Deterring diabetes

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Discover how to keep diabetes at bay or prevent it getting worse.

First world countries are in the grip of a diabetic epidemic. About 21 million Americans have the disease, and many more have pre-diabetes. The UAE has also experienced a rapid increase in diabetes cases and all indications suggest that its prevalence will continue to soar in the years ahead.

Elevated blood glucose (sugar) levels define diabetes. A fasting blood sugar reading of 126mg per decilitre (mg/dL) or higher is enough to diagnose the disease, and levels between 100 and 126 indicate pre-diabetes. But since diabetes is a leading cause of heart attack, stroke, kidney failure, visual loss, and memory loss, it's much more than a simple blood sugar problem.

Treatment can help protect diabetics from many of the complications that cause disability and premature death. But preventing diabetes from developing in the first place is even better. And while treating the disease usually requires multiple medications, prevention can be accomplished without drugs.

To be most effective, though, prevention requires multiple lifestyle modifications. Here is a rundown of the things that matter most and the little things that may help a bit more.

Weight control

When it comes to preventing diabetes, weight control is the biggie. That's because excess body fat is the strongest single risk factor for diabetes. In a Harvard study of 27 270 male health professionals, men who were even mildly overweight (body mass index/BMI, 25.4-27.1) were 2.9 times more likely to develop diabetes than the leanest men. And the more fat a man has, the higher his risk. In the Health Professionals Follow-up Study, the most obese men were 7.9 times more likely to become diabetic than their leanest peers.

Any excess body fat increases risk, but abdominal fat is particularly culpable. In the Harvard study, waist circumference was a more powerful predictor of diabetes than BMI. Men with waists larger than 40 inches were at particular risk.

Why is abdominal fat so harmful? One theory holds that abdominal fat cells produce hormones that actually counter the effects of insulin. Even without these substances, abdominal fat does not respond properly to insulin's actions.

Instead, the fat cells release free fatty acids into the blood. According to the concept of lipotoxicity, these fatty substances settle in the pancreas, damaging the beta cells and impairing insulin production. And there's more: the free fatty acids also find their way to the heart and liver, where they form deposits that lead to organ damage.

Further, the liver converts excess free fatty acids into abnormally high levels of triglycerides. In fact, the combination of abdominal obesity, insulin resistance, and elevated triglycerides are major components of the metabolic syndrome, an important precursor of heart attacks and strokes.

If abdominal fat is such a big problem, can removing it by liposuction help? Unfortunately, it can't, because the fat that really counts is deep within the abdomen, surrounding the internal organs. Subcutaneous fat within a surgeon's reach is insulin-sensitive and metabolically similar to the fat around the hips, buttocks, and thighs. In the last analysis, weight loss is the only way to correct the visceral obesity that really matters.

Although weight loss is difficult to achieve, fortunately, even a little bit can help. In the Diabetes Prevention Program, for example, each 2.2lb of weight lost reduced the risk of diabetes by 16%.

Not coincidentally, exercise and diet are the keys to comprehensive diabetes prevention.

Exercise

Physical activity requires energy, much of which is supplied by glucose. Exercising muscles need more sugar, so the body makes these muscles more sensitive to insulin, allowing them to take in more glucose from the blood. Regular exercise also makes fat more responsive to insulin.

Research shows that exercise reduces the fat cells' production of a protein (RBP4) that contributes to insulin resistance. And exercise also reduces the liver's ability to turn its glycogen stores into glucose, which would otherwise pour into the bloodstream.

Since type 2 diabetes is characterised by insulin resistance, all these effects of exercise should help prevent the disease.

Many studies from around the world reinforce the notion that exercise reduces the risk of diabetes. Three Harvard reports tell the tale. A study of 37 918 men found that the most physically active men were 49% less likely to develop diabetes than the least active.

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READERS' COMMENTS

Diabetes and Harvard Info
Posted by valerie, Abu Dhabi, UAE on Thursday 6 November 2008 at 08:54 UAE time


Harvard medical information is great to read if you are in the medical field and want science and research information but the practical side of these articles fall short of the mark. Research from US and Finland sound nice but lack correlation to the UAE. Additionally, the articles miss the "day to day" application of the message and opt for reiteration of facts that are, in essence, quite useless. Using experts like registered dietitians and other healthcare professionals who work with diabetic patients can provide real expertise such as grocery shopping and reading food labels, advice on how to handle fasting during Ramadan, practical glucose monitoring and the positive effects of exercise on glucose control. I expected more from Harvard and hope they can tailor the information to the market vs. filling a media space requirement.

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