The best approach to reversing Type 2 diabetes is a hotly contested subject. While experts agree that sustained weight loss is a fundamental part of the process, the diet a person should adopt to achieve that weight loss, and improve their glycaemic control, is less commonly agreed upon. Some studies have shown promising results for the very-low-calorie-diet approach, while others suggest the Mediterranean diet holds the key to success. What Dr David Unwin discovered in 2013 was that for certain patients, a low carb diet may trump all others.
Conventional wisdom at the time was to medicate rather than prevent, with prescribing budgets eaten up by diabetes drugs as diagnoses soared across the UK. Dr Unwin had spent a quarter of a century recommending traditional drug treatment for diabetes, in line with NHS treatment guidelines.
Then he stumbled upon the low-carb approach. Championed by prominent advocates diabetes.co.uk and others, the diet showed serious promise in improving glycaemic control for people with diabetes. He began recommending it to his patients as an alternative to medication and, so as to fully understand the difficulties his patients may face in sticking to low-carb, also adopted the diet himself.
“Back in 2013, our GP practice had a very ‘drug centred’ approach to Type 2 diabetes,” he says. “Lifestyle medicine was almost unheard of. The partners felt that rather than going on about dietary carbs I should concentrate on seeing properly sick people. This meant the only way forward was to work for free in my own time on a Monday evening. My wife came in to help me staff the surgery.
“After six months, the partners could see my results were beating what they could do with drugs, particularly when the first few patients managed to come off medication. Initially I was unsure about the low carb approach so I joined my patients on the diet and we learnt together, trialling recipes we found on the internet. We even arranged practice based cooking demos.
In 2015/16, Dr Unwin’s practice saved £40,000 on drugs. To put that in perspective, if every one of the UK’s 7,435 practices were to make an equal saving, the NHS would be £297 million better off each year. So the practice partners were, by then, firmly on side - but challenging official treatment advice across the whole of the health service was another matter entirely.
Dr Unwin was very vocal about his patients’ successes with low-carb online and in the press, publishing extensive research into the approach as an alternative to drug therapy. He also developed a peer-reviewed e-learning module for GPs explaining the science behind the low carb approach, its impact on glycaemic control and how to discuss it with patients, which won him the prestigious accolade of NHS Innovator of the Year. Last week, it was chosen by the Royal College of General Practitioners as its Course of the Month for November.
“My generation of doctors was brought up with a deep distrust of ‘the media’,” he says. “My partners were worried the first time I appeared in The Daily Mail. Despite the risks I feel the internet is democratising medicine – making relevant information so available.
“I have come to feel we can’t just ignore the internet; it’s not going to go away, so we should join in. It’s a great way to ‘find your tribe’ and become more effective. The low carb movement has a huge presence on social media. There are risks though, particularly around the temptation to give advice. So often I have to explain we supply general information online. Personal advice is something you get from your own doctor!”
For the next three years, David plans to continue encouraging doctors to promote lifestyle change over medication. “I think the idea of reversing type 2 diabetes or more properly putting it into remission without drugs is probably a valid goal for about 50% of people with diabetes.
“The longest remission in my practice is 9 years. I feel this is such a hopeful message, that there is so much people can do themselves to make a difference by cutting back on the dietary sources of glucose.
“I know that for my first 25 years of medicine I failed to make this clear enough and was too quick to prescribe lifelong medication. My goal is to help other doctors tap into the wonderful potential of people to help themselves.”
Dr David Unwin will share insights from his experience at Diabetes Professional Care 2018, 15:15-15:45 Wednesday 14 November. Register for your free place at https://www.diabetesprofessionalcare.com
Changing Health’s behaviour change programme for diabetes is now available for the 150,000 people living in Greater Manchester with Type 2 diabetes, as part of a suite of digital resources to help them better manage their condition and live healthier lives.
The NHS England and Innovate UK funded initiative makes diabetes support available from a range of providers any time, anywhere via a one-stop shop web platform, Greater Manchester Diabetes My Way. Users will benefit from digital education on lifestyle and personalised, one-to-one behaviour coaching, delivered by Changing Health, alongside tools for easier sharing of glucose monitoring data and care records with healthcare professionals.
The scheme was launched with the aim of giving people with diabetes all the skills and knowledge they need to play a more active role in managing their condition, by adopting positive diet and exercise habits and learning how to maintain lifestyle changes over the long term.
Diabetes support in Greater Manchester has in the past been limited to classroom education programmes, which are often inaccessible for those unable to travel or take time off work, or who have learning difficulties. Digital tools overcome these challenges, and in some cases, have been shown to improve uptake of diabetes support by more than 500%.
In addition to improving the support on offer for people with diabetes, the initiative is also likely to deliver significant cost savings for healthcare delivery in Greater Manchester, with fewer complications arising from the condition, fewer hospitalisations and fewer A&E attendances.
John Grumitt, Changing Health Chief Executive, said: “It’s great to be selected as one of the Greater Manchester Diabetes My Way providers and build on the evidence that with access to the right support, people with diabetes can make big changes in their lives and manage their condition more effectively.
“Health Secretary Matt Hancock shared his vision last week of delivering more patient-centric care, facilitated by digital tools. Greater Manchester Diabetes My Way will play a key role in making that vision a reality.
“We know that a large proportion of people with Type 2 diabetes want to make a change in their lives - but often, they simply aren’t sure how best to go about it. This initiative aims to change that.
“Where previous behavioural interventions faced some major practical and financial challenges, today’s launch is a win-win: people with diabetes are empowered to sustain long-term lifestyle changes, while healthcare providers benefit from better communication with their patients, better health outcomes and a lesser administrative burden.”
Naresh Kanumilli, SCN Clinical Lead for Diabetes, said: “This has the potential to be a real game-changer in Greater Manchester. With a large and growing Type 2 diabetes population, we need to adapt to the modern world and harness the power of new digital technology to embrace changes in how we support people living with diabetes.”
Notes to editors
People with diabetes can’t always tell fact from fiction. And with the internet awash with conflicting sources of information on diet, exercise and glycaemic control, it’s easy to see why. In the space of just two weeks, the Daily Express alone published or republished 17 clickbait headlines on diabetes, often misleading, and designed to appeal to readers’ fears about their health.
Here are a couple of them:
Of course, that’s not to understate the public health crisis currently facing the nation - a recent estimate by Diabetes UK suggested a record 12.3 million people are now at elevated risk of developing Type 2. But we urgently need to stem this flow of misinformation.
Even the broadsheets can be prone to misrepresenting scientific evidence. The Guardian, for example, ran in August with the headline “No healthy level of alcohol consumption, says major study”. That referred to a major mata-analysis of 694 studies to work out how common drinking was, and a further 592 that assessed the health risks, accounting for a total 28 million people and published in The Lancet.
The researchers found that for each extra drink consumed in a day, the harm increased, and that the lowest level of harm was zero drinks - the basis of the Guardian’s headline. It isn’t, however, that simple.
The study showed that 918 in 100,000 people who consume one drink a day can expect to experience an alcohol-related health issue. Yet 914 of those people will experience such a health issue no matter what, meaning only four in 100,000 do so as a direct result of consuming one drink a day(1). The study also did not account for other factors that may have been the actual cause of harm - drinkers are more likely be poorer and to smoke, for example.
Again, this is not to understate the risks; it’s beyond doubt that drinking is detrimental to health. The point, however, is that misleading headlines create a widespread lack of understanding what constitutes an achievable, healthy lifestyle - with significant implications for public health.
Many people are unaware, for example, that consuming carbs, not fats, is what typically leads to weight gain. Another common misconception is that Type 2 diabetes is a sign of having eaten too many sweets, rather than too much bread and pasta.
Peer support groups for diabetes can be tenuous in reliability too. A 2011 study of health social networks, published in the Journal of the American Medical Infomatics Association, found that only 50% were aligned with clinical practice recommendations (n=10).
Users of Changing Health’s programme for diabetes management, which combines evidence-based education on diabetes with behaviour change support, consistently tell us they were overwhelmed by the sheer volume of conflicting viewpoints on diet they had found online. Their GPs typically only have the time to hand them a stack of leaflets, and while the NHS website goes some way to helping, there’s more that could be done.
We must counter this deluge of misinformation by providing more people with clear, evidence-based guidance and support. If we don’t, there’s only one likely outcome: incidences of diabetes will continue to rise and with them, the strain on health economies across the nation.
1: New York Times, 28 August: https://www.nytimes.com/2018/08/28/upshot/alcohol-health-risks-study-worry.html
We’re on a mission to make the world a healthier place. Our crack team of lifestyle coaches, who provide personalised, one-to-one support for Changing Health users, are at the heart of that mission - and this month, we welcome three more to the fold!
Meet Petronella, Tom and Tasmyn. Each with a strong academic background in health, metabolism and/or physiology, they’re experts in behaviour change. They know how to empower people to adopt positive habits that last.
While they all draw on the same fundamental principles to support service users, they take their own approach based on the individual’s unique needs. “Motivational interviewing is an effective technique I’ve learnt to use,” says Petronella, a former tele-researcher and MSc Public Health student at the University of South Wales.
“The best way to build a rapport with users is by listening to them; I can identify what they know and what they don’t to fill in any gaps in their knowledge about diet and exercise, which supports their self-efficacy in changing their lifestyle.”
Tom, who studies for an MSc in Clinical Exercise Physiology at Northumbria and worked as a performance analyst for the university sports teams, finds that showing users the evidence behind the theory can be a useful technique.
He explains that choice is a key factor in an individual’s motivation to change, so education is key. “It allows users to make their own, informed decisions. Creating a clear action plan is invaluable too, as it gives users the tools to adapt to the unexpected and stay on track in making changes.”
Our third new recruit, Tasmyn, is completing an MSc in Health Psychology at Northumbria, investigating the effect of a nutritional intervention on mood, attention and behaviour in children with autism. Alongside her role as a lifestyle coach, she also works as a support worker for adults over 65 with physical and learning disabilities and/or dementia.
“I think the most important aspect of coaching is building that rapport with the client and to create a safe, non-judgemental environment,” she says. “The trust created allows for honest conversations and enables the client to come to their own conclusions of the goals they want to meet. Using barrier identification and coping planning techniques at this point then increases the likelihood of success.”
“Empowering people with the knowledge and skills to take control of their own health is an exciting prospect,” Tom adds. “Being a lifestyle coach allows me to apply the knowledge I’ve gained in my studies to support people in making positive lifestyle changes.”
“I’ve always wanted a job that promotes and supports positive lifestyle behaviours, particularly in food, physical activity and health,” agrees Petronella.
Tasmyn has also worked as a support worker for young adults with learning disabilities, autism and mental health issues. “A lot of my service users struggled with their weight. I found that one of the most satisfying aspects of the job was educating them on nutrition and supporting them to make lifestyle changes. I would assist them to complete their weekly shop and cook healthy meals from scratch, and thoroughly enjoyed watching them achieve their goals and see their self-confidence boom.”
Naturally, all three consider themselves something of a foodie. Tom is perhaps the most carnivorous - though he’s aiming to cook more vegetarian meals - while for Petronella, it’s all about new flavours and textures. With two growing kids to feed, with ever-changing tastes and eating behaviours, she has lots of room to experiment! Tasmyn’s food obsession of the moment is homemade pesto which, she says, is simple to make and a great way to incorporate some healthy fats into a diet.
The three are already supporting Changing Health users to make positive lifestyle changes that last. With a total seven users having now achieved Type 2 diabetes remission, and countless others lose the weight they’ve always wanted to, there’s huge scope for the team to make a real difference in people’s lives. Onwards and upwards!
Knowledge and confidence are a potent mix. That much has been made clear this morning, as new research from the Health Foundation shows that if people with long-term conditions are better supported to manage them, a staggering 436,000 emergency hospital admissions and 690,000 A&E attendances could be avoided entirely.
The findings confirm the conclusion I reached with Professor Mike Trenell of Newcastle University in 2015: that when people know what to do and they feel they can do it, they can achieve incredible things. It was on that basis that we founded Changing Health, delivering behaviour change programmes for people with Type 2 diabetes.
Many people with Type 2 don’t know how to properly manage their condition. There’s a wealth of information to take in, with too much misinformation online, and GPs rarely have enough time to give their patients much further guidance than a stack of leaflets.
But if we could give everybody with Type 2 diabetes a comprehensive understanding of diet, exercise and how lifestyle impacts on the condition – and then empower them to act on that understanding – the implications for public health are enormous.
The Health Foundation report makes a number of recommendations on how to achieve this: primarily health coaching, peer support and greater access to apps. All have been shown to improve patients’ PAM (Patient Activation Measure) scores, which predict an individual’s engagement with their health and healthcare based on over 400 peer-reviewed studies.
Indeed, a trial of Changing Health’s programme in the North West London Collaboration of CCGs found that personalised support for diabetes, including lifestyle coaching and digital education, results in a 10-point PAM increase – enough to boost patients’ score by one level (out of a total four).
According to the Health Foundation, if we can give just the lowest ability patients (level 1) the knowledge and the confidence to manage long-term conditions as well as those at level 2, we could prevent 504,000 A&E attendances, and 333,000 emergency admissions per year. That equates to 5% of all emergency attendances, and 6% of all emergency admissions in England each year.
On an individual level, we see this science in action every week as more people with Type 2 diabetes put their condition into remission. Once people know how, for example, complex carbohydrates affect their blood sugars, and they’re given a motivational boost on a regular basis, they’re often able to cut out the bread and the pasta - and begin reducing their HbA1c. It’s simply a matter of providing that support in the first place.
Fortunately, we’re seeing increasing recognition among healthcare providers that, as the Health Foundation points out, there’s a very broad spectrum of ability and confidence among people to manage long term conditions, and different approaches are needed accordingly. At the same time, technology is enabling the delivery of more personalised support for such conditions, improving patients’ self-efficacy in managing them and, as a result, living happier, healthier lives.
For Type 2 diabetes the outlook does, then, look promising. But diagnoses are still rising, and the clock is ticking. We must act fast.
Janice had Type 2 diabetes. She was stuck in some unhealthy habits - drinking four cans of coca cola a day, eating three-person portions of pasta, binging on pringles - and she needed help to make a change. In January 2018 she was diagnosed with an Hba1c level of 89, indicating a severe lack of glycaemic control.
And make a change is what she did. It began when, soon after her diagnosis, her GP referred her onto Changing Health’s Transform programme for diabetes management. Transform combines a course of digital education on diabetes with personalised behaviour change support from a lifestyle coach, and aims to give users the psychological tools to sustain a positive health behaviours over the long term.
She got off to a flying start. Kirsten, her lifestyle coach, was impressed; Janice had already begun prepping her meals in advance, swapping carbs at lunch for a healthier alternative, and dancing each night to an exercise routine - and lost a kilo in a week as a result. While it’s important to start with small changes, Janice felt she could do more, so Kirsten worked with her to set a clear, achievable short-term goal for physical activity: three brisk, 10 minute walks per day on the way to work, at lunchtime and on the way home.
By March, Janice had accelerated her progress, decreasing her portion sizes, increasing her fluid intake, cutting out crisps, swapping white bread for wholemeal and potatoes for sweet potatoes.
“She wanted to know more about the carb and sugar content of fruits and vegetables,” Kirsten says. “So I gave her a document about GI of foods and a link to a website that could be useful too. I told her carrots are quite high in GI and sugar, but they’re still vegetables and better than other things you could be eating!”
“I was very honest with Kirsten,” says Janice. “She was equally honest back, and without being judging - she was supportive and positive. I wasn’t very active - partly because I was ill and partly because of the weather, and we spoke about my frustrations with that. We discussed mini exercises I could do during the day.”
May rolled around, and it was time for another visit to the GP. There was some excellent news: Janice had reduced her HbA1c to just 55 in four months. She was well on the way to reversing her condition for good.
“I kept making swaps - I like to go to concerts, so I swapped beer for sparkling water. I haven’t touched Coca Cola, no red meat, no processed foods - I’m eating lots of fish, veggies, grilled halloumi. My partner enjoys the new diet too. I’d led him astray to be honest, but he’s just brilliant - he supports me every day”
The last time Janice and Kirsten spoke, in July, things were looking even better. Janice had reduced her HbA1c to 42 - meaning she no longer had diabetes! She’d now lost a total 14.8kg on the programme, and dropped two dress sizes to boot.
“Janice has been amazing throughout her journey on the Changing Health programme,” Kirsten adds. “She recognises that the changes she’s made are long-term lifestyle changes, rather than a short-term fix. She deserves this fantastic news!"
Does Janice have any advice for others in her position? “Be honest. That’s the key, that’s the tough thing. When I’ve been low, I’ve rung up Kirsten and beat myself up, but she looks at the bigger picture. She’s brilliant. I’ll miss her.”
Debra was in shock. A routine visit to a new GP had come with some unexpected news. “To be honest,” the GP told her, “It’s your diabetes I’m worried about.”
She’d had no idea she had Type 2 diabetes, and she didn’t know how to manage the condition either. Conscious of the waiting room filling with other patients, the GP began reeling off a list of actions Debra should take to keep things under control. “He was giving me all this information so quickly,” Debra says. “There was just too much to take in at once.”
“But I thought, there’s no way I’m living with diabetes for the rest of my life. I’m going to make a change. He offered to get me on the Changing Health app, and I started straight away.”
The Changing Health programme combines digital education, which breaks down guidance on diet and diabetes into a single straightforward course, with one-to-one support from a behaviour change coach.
Carl Lumsden, one of the Changing Health coaches, was assigned to support Debra. “She sounded a bit overwhelmed by all the information her GP had given her,” he says. “I suggested she take it in easy steps, focus on making manageable changes to her diet, and don’t do too much at once. It’s the smallest battles that win the war!”
Little swaps, it turned out, can make a big difference. Beer for gin and slimline tonic, pasta for brown cauliflower rice, fruit for vegetables and protein. Combined with some of Carl’s most tried and tested motivational techniques - setting SMART short- and long-term goals, writing them on post-it notes to leave around the house, involving others in lifestyle changes - soon Debra was seeing real progress. By the time of her second coaching phone call, she had lost a total of 8kg.
At the same time, Debra’s understanding of diabetes, diet and weight loss had rapidly improved. “The app was so helpful - I learnt so much about how my carbs affect my blood sugar - slow release carbs, fast release carbs - all kinds of things I had no idea about before. And Carl had the answer to all my questions, telling me what to google; every time, I had more questions, and he always had the answer!”
Three months after she began the programme, Debra visited her GP again - and there was news this time around too. Her diabetes was in remission.
“I did it!” she says. “Now I feel 100% better. Now I’m walking to the bus stop every day, tracking my steps, fitting as many into my job as I can. I’m about to go on a self-catering holiday, and I’m going to cook all my meals fresh so I can keep up my diet.
“Before, I was down in the dumps, sometimes I just felt like I couldn’t be bothered – I’m so much more energetic now! So I’ll keep it up for the rest of my life. I was so determined to get better. To anyone considering starting the programme, I’d say don’t be embarrassed and just give it a go – if you’re like me, then there’s a lot to learn – but that help is there for you.”
With a record 12.7 million people at elevated risk of developing Type 2 diabetes in the UK, the need to help people change their lifestyles en masse has never been more acute.
Patients already diagnosed with Type 2 are typically very aware of the need to move more and eat more healthily, but struggle to translate their intention to change into sustained action. People with prediabetes, on the other hand, can be more difficult for healthcare professionals to engage with a behaviour change intervention.
Their perception of risk is generally lower; the lack of any physical symptoms leads some to question whether they actually have a health issue and whether changes are required at all.
According to one study, people with prediabetes consistently underestimate their probability of developing Type 2; 84% considered themselves at low, very low or negligible risk. Indeed, many people with prediabetes only find out about their condition when they visit a GP with an unrelated issue, rather than on a regular check-up for diabetes as the NHS recommends.
Others are hindered by outcome expectancies. They recognise the need to change, but feel any attempt will be hopeless and so accept that they will simply remain in their current habits and that developing the condition is an inevitability. As food is perceived as a necessity for life, low outcome expectations can be further compounded by feelings of frustration and deprivation when healthcare professionals advise making changes to a dietary intake.
But digital DPPs, often dubbed “Prevention 2.0”, are addressing these challenges. By making support available on a smartphone or tablet, anytime and anywhere, digital DPPs are reducing the “hassle factor”, leading to significantly higher uptake; one digital trial in London’s Waltham Forest, for example, saw a 500% increase in just 14 days.
When a user can work through a DPP in their own home, in their own time, completion rates are much higher too, improving on users’ understanding of how prediabetes affects their health and increasing users’ risk perception of more serious health issues in the future if they don’t act on their healthcare provider’s recommendations.
Trials in behavioural economics have shown that when a complex goal, such eating more healthily, is broken down into a series of easier actions (eg eating five a day), outcome expectancies can be significantly improved. On a digital DPP, participants can set their own clear, achievable short-term goals and can refer back to them on their phone at any time, boosting motivation to sustain a healthier lifestyle over the long term.
Instant, one-click referral systems also reduce wait times between referral and access to just minutes - as opposed to weeks or sometimes months for a face-to-face DPP - minimising drop-offs as people become demotivated over time without support.
Digital DPPs therefore show serious promise in improving access to support - among even the hardest to reach groups - and overcoming the psychological barriers to sustaining lifestyle changes for people with prediabetes. As the NHS scales access to such programmes across the UK, turning the tide on diabetes has never seemed more possible.
Author, Holly Hart, MSc, is a qualified Health Psychologist and one of Changing Health’s lifestyle coaches. This article is based on real life case studies, including two users who achieved Type 2 diabetes remission in 10 weeks between April to June, 2018.
People with Type 2 diabetes usually know they need to make a change, and they have the motivation to do so. But their self-efficacy - that is, their beliefs about their capabilities to succeed - is often low; they perceive significant barriers preventing them from sustaining a healthier lifestyle.
There are, however, some useful techniques to help people with diabetes overcome the barriers to change and translate their motivation into action. Here are a few recommendations from my experience supporting people to better manage their condition:
1) Letting people know that good food can be cheap
Many people think fresh, “healthy food” is more expensive (it doesn’t have to be!), while others may be hampered by a lack of social support - often key to success. Some may worry that eating as a family may require the entire family to change their diet, and some may have been disillusioned by a lack of success when trying to make lifestyle changes in the past.
2) Making education simple
People with diabetes report that one of their biggest barriers to making the changes they need to is a lack of access to education and information. Those who do receive guidance from their healthcare provider often tell us that there was too much to take in, too quickly, and they ended up with only a limited understanding of how their condition affects them. We tend to provide links to websites and tell people what to search for online instead, so they can learn at their own pace in their own time.
3) Showing that dieting doesn't mean no food
A common misconception we find among people with diabetes is the idea that following a diet means cutting out your favourite food and getting up at 4am for an exercise class. In fact, the simplest lifestyle changes are typically the key to successful management or even remission of diabetes. The inspirational success stories you get to hear as a coach are testament to this approach, and communicating to patients that their lifestyle changes don’t need to be radical can transform their outcome expectations.
Debra, a Changing Health user who recently achieved remission in 10 weeks, did so by making only “little swaps”, like pasta for cauliflower rice, so a healthier diet didn’t feel like a chore to maintain. It’s also important to avoid warning people with diabetes about what will happen if they don’t make a change; research has shown this doesn’t work.
Instead, we find that listing the benefits of a healthier lifestyle can be much more effective, particularly those which impact the most on everyday life: improved cognition and memory, better concentration, reduced tiredness and feeling less out of breath when walking the dog or taking the children to the park. focusing on past successes (identifying and emphasising previous, successful attempts to initiate lifestyle change) has been linked to optimal care consultations and better clinical outcomes.
Pairing this with discussions about how to overcome barriers that have occurred in the past, or might come up in the future, enables the patient to think more positively about making a change and this positivity is key.
4) Setting achievable goals from the outset
Healthcare providers can also support patients on their journey towards a healthier lifestyle by encouraging them to set clear short, medium and long-term goals. SMART goals - specific, measurable, achievable, realistic and timely - keep patients focussed every step of the way and have been proven to be effective in improving outcomes.
If patients write these goals down, the chances of success are even higher - up to 42%, according to new research. Changing Health coaches suggest users write down their progress so far on post-it notes and leave them in prominent places around the house, boosting their motivation to keep going when times are tough.
5) Personalising the approach to support
Every individual is at a different stage in their behaviour change journey and so it’s important to take their unique circumstances into account. Ultimately, it’s about re-framing the conversation to focus on their own possibilities of success, rather than the consequences of failure, at every point of contact.
The biggest lesson I’ve learnt, though, is that while people with diabetes don’t often realise that transforming their health can be a straightforward process - once they do, they’re bound to surprise you.
Watch Sheinaz, a GP Practice Manager who achieved diabetes remission with Changing Health, tell the story of her weight loss journey in NHS Digital’s short film here: https://bit.ly/2v67fvR
Meet Sheinaz. She’s a GP Practice Manager in Gateshead, Newcastle, and she was largely sceptical of the power of digital interventions to help people Type 2 diabetes change their lifestyle and better manage their condition. Until she tried one out for herself.
On 13 January 2018, Sheinaz was diagnosed with diabetes. Her GP told her that her HbA1c level, an indicator of blood glucose control, was at 52. That meant her condition was under control - but only just. It was enough to motivate Sheinaz to begin making some big lifestyle changes, and when her GP offered to refer onto the Changing Health programme to help her do so, she accepted - albeit with some reservations about whether it would be of much use.
The programme comprises a course of digital education on diabetes to improve participants’ understanding of how diet impacts on their condition, combined with one-to-one lifestyle change coaching from an expert in health psychology and behavioural science.
“I was devastated to hear the diagnosis, absolutely devastated” she says. “I just thought, ‘I have a healthy diet, I do all the things I could possibly do, what more can I do?’ Going to a group session wasn’t really sustainable for me, and the other option was having a health app.
“When you’re being monitored by your GP practice you’re only seen once a quarter, so I thought having the app available will help me to maintain that consciousness of the long term condition I have, and it’s an alternative that actually works better than seeing your GP”
As Sheinaz worked her way through the programme, her preconceptions of digital health apps changed entirely. She was moving more. She had more energy. With a few pointers from her lifestyle coach on the best changes to fit her own circumstances, soon she was cooking tasty, healthy meals every day, building positive habits into her daily routine rather than treating weight loss as a chore. “I increased my physical activity on a daily basis using the app, and having my own personal health coach really helped too.”
It was a complete change of mindset for Sheinaz - and it paid off. In just ten weeks she had lost 18lb, or a little over 8kg. Then came more good news.
“I spoke to my GP on the phone. He said ‘you don’t have diabetes’ - I said ‘yes I do, I was diagnosed ten weeks ago!’ - and he said ‘well your blood sugars are normal; you’ve reversed your diabetes.’”
Sheinaz was ecstactic. And six months on from the original diagnosis, she’s living a whole new life. “In myself I feel better, my memory’s much better… I’m sleeping really really well, bouncing with energy, and bouncing with confidence. I love the diet and I’ve got so much energy as a result, and I’m still losing up to half a pound per week but I never feel like I’m on a diet.
The Changing Health programme was designed to empower users not only to adopt healthier habits, but crucially, to keep them up - for good. That looks promising for Sheinaz. As of mid-July, she’s now lost a total of 24lb and dropped two dress sizes.
“I can still use the app and the coaching sessions for another six months, but I don’t really need them; it’s become a habit now. I’m being creative about cooking, and I’m eating less carbs, but you know what? I don’t miss them at all.”
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