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Diabetes management – prevention and lifestyle changes


According to the American Diabetes Association, approximately 24 million people in the United States have diabetes and over 50 million are at risk for developing the disease.  As of 2006, diabetes ranked as the seventh leading cause of death in the country. With a growing population of newly diagnosed diabetics, it is important to be proactive in the prevention of this chronic illness.

Richard D. Siegel, MD, Co-Director of the Diabetes Center at Tufts Medical Center and an expert in diabetes, answers some common questions about type 2 diabetes, the most common form of the disease.

What is type 2 diabetes?

Type 2 diabetes is the most common form of diabetes, a disease with high levels of sugar in the blood.  The disease is caused by a combination of a relative deficiency of insulin and an inability by the body to use insulin appropriately.  Insulin is a hormone made in the pancreas which allows the body to use and store sugars and starches.

How is type 2 diabetes treated?

It is treated with changes in lifestyle including diet and activity.  Many patients may require medications including a several classes of pills or injectable medications including insulin.  For selected patients who are significantly overweight, surgical procedures including gastric bypass surgery and adjustable gastric banding may also help to lower blood sugars.

Is there a cure for type 2 diabetes?

Currently, there is no true “cure” for type 2 diabetes.  However, patients may achieve a “remission” and have very normal sugars if they achieve significant weight loss and lifestyle changes early in the disease process.

What complications can arise as a result of having type 2 diabetes?

The goal of treatment is to avoid the effect of high blood sugars on different parts of the body.  Complications after many years of high sugars include problems with the eyes, kidneys, nerves, heart and blood vessels.

What are symptoms or early signs of type 2 diabetes?

Many people will not have any specific symptoms and will only find out about their diabetes from a blood test. For those who do experience warning signs, these can include frequent thirst, frequent urination, fatigue and unexplained weight loss.

Are there any genetic predispositions for type 2 diabetes? Are any persons at greater risk?

Type 2 diabetes frequently runs in families.  Weight gain over time may bring out the predisposition toward the disease.  It occurs more commonly in Native Americans, Latino Americans, African Americans and Asian Americans as compared to Caucasians.   The risk for diabetes increases with age.  Women with diabetes during pregnancy (gestational diabetes) are also at higher risk for getting type 2 diabetes later in life.

How does diet and physical activity help prevent or delay the disease?

A research study published earlier in the decade showed that intensive lifestyle changes can at least delay getting type 2 diabetes in people who are at high risk for the disease.  These people made changes to their diet by cutting calories and exercising for 150 minutes per week with a goal of losing about 7 percent of their weight (about 10-20 lbs.).  While it is not clear if these lifestyle changes truly prevented diabetes, it is felt that these changes allow the body to make and use insulin more effectively.   The intensive lifestyle changes were better than a medication in delaying the onset of the disease.  A recent update to this study showed that the lifestyle changes continued to be effective up to 10 years afterwards.

How will type 2 diabetes treatment affect my lifestyle?

Initial treatment of type 2 diabetes involves education and counseling by a health care team, including a primary care provider, registered dietitian and, very often, a diabetes educator. Education helps people to incorporate diet, exercise and medication lifestyle changes into a daily routine. Some people may need to learn how to monitor their blood sugar or how to use injectable medication such as insulin.

Due to the increasing rate of type 2 diabetes in our society, how does this impact our rising healthcare costs now and in the future?

In 2007, it was estimated that the national cost of diabetes in the United States was about $174 billion. About one third of this cost is “indirect” which includes the cost of reduced productivity at work.  About $1 in $10 health care dollars has been attributed to diabetes.  As type 2 diabetes is expected to continue to increase, if only a small percentage of the disease can be prevented, this should have a significant impact to cut health care costs in our country.