5 Ways to Prevent Diabetes
By Edward C. Geehr, M.D., LifeScript Chief Medical Officer
Published July 29, 2007
Jumping on your bike or going for a jog can do more than just burn calories and boost energy levels. And cutting back on fast food and saying “Yes!” to coffee is more than just a dietary choice. This strange mix of variables can also help you fend off the most common form of diabetes
Diabetes can strike at any age. And with the rise of obesity in the United States, the number of people with preventable diabetes is soaring. A staggering 21 million American children and adults – 7% of the nation’s population – have diabetes, contributing to 225,000 deaths annually. The economic impact – around $132 billion per year – is also alarming. And nearly one-third of diabetics – around 6 million people – don’t even know they have the disease.
Fortunately, you can prevent or slow down the most common form of diabetes, type 2, through five highly effective interventions, four of which are inexpensive and can be done on your own. Here are the facts about each form of the disease and the ways you can lower your risk of type 2 diabetes.
Type 1 Diabetes
Usually diagnosed in children and teenagers, type 1 diabetes can be particularly devastating. About 150,000 people below age 18 have diabetes, or about one in every 400-500 children. Each year, more than 13,000 new cases of Type 1 diabetes turn up.
The body’s immune system attacks the cells in the pancreas that make insulin, and insulin production switches off.
Insulin is what allows our bodies’ cells to absorb glucose – the form of sugar created from carbohydrates like breads, pastas, fruits, and vegetables. When insulin has difficulty entering our cells, its buildup in the blood leads to high blood sugar. Abnormal blood-sugar regulation has wide-ranging effects; it can damage the eyes, heart, kidneys, and other organs.
To survive, type 1 diabetics must have daily insulin injections.
Type 2 Diabetes
The most common form of diabetes is type 2, once called adult-onset diabetes. The term adult-onset is no longer used because type 2 is becoming increasingly common among children and adolescents – 8%-45% of child diabetics have type 2 diabetics. Children with type 2 diabetes are typically overweight or obese and have a family history of diabetes.
Type 2 diabetes is more common among certain ethnic groups, particularly young Native Americans in whom the incidence can be 20-30 times higher than in the general population. An elevated risk of type 2 diabetes is also observed in young African Americans, Latinos, Asian-Americans, and Pacific Islanders.
In this form of diabetes, the pancreas can produce insulin, but either doesn’t produce enough or the cells of the body are unable to use the available insulin, a condition called insulin resistance. The pancreas reacts by producing more and more insulin but simply can’t keep up with demand, and glucose begins to build up in the bloodstream. Some people with insulin resistance have both high insulin and high glucose levels at the same time. Although type 2 is the most common form of diabetes, it is also the most preventable.
In addition to those already diagnosed with type 1 or 2 diabetes, another 54 million Americans are at high risk of developing type 2 diabetes, called pre-diabetes. Pre-diabetics have elevated blood sugar levels (measured by fasting plasma glucose – FPG) and exhibit early signs of insulin resistance (established with oral glucose tolerance testing - OGGT), yet their blood-sugar levels are not high enough for a diagnosis of diabetes.
Those pre-diabetics at greatest risk of progressing to diabetes have both high glucose levels after fasting, called impaired fasting glucose (IFG), and high glucose levels after eating, called impaired glucose tolerance (IGT), plus other risk factors. These factors include middle age (older than 45), a family history of diabetes, obesity (a body mass index, BMI, of 30 or greater), and elevated blood pressure and blood lipid (fat) levels. These risk factors, combined with IFG and IGT, suggest a greater risk of future diabetes than abnormal blood glucose levels alone.
Studies also show that pre-diabetics may have signs of organ damage previously only detected in diabetics. So measures designed to delay or prevent the onset of diabetes may also help reverse or at least stop the progression of organ damage in pre-diabetics.
Top 5 Steps to Prevent Diabetes
Walking has been shown to be effective in preventing the onset of diabetes in middle-aged women. In an article published in Journal of the American Medical Association, the rate that diabetes normally develops at was cut in half in those who walk regularly. Even when taking into account the differences in body mass index, walking still reduced the incidence of diabetes. And the more often women walked and the more vigorous their pace, the greater the benefit.
2. Combine Modest Weight Loss with Exercise
While exercise alone has been shown to be effective for delaying the development of diabetes in middle-aged women, the combination of modest weight loss and exercise has been shown to be the most effective strategy for all groups.
The Diabetes Prevention Program (DPP), a 27-center clinical trial, examined the effect of lifestyle changes compared with glucose-lowering drugs. Diet and exercise were nearly twice as effective as drug therapy. Those who exercised just 30 minutes per day five times per week and lost an average of 7% of their body weight reduced their risk of developing diabetes by 58%. Those taking metformin, a glucose-lowering drug, reduced their risk by 31%.
In the DPP, taking the drug metformin cut risk by 31%. Two other studies, each using a different class of glucose-lowering agent – troglitazone (not available in the U.S.) and acarbose – also showed reductions in the rate of diabetes. Even after patients stopped taking troglitazone for several months, the preventive effects continued, suggesting the drug may help avoid, not just delay, diabetes.
A more recent study, DREAM (diabetes reduction assessment with ramipril and rosiglitazone medication), found that rosiglitazone (Avandia) appeared to cut the risk of developing diabetes or – or dying of it – by more than half. In many participants, the drug also helped the body return to normal blood-sugar function. In 2006, however, the FDA required Avandia to include a label warning about the possibility of an increased risk of heart attacks and heart-related chest pain, particularly in patients with pre-existing heart disease.
4. A Cup of Joe
Several studies have shown that drinking coffee helps lower the chance of developing type 2 diabetes. In fact, both current and former coffee drinkers who did not have diabetes had a 60% lower chance of getting type 2 diabetes. One of the studies found that both caffeinated and decaffeinated coffee lowered the risk, which suggests that it may be an ingredient other than caffeine that is doing the trick.
5. Calcium and Vitamin D Supplements
Researchers at Brigham and Women’s Hospital in Boston found that a combined daily intake of more than 1,200 milligrams of calcium and 800 units of vitamin D was linked with a one-third lower risk for developing type 2 diabetes. Further studies are needed to confirm the finding, but the supplements are nonetheless worth taking: They may also ward off osteoporosis.
The upshot: To avoid becoming one of the growing number of Americans who have type 2 diabetes, lose a modest amount of weight, exercise 30 minutes per day, take supplemental calcium and vitamin D (unless your doctor advises against it), and drink coffee.
Also, ask your doctor about glucose-lowering medications.
What's Your Sugar IQ?
Can eating too much sugar cause diabetes? Does honey have fewer calories than refined sugar? Being smart about your sugar intake can not only help you cut hidden calories, but also make better food choices. Find out how much you know with this sugar quiz.
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By Edward C. Geehr, M.D., LifeScript Chief Medical Officer
Catholic News Service
Published July 29, 2007
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