Defeat Diabetes Month

By: Lauren Pappalardo, MS Student at Pace University

According to the Centers for Disease Control and Prevention (CDC), 37.3 million Americans have diabetes, and approximately 90-95% of them have type 2 diabetes. Additionally, 96 million Americans – more than 1 in 3 – have prediabetes and are likely to develop type 2 diabetes in the future. Type 2 diabetes is a chronic disease characterized by hyperglycemia, insulin resistance, and impairment in insulin secretion. Over time, type 2 diabetes can damage blood vessels in the heart, eyes, nerves, and kidneys. Most notably, there is a strong association between type 2 diabetes and cardiovascular disease, the leading cause of death in the United States. Type 2 diabetes has become so prevalent, that in 1994, the CDC declared that it had reached epidemic proportions and should be considered a major health problem in the United States.

Since this declaration, there have been many responses from national health organizations, including the Defeat Diabetes Foundation (DDF) who declared April Defeat Diabetes Month. Through this initiative, the DFF encourages testing for type 2 diabetes and raises awareness around risk factors. Risk factors for type 2 diabetes, according to the CDC, include:

• Having prediabetes
• Being overweight / obese
• Being 45 years or older
• Having a parent, brother, or sister with type 2 diabetes
• Being physically active less than 3 times a week
• Having ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds.
• Being African American, Hispanic, or Latino, American Indian, or Alaska Native person

As many of these risk factors are lifestyle-related, the DFF’s Defeat Diabetes Month also aims to raise awareness around lifestyle and dietary changes that can aid in the prevention of type 2 diabetes. While prevention can never be guaranteed, below is a list of lifestyle factors that have been shown to help prevent or delay the development of type 2 diabetes and should be considered by those at risk.

• 1.     Achieve / Maintain a Healthy Weight
• ·       At all ages, the risk of type 2 diabetes rises with increasing body weight. More specifically, obesity (BMI of 30.0 or higher) is strongly associated with a high prevalence of prediabetes and is an independent risk factor for type 2 diabetes. Therefore, achieving and maintaining a healthy weight is a desirable outcome in preventing prediabetes and type 2 diabetes. The term “healthy weight” is defined as having a BMI between 18.5 and 24.9 and a waist circumference below 40 inches for men and below 35 inches for women. A waist circumference above these values can indicate excess visceral fat and increased risk for disease.
• 
  One of the first controlled randomized studies to demonstrate the link between weight and type 2 diabetes risk, The Finnish Diabetes Prevention Study, reported that the incidence of type 2 diabetes was significantly lower in overweight individuals with impaired glucose tolerance who achieved a 3.5 - 4.5kg weight loss in two years compared to those who lost 0.9 - 1.0kg. In a subsequent study, lifestyle intervention including a 7% weight loss reduced the incidence of type 2 diabetes by 58% in nondiabetic persons with elevated fasting and post-load plasma glucose concentrations, compared to the control group. The intervention was also significantly more effective in reducing risk compared to metformin.
  
  Since these findings, research continues to show that achieving a healthy weight reduces the risk of type 2 diabetes. Weight loss should only be a goal for individuals currently overweight or obese. The CDC recommends assessing your weight by calculating your BMI and measuring your waist circumference. Tips for achieving a healthy weight include healthy eating, physical activity, and learning how to balance the calories you consume with the calories your body uses.
  
• 2.     Get Active
• ·       Physical inactivity is a key risk factor for prediabetes and type 2 diabetes. Physical activity has been linked to better glycemic control and improved insulin sensitivity in both normal and individuals with insulin resistance. While there is no one exercise prescription for all individuals, the CDC recommends performing at least 150 minutes of moderate-intensity aerobic exercise per week to reduce the risk of developing type 2 diabetes.
• 
  The impact of being physically active in preventing type 2 diabetes has been demonstrated in several studies. Notably, a meta-analysis of 28 prospective cohort studies of physical activity and type 2 diabetes, showed a lower risk of developing the disease in those who performed 150 minutes per week of moderate physical activity compared to those who were sedentary. This included activities such as brisk walking, jogging, swimming, tennis, and other aerobic exercises. Additional benefits and an even lower risk of developing type 2 diabetes were seen with higher levels of physical activity.
• Regular physical activity may also result in other favorable outcomes including weight loss and improvements in cardiovascular health. The CDC recommends incorporating some of the following examples of moderate-intensity physical activities into your weekly routine.
• ·       Walking briskly
• ·       Doing housework
• ·       Mowing the lawn
• ·       Dancing
• ·       Swimming
• ·       Bicycling
• ·      Playing Sports

• 3.     Eat a Healthy Diet  
• ·       While diet plays an important factor in disease prevention, there are few trials exploring the effects of diet alone (without physical activity or weight loss) for the prevention of type 2 diabetes. There is also no one diet plan or food group shown to decrease risk. A recent comprehensive review summarized the effect of dietary factors and diet interventions on type 2 diabetes risk and concluded the following points:
  
• ·       Dietary interventions that are low in calories and carbohydrates (i.e. 25-30kcal/kg or carbohydrate <120g/d) significantly lowered the risk of type 2 diabetes in both general and high-risk populations. These recommendations may not however be appropriate for all individuals. As always, the RD should take individuality into account when making recommendations.
  
• ·       “Good quality” carbohydrates, defined as being low on the glycemic index and high in fiber, are associated with increased insulin sensitivity, and improved beta-cell function, therefore aiding in prevention.
  
• ·       High fiber intake from fruits, vegetables, and whole grains, can improve whole-body insulin sensitivity and support weight management to lower risk.
  
• ·       Sugar sweetened beverages significantly increase the risk of type 2 diabetes.
  
• ·       Artificial sugar sweetened beverages may be associated with higher risk of type 2 diabetes, but more research is needed.
  
• As there is no “diabetes diet”, the American Diabetes Association recommends a general dietary strategy for people with prediabetes that involves high intake of non-starchy vegetables, fruits, legumes, nuts, beans, fish, whole grains, and unsaturated fats such as olive oil. They also recommend limiting red meat, alcohol, and foods high in refined sugar.

Resources:

Centers for Disease Control and Prevention. (2022, November 3). Get active! Centers for Disease Control and Prevention. Retrieved April 10, 2023, from https://www.cdc.gov/diabetes/managing/active.html 

La Sala, L., & Pontiroli, A. E. (2020, October 31). Prevention of diabetes and cardiovascular disease in obesity. International journal of molecular sciences. Retrieved April 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663329/ 

Smith, A. D., Brage, S., Woodcock, J., & Crippa, A. (2016, December). Physical activity and incident type 2 diabetes mellitus: A systematic review and dose-response meta-analysis of prospective cohort studies. Diabetologia. Retrieved April 10, 2023, from https://pubmed.ncbi.nlm.nih.gov/27747395/ 

Toi, P. L., Anothaisintawee, T., Chaikledkaew, U., Briones, J. R., Reutrakul, S., & Thakkinstian, A. (2020, September 6). Preventive role of diet interventions and dietary factors in type 2 diabetes mellitus: An umbrella review. Nutrients. Retrieved April 10, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551929/ 

Tuomilehto, J., Uusitupa, M., Salminen, V., Rastas, M., Louheranta, A., Laasko, M., Keinänen-Kiukaanniemi, S., Ilanne-Parikka, P., Hamalainen, H., Valle, T. T., & Eriksson, J. G. (2001, May 3). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. The New England journal of medicine. Retrieved April 10, 2023, from https://pubmed.ncbi.nlm.nih.gov/11333990/