the programme for her one year doctoral residency after completing her Masters in OT. Her presentation covered 4 areas:
  1. What is diabetes? How does it impact on function?
  2. What are the self care behaviours of diabetes self care and management?
  3. OT's role in diabetes prevention and management.
  4. Lifestyle Redesign Diabetes Program
 Chantelle Rice, OTD, OTR/L

Diabetes is a chronic and progressive disorder of glucose metabolism related to insulin deficiency and/or resistance. I am not going to go into further detail here as there are many places to look up this information, however it is useful to reflect on a few 'fast facts' that show why prevention and management are so important (these are US based, but other developed countries have similar issues).
  • over 25 million people in the US have diabetes
  • among US adults, diabetes is the most common cause of kidney failure, non-traumatic lower limb amputations & new cases of blindness.
  • excluding stroke & heart disease, diabetes is the 7th commonest cause of death.
  • compared to non-Hispanic whites, diabetes risk is 77% higher for non-Hispanic blacks, 66% higher for Hispanics and 18% higher for Asian-Americans.
In the US, OT is one of 13 disciplines that are eligible to become Certified Diabetes Educators (CDE), a formal qualification requiring a period of study and assessment, follow this link for more information.
Treatment at the different stages may progress through lifestyle modifications, oral medication and lastly insulin therapy. Diabetes has numerous harmful long term complications so the longer the disease can be prevented or managed the better for the individual and for society.

People who attend the Lifestyle Redesign Diabetes Program may have diabetes, be in the 'pre-diabetes' stage or may be aware that they have a high risk of developing diabetes- it is more common in people with certain metabolic disorders such as polycystic ovaries. 

OT can intervene at any of these stages by working with individuals to assess their daily occupations and to create sustainable health promoting routines based on the 7 areas of lifestyle change that have been shown to be effective in managing diabetes:
  1. Healthy Eating- e.g. how food choices affect blood sugars, sustainable routines around food and snacks, safe food preparation in view of reduced sensation or vision, finding 'healthy pleasures' to replace eating 'comfort food'.

2. Being Active- e.g. understanding the benefits of physical activity specific to diabetes such as improved insulin resistance, reduced blood pressure; setting 'SMART' goals for activity; educating about contraindications and precautions.

3. Healthy coping- e.g. addressing the high risk in people with diabetes for stress, depression, eating disorders and anxiety. This could include working on social and emotional support, providing information or reviewing time management strategies.

 4. Risk Reduction- e.g. making sure appointments to screen for complications are kept, managing 'hypos' and sick days, developing strategies to keep track of medical appointments, test results etc.

5. Monitoring- e.g. incorporating essential checks like foot inspections, weight and blood glucose into everyday routine.

 6. Taking Medications- e.g. ensuring the client understands the regime and helping the person embed it into their daily routine.

7. Problem Solving- the OT and client work as a collaborative with the client as problem solver. The OT will assess the client's readiness for change and any other factors such as literacy or cognitive function and use the most appropriate strategies to help to identify barriers and supports and to enable the individual to achieve success. Factors relevant to individuals will be included as required such as difficulties due to reduced sensation or pain, visual problems, need for adaptive equipment, home evaluations etc.

The OT needs to draw on knowledge of change theory, a thorough knowledge of diabetes, motivational interviewing skills as well as a knowledge of the program's theoretical underpinning. The intervention lasts 16 weeks. There are similarities to the Weight Management program as healthy eating is obviously very important, but this program addresses issues specific to diabetes.

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