Type 2 diabetes remission: how little swaps changed Janice’s life

 

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.”

Personalised Support For Patients Could Save The NHS Millions

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 were provided personalised support, 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.

How Would Personalised Support Work?

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.

Technology Simplifies Personalised Support

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.