Dietary interventions traditionally focus on medically relevant primary outcomes (e.g., blood glucose), often failing to recognize complexity of nutrition-education and the impact of the educator on knowledge-transfer. Current Diabetes Canada Clinical Practice Guidelines (2018) recommend low glycemic index (GI) food and drink for glycemic control. These recommendations are based upon decades of high-quality evidence supporting GI-utility in type 1, type 2 and gestational diabetes (GD). Nevertheless, evidence suggests that nutrition educators are not including GI-education in practice. Since 2007, efforts have been made to explore these findings, addressing feedback from stakeholders, and applying an integrative approach to dissemination. This has resulted in development and dissemination of several education materials (with Diabetes Canada and Dietitians of Canada). The majority of Canadian data available on GI-utility is based on Ontario-based patients attending in-person appointments led by seasoned Dietitians/ Diabetes Educators. Clinicians, trainees, and patients at the IWK Health Centre, Nova Scotia, are interested in (local) effectiveness of these materials. Their patients, blended treatment for GD (in-person and online), provide an opportunity to evaluate previously developed GI intervention(s), in an Atlantic Canadian context. This talk will provide an overview of the work done since 2007, providing insight into contemporary integrative GI-KT efforts.
Design: Randomized control trial (RCT-NCT04272840). 60 participants, receiving standard care education for GD, will be randomly allocated to a control or intervention group (low GI). The intervention (and associated evaluation) was developed using a four-step pedagogical model, called Kirkpatrick Model. Outcomes include: 1) satisfaction, 2) knowledge uptake, 3) behaviour change (primary outcome) and 4) glycemic control and was the basis of the glycemic index questionnaire (GIQ©). The GIQ, three-day diet record, and self-monitored blood glucose are collected from participants pre- and post- intervention (repeated measures). Prior to collection of these data, feedback has been collected from Dietitians providing standard care (mixed-form questionnaire) and integrated into the intervention. Currently, feedback from recent East Asian immigrant patients (mixed form questionnaire) are also being collected; a growing patient population at IWK.
Dietitians (n = 4) were satisfied with the intervention and reported learning novel information and counseling approaches when reviewing the resources. The RCT was active for three months before pandemic shutdown (March 2020). Reactivation occurred January 2021. To date, 19 letters of information and 2 consents have been signed. We predict, the intervention will satisfy GD participants, increase their GI-knowledge, and support a statistically and clinically significant decrease in diet-GI within and between groups.
Adaptation of materials for Atlantic Canadians represents a necessary step in the knowledge-to-action cycle for GI-KT.