Diabetes - Prevention


How to reduce your risk

You can do a lot to lower your chances of getting diabetes. Exercising regularly, reducing fat and calorie intake, and reaching and maintaining a healthy weight can help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy.

What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol.

  • Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses such as meat, desserts, and foods high in fat. Increase the amount of fruits and vegetables.
  • Limit your fat intake to about 25 percent of your total calories. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. Your doctor or a dietitian can help you figure out how much fat to have. You can also check food labels for fat content.
  • Limit your sodium intake to less than 2,300 mg-about 1 teaspoon of salt-each day.
  • Talk with your doctor about whether you may drink alcoholic beverages. If you choose to drink alcoholic beverages, limit your intake to one drink-for women-or two drinks-for men-per day.
  • You may also wish to reduce the number of calories you have each day. Your doctor or dietitian can help you with a meal plan that emphasizes weight loss.
  • Keep a food and exercise log. Write down what you eat, how much you exercise-anything that helps keep you on track.
  • When you meet your goal, reward yourself with a nonfood item or activity, like watching a movie.

Research has demonstrated that people at risk for type 2 diabetes can prevent or delay developing type 2 diabetes by losing a little weight. The results of the Diabetes Prevention Program (DPP) showed that moderate diet changes and physical activity can delay and prevent type 2 diabetes. Participants in this federally funded study of 3,234 people at high risk for diabetes experienced a 5- to 7-percent weight loss.

Study participants were overweight and had higher than normal levels of blood glucose-pre-diabetes, also called impaired glucose tolerance. Both pre-diabetes and obesity are strong risk factors for type 2 diabetes. Because of the high risk for diabetes among some minority groups, about half of the DPP participants were African American, American Indian, Asian American, Pacific Islander, or Hispanic/Latino.

DPP participants also included others at high risk for developing type 2 diabetes, such as women with a history of gestational diabetes and individuals aged 60 and older.

The DPP tested two approaches to preventing diabetes: lifestyle change-a program of healthy eating and exercise-and the diabetes drug metformin. People in the lifestyle change group exercised about 30 minutes a day 5 days a week, usually by walking, and lowered their intake of fat and calories. Those who took the diabetes drug metformin received information on exercise and diet. A third group only received information on exercise and diet.

The results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. In the first year of the study, people lost an average of 15 pounds. Lifestyle change was even more effective in those aged 60 and older. They reduced their risk by 71 percent. People receiving metformin reduced their risk by 31 percent.

Prevention: 8 simple steps

The good news is that there is a lot you can do now to lower your risk of developing both pre-diabetes and type 2 diabetes. The latest research suggests that more than half of new cases of diabetes could be prevented through lifestyle changes. Here are six steps that can greatly reduce your odds.

1. Lose excess weight. Extra body fat prevents insulin from working properly in the body, thereby laying the groundwork for type 2 diabetes- sometimes as early as childhood. In fact, being overweight or obese is the biggest risk factor for type 2 diabetes. Abdominal obesity seems to be worse than the pear-shaped pattern. The fat that's contained within the abdominal cavity gets broken down into fatty acids, is released more easily into the bloodstream and interferes with the way insulin works. For most overweight and obese people, losing as little as 7 percent of their current body weight would substantially lower their risk of developing diabetes.

2. Swap carbohydrates. It's smart to cut back on your overall intake of refined carbs such as cookies, cake and the like because they raise blood sugar, which can make you eat more. Increase the amount of fiber-rich whole grains, fruits, nuts, legumes and vegetables. A recent study at the University of Helsinki in Finland found that a reasonably high intake of dietary fiber -the median intake for women in the study was 17 grams a day and included both the soluble and insoluble kinds-seems to increase the body's ability to respond to and use insulin, and may help prevent type 2 diabetes. Aim to get 25 grams daily from a variety of foods.

3. Cut back on fat. Particularly harmful fats include saturated fat, cholesterol and trans fatty acids; research has found that all of these can increase insulin resistance, in which the body doesn't use insulin efficiently. Polyunsaturated or monounsaturated fats -found in seafood and vegetable oils, respectively -are associated with a lower risk of developing diabetes. Even if you trade bad fats for good ones, keep an eye on your overall intake. In a study at the University of Auckland in New Zealand, researchers found that when people who had blood-sugar abnormalities reduced their total fat intake by 34 grams per day, their ability to metabolize carbohydrates (what's called glucose tolerance) improved, and a lower percentage developed type 2 diabetes a year later than those who didn't slash fat. Total fat intake should not exceed 25-30 percent of your daily calories.

4. Exercise regularly. Data suggest that even 30-40 minutes of brisk walking, five times a week, can decrease your risk by up to 40 percent. Why? When you exercise, your muscles take sugar out of the bloodstream and use it, which causes blood-sugar levels to decline. Add weight loss to the equation and your risk drops even further: Research at the National Institute of Diabetes and Digestive and Kidney Diseases found that when overweight people lost 7-10 percent of their body weight and began taking half-hour walks five days a week, they cut their odds of developing diabetes by 58 percent. And it's likely that the lower your blood-sugar levels, the lower your risk for heart disease.

5. Watch your alcohol intake. Among healthy women, moderate drinking (defined as about a glass and a half of wine per day) may reduce the risk of developing type 2 diabetes, according to a recent study at Karolinska Institute in Stockholm, Sweden. More than that, however, appears to increase the risk in lean women, though not in those who are overweight. Because the research has been mixed as far as alcohol goes, it's important not to overindulge. If you do drink, have food with your alcohol. Abstain if you're starting medication for diabetes or pre-diabetes, or if you have a strong family history of diabetes.

6. Have your blood-sugar level tested. Fasting blood sugar (a measure of your blood-sugar level after you haven't eaten for eight to 12 hours) is considered normal if below 100 milligrams per deciliter, but a person with pre-diabetes has a fasting blood-sugar level between 100 and 125 mg/dl, and someone with full-fledged diabetes has blood sugar measuring 126 mg/dl or above. If you do have a pre-diabetic condition, know that it can be reversed. Once you get diabetes, however, reversing it is a lot harder.

7. Be physically active every day. Regular exercise tackles several risk factors at once. It helps you lose weight, keeps your cholesterol and blood pressure under control, and helps your body use insulin. If you are not very active, you should start slowly. Talk with your doctor first about what kinds of exercise would be safe for you. Make a plan to increase your activity level toward the goal of being active at least 30 minutes a day most days of the week.

Choose activities you enjoy. Some ways to work extra activity into your daily routine include the following:

  • Take the stairs rather than an elevator or escalator.
  • Park at the far end of the parking lot and walk.
  • Get off the bus a few stops early and walk the rest of the way.
  • Walk or bicycle whenever you can.

8. Take your prescribed medications. Some people need medication to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor about medicines to prevent type 2 diabetes.

Adapted from the National Institute of Diabetes and Digestive and Kidney Diseases (www.niddk.nih.gov)

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