Teaching for Health Series (Vol. 2 No. 16)

​Type 2 Diabetes Prevention
By Mary Gynn, RN, BSN, MSN/MS, MPH, Diabetes Educator
The first step is for all of us to look into our family histories and search for people who have had or now have Type-2 diabetes. Second, we need to ask if we could possibly be carrying the gene. If yes, that’s a huge indicator. Either way, prevention is important for all of us, starting early in life. We shouldn’t wait until we get the diabetes diagnosis. Here are a few interventions:
LIFESTYLE MODIFICATION
A healthy lifestyle (i.e., a quality diet, avoidance of weight gain, abstinence from smoking, regular physical activity) is associated with a greatly reduced risk for developing Type-2 diabetes. In a Diabetes Prevention Program (DPP) study published by the New England Journal of Medicine in 2002, 3234 subjects with prediabetes were randomly assigned to three groups: 1) a lifestyle intervention with the goal of losing 7 percent of body weight and increasing physical activities to 150 minutes/week), 2) metformin, or (3) a placebo. It was found that, compared to placebo, lifestyle and metformin decreased the development of Type-2 diabetes by 58 and 31 percent, respectively.
WEIGHT LOSS
There is strong and consistent evidence that obesity management can delay progression from Prediabetes to Type-2 diabetes. The ADA recommends a goal loss of 7 percent of body weight (ADA 2016 Loss of as little as 5-10 percent of body weight can prevent the development of Type-2 diabetes (Portero & Mcclellan, 2014). In the DPP study mentioned above, the strongest predictor of diabetes prevention was weight loss.
QUALITY OF DIET
The most successful nutritional strategy for the prevention and management of diabetes is one that individuals can adapt and follow permanently. It appears that the quality of the dietary fats and carbohydrates is more crucial than the quantity of the nutrients that are consumed. A quality diet can reduce disease risk by reducing oxidative stress and insulin resistance. In particular, diets rich in fruits, vegetables, legumes, nuts, seeds, fish and naturally high-fiber grains, and lower in refined grains (processed foods), red or processed meats and sugar-sweetened beverages, have been shown to reduce the risk of diabetes (Ley, 2014). Several dietary patterns of quality can be tailored to personal and cultural food preferences with calories adjusted for weight control and diabetes prevention.
LOW GLYCEMIC CARBOHYDRATES
The glycemic index and glycemic load assess how a carbohydrate influences blood glucose levels (see: www. mendosa.com/gilists.htm). The glycemic load is the most immediate and direct measure of how a serving of food will affect blood sugar. Index and load knowledge has been shown to be beneficial for reducing body weight, total body and visceral fat, levels of inflammatory markers, and the occurrence of high cholesterol and hypertension.
QUESTION:
What is preventing us from preventing Type-2 diabetes?
• Diabetes prevention education is not widely practiced in the U.S.
• The majority of those with prediabetes remain undiagnosed or unaware
• Few have access to an accredited lifestyle-interven tion provider
• Most insurance providers do not cover services for preventing Type-2 diabetes
• The deadly, debilitating and costly complications of diabetes do not appear immediately after disease onset. They typically emerge a decade or more later.
• The challenge of prevention in the “real world.” While diabetes prevention has been demonstrated in research trials, the success rate appears to be low in the “real world.”
Perhaps only a population-based approach to prevention can address a problem of this magnitude, to increase focus on interventions aimed at children and their families and change the fate of our future generations.
Mary Gynn, RN and Diabetes Educator, facilitates diabetes education workshops in many Florida areas. Contact mtmgynn@gmail.com.
Mary Gynn is an RN, MSN/MS, MPH and Diabetes Educator. Visit http://www.teaching for health.com to learn more.
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