Awareness and Perception of Plant-Based Diets for the Treatment and Management of Type 2 Diabetes in a Community Education Clinic: A Pilot Study

Hindawi Publishing Corporation Journal of Nutrition and Metabolism Volume 2015, Article ID 236234, 6 pages http://dx.doi.org/10.1155/2015/236234 Research Article Awareness and Perception of Plant-Based Diets for the Treatment and Management of Type 2 Diabetes in a Community Education Clinic: A Pilot Study Vincent Lee,1 Taylor McKay,2 and Chris I. Ardern1,3 1 Diabetes Education Centre, Southlake Regional Health Centre, Newmarket, ON, Canada L3Y 2B1 Department of Human Health and Nutritional Science, University of Guelph, Guelph, ON, Canada N1G 2W1 3 School of Kinesiology and Health Science, York University, Toronto, ON, Canada M3J 1P3 2 Correspondence should be addressed to Vincent Lee; Received 3 September 2014; Accepted 8 January 2015 Academic Editor: C. S. Johnston Copyright © 2015 Vincent Lee et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To assess awareness, barriers, and promoters of plant-based diet use for management of type 2 diabetes (T2D) for the development of an appropriate educational program. Design. Cross-sectional study of patients and healthcare providers. Setting. Regional Diabetes Education Centre in ON, Canada. Participants. 𝑛 = 98 patients attending the Diabetes Education Centre and 𝑛 = 25 healthcare providers. Variables Measures. Patient questionnaires addressed demographics, health history, and eating patterns, as well as current knowledge, confidence levels, barriers to, promoters of, and interests in plant-based diets. Staff questionnaires addressed attitudes and current practice with respect to plant-based diets. Analysis. Mean values, frequency counts, and logistic regression (alpha = 0.05). Results. Few respondents (9%) currently followed a plant-based diet, but 66% indicated willingness to follow one for 3 weeks. Family eating preferences and meal planning skills were common barriers to diet change. 72% of healthcare providers reported knowledge of plant-based diets for diabetes management but low levels of practice. Conclusions and Implications. Patient awareness of the benefits of a plant-based diet for the management of diabetes remains suboptimal and may be influenced by perception of diabetes educators and clinicians. Given the reported willingness to try (but low current use of) plant-based diets, educational interventions targeting patient and provider level knowledge are warranted. 1. Introduction Diabetes has become a global epidemic affecting an estimated 371 million people (in 2012), a number that is expected to reach 552 million by 2030 [1]. With healthcare costs approaching $490 billion for the treatment of diabetes [2], alternative (patient-centered) lifestyle management approaches and cost-effective dietary interventions such as plant-based diets are a focus of increasing attention [3]. Recent research has revealed that 58% of type 2 diabetes (T2DM) cases can be prevented or delayed through lifestyle changes such as increased physical activity, healthy eating, and weight loss [3]. Other large cohort studies have shown that the prevalence of T2DM is significantly lower amongst people following a range of plant-based diets [4–6] and that those with greater adherence to plant-based foods, such as a low-fat vegan diet, experience the greatest benefit. Tuso et al. (2013) define a plant-based diet as a regimen that encourages whole, plant-based foods and discourages meats, dairy products, and eggs as well as all refined and processed foods [7]. (The definition of other variants of plant-based diets is included in the questionnaire.) Various studies suggest that plant-based diets can be an effective Medical Nutrition Therapy (MNT) for the treatment and management of T2DM [8], specifically by improving body weight, cardiovascular risk factors, and insulin sensitivity [9–11] and reducing the need for diabetic medications [12–14]. Providing MNT to people with diabetes demonstrates effectiveness in reducing hospitalization and physician services by 9.5% and 23.5%, respectively, which, in turn, reduces healthcare costs in 2 the long-term [15]. Studies show that a plant-based diet is as effective, if not more effective than an ADA-recommended diabetes diet at reducing certain clinical markers such as HbA1c levels [14]. With the growing body of evidence, the new 2013 Canadian Diabetes Association Clinical Practice Guidelines (CDACPG 2013) recommend the use of plantbased diets for management of T2DM [16]. However, this dietary pattern is often perceived to be extreme and difficult to follow, and this perception may be influenced by the healthcare providers that diabetic patients encounter. Despite a strong understanding of the health benefits of a plant-based diet, healthcare providers commonly cite low patient interest and difficulties in facilitating patient adoption as reasons for not promoting plant-based diets. In order to provide insight into the justification for (and development of) an effective and patient-focused education program, a survey of patients and clinicians was undertaken to assess the awareness, confidence, perceived barriers and promoters, and educational needs for using a plant-based diet in the prevention and management of T2DM. Journal of Nutrition and Metabolism 2.3. Staff Questionnaire. Staff members of the diabetes team were also asked to provide responses to a brief questionnaire on their attitudes and practices regarding plant-based diets. The health professional survey was offered to all staff members working at the DEC and included registered nurses (RN), endocrinologists, and registered dietitians (RD). The survey ran from March 25, 2013, to April 12, 2013, and was completed by 25 staff members: 11 RN, 1 endocrinologist, and 13 RD. 2.4. Data Analysis. Mean values (𝜇) and frequency counts (𝑛, %) were used to describe the demographics, health history, and dietary practices and perceptions of participants for continuous and categorical variables, respectively. After developing a character profile of participants (e.g., Body Mass Index (BMI), diabetes type, duration of diabetes, new versus continuing patient, weight management strategies, etc.), logistic regression was used to explore the relationship between clinical and education-related factors on the willingness of patients to change to a vegetarian diet. All analyses were conducted using SPSS (v 19), with significance set at alpha = 0.05. 2. Methods 2.1. Participants and Study Design. The Diabetes Education Centre (DEC) at Southlake Regional Health Centre (SRHC) provides assessment and therapeutic and self-management education for adults with type 1, type 2, gestational diabetes, and prediabetes in York Region, ON, Canada. With the mission of providing a broad-based education on the prevention and management of diabetes, the DEC has approximately 12,500 patient vi (...truncated)