Diabetes Prevention (Type 2 Diabetes)

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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How can type 2 diabetes be prevented?

One of the most important factors in the development of diabetes is genetics (over which we have no control). However, there are things in our environment and lifestyle we can control to lower our personal risk of developing diabetes, including exercise and weight loss.

Exercise

When adjusted for family history, the benefits of exercise can be evaluated based on previous studies. Of note, for every 500 kcal burned weekly through exercise, there is a 6% decrease in relative risk for the development of diabetes. This data is from a study done in men who were followed over a period of 10 years. The study also notes a greater benefit in men who were heavier at baseline. There have been similar reports on the effects of exercise in women.

Exercise is thought to be a major determinant of insulin sensitivity in muscle tissue. By increasing exercise, the body uses insulin more efficiently, for up to 70 hours after the exercise period has occurred. Thus exercising three to four times per week would be beneficial in most people.

The same benefits are seen when looking specifically at patients with impaired glucose tolerance/impaired fasting glucose. When diet and exercise are used as tools in this population over a six year study and compared to a control group, glucose tolerance improves by about 76% compared to deterioration in 67% of the control group. The exercise group also had a lesser rate of progression to type 2 diabetes.

It should be noted that a lot of the benefit of exercise occurs independent of weight loss. However, when combined with weight loss, the benefits increase substantially.

Weight Loss

In patients at risk for diabetes, weight loss can improve insulin sensitivity as well as delay, and even prevent progression to type 2 diabetes. In patients with overt diabetes, weight loss can play a tremendous role in improving blood sugar control.

Two large studies - one in Finland and the other one U.S. (the Diabetes Prevention Program- DPP) have shown the benefit of weight loss in diabetes prevention. In the Finnish study, more than 500 men and women with impaired glucose tolerance were assigned to a control group or an exercise/weight loss group. By the end of the study, the weight loss group had lost about 8 pounds, and the control group about 2 pounds. The weight loss group had significantly less participants develop diabetes than the control group.

The DPP study showed a similar result. In this study, there was also a group taking metformin (Glucophage) as a preventative measure. At the end of the study, the lifestyle group actually did better at prevention of diabetes than those taking metformin. In fact, the study was stopped early, because the benefit of weight loss (the weight loss group lost about 15 pounds on average and kept it off) was so dramatic.

Smoking

Smoking 16 to 20 cigarettes a day or more can increase a person's risk of developing diabetes to more than three times that of nonsmokers. The exact reason for this isn't well understood. It may be that smoking directly decreases the body's ability to utilize insulin. Moreover, it has been observed that after smoking, blood sugar levels increase. Finally, there is also an association between smoking and body fat distribution, smoking tends to encourage the "apple" shape, which is a risk factor for diabetes.

Nuts

In as study of over 83,000 women consuming nuts (and peanut butter) seemed to show some protective effect against the development of diabetes. Women who have more than five one-ounce servings of nuts a week lowered their risk of developing diabetes compared to women who consumed no nuts at all.

Medically Reviewed by a Doctor on 4/14/2016

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