Can Lifestyle Changes Help Prevent Diabetes Mellitus?

Introduction


India has the largest diabetic population in the world. Diabetes is a metabolic disease characterized by high blood glucose levels over a period of time. The high glucose levels are associated with frequent urination and increased thirst and hunger. This disease can cause severe complications leading to increased mortality (death). Diet, obesity and decreased physical activity are significant factors leading to increased incidence of this condition. Prevention thereby involves lifestyle changes such as regular exercise, healthy eating, weight management, and smoking cessation.


Statistics


The worldwide prevalence of diabetes was 2.8% in 2000, and it is expected to increase to 4.4% by 2030. Worldwide the total number of persons with this condition is estimated to increase from 171 million in 2000 to 366 million in 2030.


Causes


Insulin produced by the pancreas regulates the plasma glucose. Genetic abnormalities of insulin gene cause defective production of insulin leading to type 1 diabetes.

In type 2 diabetes, the body is unable to regulate blood sugar levels due to insulin resistance. Several factors are involved in this condition, including increased calorie intake (high-fat diet) and lack of exercise. 


Complications


Diabetes can lead to stroke, kidney, eye damage, and foot ulcers. Complications of this condition include diabetic ketoacidosis, nonketotic hyperosmolar coma, diabetic retinopathy, diabetic nephropathy, diabetic foot ulcers, and diabetic neuropathy.



Lifestyle changes


1. Physical activity


A sedentary lifestyle increases the risk of this condition. Physical activity helps burn extra calories. Modern living that comprises cars, elevators, dishwashers, and computers has replaced regular forms of physical activity from our daily lives.

Avoid sitting for prolonged periods. Prolonged sitting should be interrupted with bouts of light activity every 30 mins.

Aerobic exercises such as walking, jogging, cycling, swimming, and yoga practices have a possible role in the prevention of this condition. A simple exercise like brisk walking at least 30 mins/day decreases the risk by 58%.


2. Weight management


Obesity is the most important risk factor for the development of this condition. The key to maintaining a healthy weight is by making behavioral changes. This is accomplished by setting specific realistic goals such as


1. Make exercise a part of your everyday life

2. Avoid eating out of habit, boredom or emotional reasons

3. Choose your plate appropriately: Balanced diet (appropriate portions of food)

4. Intake of fiber-rich foods (whole grains, vegetables, fruits, legumes)

5. Quench your thirst with water, a healthy beverage rather than sugary drinks


3. Smoking


Smoking is an independent risk factor for this condition. Smokers are 30-40% more likely to develop diabetes than non-smokers. The more cigarettes you smoke (20/day) higher is your risk. Specific strategies that help smokers quit include


  • Replace smoking with a new and healthy habit

  • Use of nicotine replacement therapy

  • Psychotherapy (counselling)

4. Alcohol


Increased alcohol intake raises the risk of this condition by 30-40% as compared to substantial drinkers (occasional drinking).

Moderate amounts of alcohol were found to increase insulin sensitivity and HDL (good) cholesterol levels while heavy intake increased the triglyceride levels and impaired glucose metabolism.


5. Diet


Diet plays a significant role in the maintenance of blood sugar levels in obese persons or pre-diabetics. A diet high in fat and low in fruits, vegetables, and whole grains is associated with the onset of diabetes. Foods with low sugar levels delay the onset.


Dietary management should not only aim to achieve glucose control but also normalize dyslipidaemia. A Mediterranean diet characterized by high vegetable intake, olive oil and moderate consumption of protein, saturated fats, and refined carbohydrates was beneficial in diabetic people with dyslipidemia.

Intake of 1-2 g/day of plant sterols (juices and margarine) reduces LDL (bad) cholesterol levels.


References


1. Feldman AL, Long GH, Johansson I, Weinehall L, Fhärm E, Wennberg P, Norberg M, Griffin SJ, Rolandsson O. Change in lifestyle behaviors and diabetes risk: evidence from a population-based cohort study with 10 year follow-up. International Journal of Behavioral Nutrition and Physical Activity. 2017 Dec;14(1):39.

2. Khan MU. Lifestyle modification in the prevention of type II diabetes mellitus. Oman medical journal. 2012 Mar;27(2):170.