Refer your Patients

Does your patient have prediabetes, defined as having a HbA1C level between 5.7 to 6.4 mmol/L (American Diabetes Association) or having a score of 5 or higher on the American Diabetes Association type 2 diabetes risk assessment checklist (for review of this screening tool, please see here: Screening)?  If so, they may be eligible to participate in a free, research-developed and tested lifestyle program (for information about the program, please click here: About the Program) to help reduce their risk of developing type 2 diabetes.


Who can participate?

Patients must be between the ages of 18 and 75 and at risk for developing type 2 diabetes. They must also be able to read and comprehend English, and have a BMI between 25 and 45 kg/m2.


Who should not participate?

The program might not be appropriate for all individuals. Patients will not be eligible to participate in the Small Steps for Big Changes program if they:

  1. have a heart condition and have been advised by you to limit physical activity.
  2. have chest pain when performing any physical activity.
  3. lose their balance or lose consciousness because of dizziness.
  4. have bone or joint problem (for example back, knee, or hip) that could be made worse by a change in physical activity.
  5. hypertension that is not controlled by medication (systolic blood pressure (BP) >160 mmHg and/or diastolic BP >99 mmHg).
  6. have type 2 diabetes.
  7. have had a change in medications (e.g., statins, acarbose, anti-depressants) in the previous 3 months.
  8. have prior history of cardio- or cerebrovascular disease, myocardial infarction, or stroke.
  9. are pregnant or planning to become pregnant in the next 12 months.
  10. have uncontrolled major depressive episodes.


How can I refer my patients?

There are three ways you can refer your patients to this program:

  1. Order a blood requisition.
    • Have your patients haemoglobin A1c (HbA1c) tested for those who may be at risk of T2D. Valley Medical Laboratories will fax you a list of your patients whose HbA1c scores fall within the prediabetic range (5.7 to 6.4 mmol/L) just as they do when informing you of your patients who fall within the diabetic range. You will be asked to provide your consent on which patients you feel it would be appropriate to send a simple letter of information about the Small Steps for Big Changes program in the mail; fax that list back to Valley Medical Laboratories. In turn, Valley Medical Laboratories will mail out information letters about the program to only those whom you have deemed appropriate to receive this hard-copy letter.
  2. Direct referral. 
    • If you think your patient would benefit from this exercise and diet counselling intervention, have the conversation that you think Small Steps for Big Changes would be a suitable program for them. If your patient would like to be contacted by our team, please feel free to email us ( or Dr. Mary Jung ( with your patients name, email and phone number.
  3. Verbal encouragement.
    • Speak with your patients whom you think may benefit from this exercise and diet counselling intervention. Encourage your patients to visit this website and complete the ADA screen online. Those interested in finding out more about the program should be encouraged to contact the Small Steps for Big Changes program staff.

You can also, at any time, encourage your patients to find out more about the program by sending them to this website. We are happy to respond to any questions they or you may have with respect to the program. To contact the principal investigator please call Dr. Mary Jung at (250) 807-9670 or email


How did my patient get word of this program?

Your patient may have received a letter in the mail introducing them to Small Steps for Big Changes if you recently administered a blood requisition for HbA1c and consented to Valley Medical Laboratories mailing them a general information letter about the program.

They may also have heard about the program from friends or family members and inquired with Small Steps for Big Changes staff directly.