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SLT4R Final Presentation (Diabetes)
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SLT4R Final Presentation (Diabetes)


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  • 1. SHARED LEARNING TEAM 4R Diabetes Type 2 Incidence & Prevention
    • Our aim is to inform, educate and prevent the onset of
    • Type 2 diabetes in
middle adulthood
    • Why do we want to prevent Type 2 Diabetes?
    • The New Zealand government has identified Diabetes has become a primary health challenge as a major cause of death and illness.
      • 157,000 people have diabetes in New Zealand, 142,000 have Type 2, that’ s 90%! 1
      • Type 2 is largely preventable, caused by a combination of genetic and environmental factors which damage the insulin producing cells. Obesity and excess weight accelerate the damage. 1
      • People that are more likely to get Type 2 Diabetes are people who are overweight or people that don ’t exercise enough 1
      • Type 2 diabetes usually occurs in adulthood after the ages of 30 - 40 years. However, increasing numbers of teenagers and children are developing Type 2 diabetes . 1
      • Type 2 diabetes can be passed down the generations from a blood relative, this doesn ’t necessarily cause it but with the combination of poor diet and lack of exercise, there ’s a greater chance Type 2 could develop. 1
      • A 78% increase in cases of Type 2 diabetes from 1996 has been predicted for the year 2011! 1
      • The cost to society for treatment of diabetes was estimated in 2004 as $340M per year, expected to increase to $1B in 2021 2
    • 1 New Zealand Health Information Service (2008).
    • 2 Diabetes New Zealand (2008).
  • 3. INTRODUCTION continued…
    • New Zealand supports both a biomedical health model and through the Maori Health Strategy recognises a more holistic approach to healthcare and well-being, in line with cultural values held within the Maori community in New Zealand (Ministry of Health, 2008).
    • The campaign against diabetes recognises the diversity in this unique approach to healthcare by demonstrating the Treaty principles of Partnership, Participation and Protection (Broom et al., 2007).
    • Campaign material and presentation is culturally safe. Proposed plans do not impose or impact negatively on other cultures, but encourage the principle of protection; children and schools are actively recruited to implement the fight against diabetes campaign, and the campaign itself targets children as educating them now ensures future improvement (Broom et al., 2007).
    • By working alongside the Ministry of Health and Ministry of Education and their partnering Maori committees, our campaign demonstrates partnership and participation principles (Broom et al., 2007).
    • Benefits of Nutrition
    • D oes the dietary environment of the individual matter to support cardiovascular health and neurovascular health? The answer seems to be a solid yes ( Macdonald, 2008).
    • Reducing simple sugars in the diet:- improves body composition, lipid and lipoprotein profiles and reduces glycaemic index
    • Regulations r educes blood pressure- as well as treating diabetes, metabolic syndrome and obesity may be treated
    • R educes risk factors for heart disease (Layman et al, 2008).
    • O nce the medical field has a clearer understanding and acceptance of diet as a powerful tool as a powerful treatment option, we will begin to change disease patterns by leaps and bounds
    • A s with most epidemics, the best outcomes are from the simplest, most fundamental remedies - practical processes clinicians on the front lines can use, such as good nutrition (Macdonald, 2008).
    • Benefits of Exercise
    • “ Physical activity is recognized to produce multiple general and diabetes-specific health benefits. Yet despite the multitude of benefits, many people are physically inactive” (Hayes & Kriska, 2008, pg. 19)
    • Exercise is beneficial by avoiding both the acute and long-term complications of ハハ diabetes mellitus (Erasmus et al, 2008) Because:- Likelihood of the occurrence of heart problems is decreased (Praet, 2008)
    • G lycaemic control is improved (Praet, 2008)
    • L ipid profile and blood pressure regulated due to maintenance of regular blood p ressure (Lilly, 2006)
    • Enhances insulin sensitivity (Lilly, 2006)
    • R eversal of endothelial dysfunction in individuals with diabetes mellitus (Moien-Afshari et al, 2008)
    • Target audience
    • Intermediate and secondary schools.
    • As incidence of Type 2 Diabetes is not apparent until middle adulthood (Diabetes New Zealand, 2008), early education is necessary. Targeting this age group also addresses the rising incidence of Type 2 Diabetes among teenagers (Diabetes New Zealand, 2008).
    • Objective
    • To build into the teaching curriculum, a programme toward healthier eating and better exercise
    • practices.
    • By linking the programme to existing subjects in school curricula, the benefit of education will carry through to completion of secondary education. For example Te Reo, Health, Physical Education, and subjects that encompass life skills education.
    • Proposed duration 1 year pilot
    • Proposed structural implementation 3rd - 4th form - compulsory subject content
    • 5th - 7th form - elective subject
    • Cooking Classes
    • Aim: To educate students on healthier cooking and eating options.
    • Incentive: Weekly cooking competition judged by panel of students. Winning recipe is featured in school tuck-shop.
    • “ Stamp of Approval” Loyalty Program
    • Aim: Raise student awareness of healthier eating options in tuck-shop e.g. stickers next to foods meeting NZ health standard/ food classification standards.
    • Incentive: Loyalty card stamped for every healthy option bought. Completed cards go into draw to win sports gear for team or own use e.g rugby ball, rebel sports voucher.
    • Interschool Sports Programme
    • Aim: Initiate involvement, competition and education by interacting with similar minded/ programmed schools; encouraging other schools to adopt programme.
    • Incentive: Interschool semester tournaments e.g. athletics day, cross country, swimming; competing for a winner’s cup final, or sports equipment voucher for school.
    • Leadership Programme
    • Aim: Develop a leadership programme within secondary students to coach sport or educate primary school children on the benefits of regular exercise.
    • Incentive: Aimed at higher secondary school students, awarding extra NCEA credits toward Bursary for “leaders”; linked with extra curricular community service subjects.
    • School Gym Programme
    • Aim: To encourage an active exercising routine through recognised group fitness classes after school or during lunch hours e.g. pump, body combat, pilates/ yoga.
    • Approach the Ministry of Education (MoE) to explore
      • collaborative approach to developing ongoing course content to build into school curricula
      • current funding options available
      • tie-in with existing programmes e.g. Fuelled4school (2008), Push Play, Smokefree, Team-up (New Zealand Ministry of Education, 2008).
    • Once MoE on board
      • Present to school Board of Trustees and teachers on programme integration.
      • Develop appropriate print media for school environment, in collaboration with Te Hauora (Maori Health) and Ministry of Health strategies. Source resource funding from Ministry.
      • Monitor, evaluate, review and report programme success at end of year 1, to education providers and concerned parties.
    • How can we measure the success of our plan?
    • T he success of this program will not be known until 10-20 years down the track when targeted
    • high school students reach the ages of 30-40 years; those are the ages most at risk of diabetes
    • type 2.
    • A few short term solutions to measure the success of this program are to:
    • Monitor the school gym program for attendance
    • Monitor loyalty program - returned cards are a way to measure numbers,
    • Monitor number of people participating through leadership program and earning extra credits,
    • Utilise a school survey that can be filled out during form class to measure amount of exercise and good nutrition.
    • Positive reinforcement and how we used it:
    • We have developed incentives with our strategies in line with positive reinforcement to ensure a successful outcome in the future. Positive reinforcement involves having a positive consequence to a positive action therefore reinforcing the action and making it appealing (Sarafino 2004).
    • W e have based positive reinforcement both into our exercise and nutrition plan. I n the nutrition plan we did this by making a competition of who can cook the healthiest food with the reward being their food in the tuck-shop and the prize draw for sports gear when they buy food that meets NZ health standards. I n the exercise plan we did this by providing an opportunity to gain credits through the leadership program and by providing a cup that can be won through the interschool competitions.
    • O ur goal in using this strategy is so healthy eating and regular exercise becomes a positive part of the student s’ lives now and in the future, which ties in with our primary goal in preventing diabetes type 2 in our future generations.
    • Erasmus, R. T., Blanco, E., Okesina, A. B., Gqweta, Z., & Matsha, T. (1999). Assessment of glycaemic control in stable type 2 b lack South African diabetics attending a peri-urban clinic. The Fellowship of Postgraduate Medicine. Retrieved 30 May 2008, from: http: //pmj . bmj .com/cgi/content/full/75/888/603
    • Broom, D., Deed, B., Dew, K., Durie , M., Germov , J., Kirkman , A., et al. (2007). Health in the context of Aotearoa New Zealand. Melbourne , Australia: Oxford University Press.
    • Diabetes New Zealand. (2008). About type 2 diabetes. Retrikeved June 10, 2008, from
    • Fuelled4school. (2008). Retrieved June 10, 2008, from
    • L illy, L. S. (2006). Pathophysiology of heart disease. A Collaborative Project of Medical Students and Faculty. Boston: Lippincott Williams & Wilkins .
    • Layman, D. K. , Clifton, P. , Gannon, M.C. , Krauss, R.M. , & Nuttall , F.Q. ( 2008). Protein in optimal health: Heart disease and type 2 diabetes. American Journal of Clinical Nutrition 87 (5), pp. 1571S-1575S.
  • 13. REFERENCES continued…
    • Macdonald, P. (2008). Making the Connection Between Diet and Nutrition and Cardiovascular and Alzheimer's Diseases. E xplore: The Journal of Science and Healing 4 (2), pp. 148-153
    • Ministry of Health, (2008). Retrieved June 10, 2008 from
    • Moien-Afshari , F. , Ghosh , S. , Khazaei , M. , Kieffer , T.J. , Brownsey , R.W. , & Laher , I. (2008). Exercise restores endothelial function independently of weight loss or hyperglycaemic status in db/db mice. D iabetologia, pp. 1-11. ハハ Hayes, C., & Kriska, A. (2008). Role of Physical Activity in Diabetes Management and Prevention. Journal of the American Dietetic Association 108 (4 SUPPL.), pp. S19-S23.
    • New Zealand Health Information Service. (2008). Mortality and demographic data 2002 and 2003. Retrieved June 10, 2008, from
    • New Zealand Ministry of Education. (2008). Retrieved June 10, 2008, from
    • Praet, S. F. E., Van Rooij , E.S.J. , Wijtvliet , A. , Boonman-De Winter, L. J. M. , Enneking , Th . , Kuipers , H. , Stehouwer , C. D. A. , & Van Loon, L. J. C. (2008). Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: A randomised controlled trial. D iabetologia 51 (5), pp. 736-746.
    • Praet, S. F. E., & Van Loon, L. J. C. (2008). Exercise: The brittle cornerstone of type 2 diabetes treatment. Diabetologia 51 (3), pp. 398-401.
    • Sarafino, E. P. (2004). Bahavior Modification . Illinois, Waveland Press.
    • Maori Health. (2008). Addressing Maori health: Maori health models . Retrieved June 3, 2008, from