A week does not go by where a patient does not ask me about whether or not they have diabetes. It can either stem from symptoms they are having that could be attributable to diabetes and/or a family history of the condition. The patient’s interest is also heightened by media coverage of the growing epidemic of obesity in this country and the risk this holds for developing diabetes. Indeed, type 2 diabetes, which comprises 90% of all diabetics, is a growing public health problem.
In addition to obesity, the rise in diabetes is also attributed to a sedentary lifestyle as well as unhealthy dietary habits. Seventy-nine million people in the U.S. have prediabetes. Their risk of developing type 2 diabetes is 4-12 times higher than it is for people with normal glucose numbers. Why the importance of preventing this condition? Diabetes can lead to the development of a number of disabling and costly complications including amputation, stroke, heart disease, kidney failure, and blindness. Another way to look at this is that one third of U.S. adults exhibit prediabetes. Since prediabetes confers significant risks for developing type 2 diabetes, prevention becomes a key component to one’s health care. Sadly, only 7% of persons with prediabetes are aware that they have prediabetes.
Looking at this another way, the costs associated with diabetes mellitus in this country are increasing. Even though people with diabetes comprise less than 6% of the U.S. population, roughly 1 in 5 health care dollars is spent caring for people with diabetes.
As for prevention, there is strong evidence showing that early detection of people at high risk followed by changes in lifestyle can reduce the incidence of type 2 diabetes mellitus and its complications. Efforts are underway at Meriter to increase awareness. Making patients aware that they can reduce that risk by making modest lifestyle changes is of paramount importance.
Even so much as a small weight loss upfront can reduce this risk. Each year 11% of persons with prediabetes who do not lose weight and do not engage in moderate physical activity will progress to type 2 diabetes mellitus. Weight loss has consistently been shown to be an effective means of preventing type 2 diabetes. Ideally, losing 10% of one’s body weight would have huge benefits but it should be stressed that even a lesser amount of weight loss would be beneficial as well.
Another way to prevent this epidemic is by dietary intervention. Increased consumption of green, leafy vegetables reduces the risk of type 2 diabetes in contrast to the popular belief that a diet high in fruits and non-leafy greens reduces this risk. Decreased consumption of processed foods, red meat, sugar-sweetened beverages, and starchy foods may retard the progression of type 2 diabetes. Watching intake of high-fat dairy is also prudent to decrease one’s risk. A Mediterranean diet with its consumption of olive oil, nuts, low-fat dairy and moderate alcohol consumption (mainly red wine) is also quite healthy. As an interesting aside, patients who drank more than 4 cups of coffee had a lower risk of type 2 diabetes compared with those who drank less than 2 cups per day. Increasing coffee consumption, however, as a public health strategy cannot be recommended at this time.
Aside from what has already been mentioned, there are certain medications that have been studied for the prevention of diabetes. Without going into great detail, the most studied has been metformin. It is probably the safest. Interventions that use drugs are less preferred than diet and exercise since the drugs’ effects tend to wane after their use is stopped and adverse effects may also result not to mention the cost associated with taking pills.
Several patients have asked me about using vitamin D as a means of preventing diabetes. Suffice it to say, the current evidence is insufficient to recommend this supplement for the prevention of diabetes.
Learn more about Meriter’s Diabetes Clinic.