Development of an Innovative Home-based Strategy for FrAilty preveNTion in AdultT With dIabetes and Chronic Kidney Disease (FANTASTIC)

Research Hypothesis: A home based video program focused on education related to lifestyle modification (diet, physical activity) over 6 months will result in improved measures of muscle strength/muscle functionality, health related quality of life and reduced measures of frailty and health care utilization in adults with DM and CKD.

V. Expected Outcomes: Results from this study will address two important questions a) identification of features of frailty/pre-frailty in adults with DM and CKD who should be targeted for lifestyle intervention b) development of home based programming for individuals with pre-frailty/frailty in the community dwelling adults with DM. This information is needed to help our clinical teams screen for frailty/pre-frailty and to focus health care resources on developing rehabilitation strategies to prevent and treat adults patients with DM and Frailty. This is particularly relevant for those who are 'vulnerable to Frailty' (pre-frail), but do not have the full condition. Prevention of the progression to full FRAILTY is critical to ensure optimal mental health HRQOL, to reduce health care use and to improve diabetes interventions in the community for those most vulnerable (Core Area 1). This will promote healthy aging in the community setting in obese adults with DM by supporting independent living, quality of life, mental health and delayed care utilization (Core Area 2) and will ensure healthy lives and promote well-being of all adults with DM at all ages (Goal 3).

Study Design:

There are two phases of this study. 1) Development of Video programming and 2) Open-label non-blinded study.

Phase 1 (see Table 1): Home Video content will be developed based on the principals of social cognitive theory. Video content will include two components a) resistance exercise (based on Canadian Diabetes Association video's that are adapted to meet the patient's functional capacity and b) the concepts of nutrition literacy. This will be done so a comprehensive approach to the lifestyle factors known to contribute to frailty (diet, exercise) can be developed in the educational programming of the video content (mp4 files). The resistance exercises will based upon Diabetes Canada resistance exercises which will have been adapted to meet the functional abilities of the patients in this population (based on the Investigator's earlier studies in DM and CKD) (Mager et al Can J Diabetes 2019) and https://www.diabetes.ca/getmedia/0a646e26-9e1c-4769-975f-51876edf6ecd/resistance-band-exercises-2.pdf.aspx ). Video content filming will be supported in the field by trained RA/graduate student and exercise specialists and then vetted for content and face validity by experts in the field (PT, MD, RD, geriatrician and exercise specialist CI and collaborators). We will also elicit patient feedback in vetting video content from participants from ongoing studies in the area (Pro00049292) and/or by recruiting potentially interested patients in the clinics. Participants who participate in this phase of the study will not be enrolled into Phase 2 of the study.