Prevention of Diabetes Mellitus

Diabetes Mellitus is a chronic metabolic disorder in which there is increase in  blood glucose level resulting from inadequate production of insulin, inadequate action of insulin (resistance) or both. Type 2 Diabetes Mellitus (T2DM) accounts for over  90% cases of diabetes world wide. 

The natural history of Type 2 diabetes includes 3 stages : normal glucose tolerance where  blood glucose levels are normal, pre-diabetes and overt T2DM. Preventive strategies therefore work at normal and pre-diabetes stage. It’s important to know that even  though blood glucose levels are not as high in pre-diabetes stage as in overt diabetes but it can still lead to  complications like stroke, heart disease, fatty liver etc. Therefore pre –diabetes should not be overlooked.

Pathogenesis of T2DM  is complex  wherein environmental triggers precipitate T2DM in genetically predisposed individuals . These  environmental factors can be classified into  modifiable and non-modifiable. Non modifiable risk factors include age, ethnicity and family history whereas modifiable risk factors include unhealthy diet , obesity ,sedentary habits ,  stress etc .While discussing  prevention of diabetes it’s pertinent to address these modifiable risk factors.

So there are various measures that can be taken to prevent diabetes

  1. Lose weight : 7-10% weight loss has been shown to cut down risk of progression to Type 2 diabetes by over 50%  and achieve beneficial outcomes in  lipids, and blood pressure as well.
  • Cutdown on carbs : Carbohydrate consumption in India may go up till 60-65 % in diet. Efforts should be made to avoid refined carbohydrates  , simple sugars , starchy vegetables  instead consumption of complex carbohydrates which are minimally processed should be encouraged . Carbohydrate counting also helps keep track of total amount of carbs taken in a day.
  • Increase intake of  dietary fibre and protein : Proteins have higher satiety factor and hence there  is lesser munching tendency in between meals. Lean sources of protein (including plant-based sources as well as lean meats, fish, and poultry) should be included in diet.  Similarly fibre rich food keeps you fuller for longer period and help in delaying onset of diabetes  and lipid disorders.

Diabetic plate method “50-25-25”  helps in making good food choices and controlling portion size. The three divisions on the plate (9inch size) should be  50% non starchy vegetables, 25% whole grains and 25% protein rich food.

  • Exercise : Engage in 150 minutes  or more of moderate-vigorous intensity exercise per week, spread over at least 3 days/week, with no more than 2 consecutive days without activity.  Mix of aerobic and resistance exercises should be undertaken. Exercise  improves insulin sensitivity which leads to better utilization of glucose. Also one should avoid prolonged sitting.
  • Quit smoking : There is  convincing evidence to support the causal link between cigarette smoking and health risks. Smoking may have a role in the development of type 2 diabetes hence should be discouraged.
  • Hydration :  Replace sugar-sweetened beverages (including fruit juices) with water or low calorie, no calorie beverages

Type 2 Diabetes is majorly a  life style disorder and largely preventable by taking simple steps like eating a healthy diet , exercising more, maintaining calorie deficit and losing weight. It is important to identify those at risk and screen them to prevent the disease.

Dr. Jimmy Pathak

Consultant – Endocrinology

Metro Heart Institute with Multispecialty, Faridabad

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