Diabetes prevention can be categorized into two groups:
- Primary prevention
- Secondary prevention
Identifies and protects individuals at risk from developing diabetes. It therefore has an impact by reducing both the need for diabetes care and the need to treat diabetes–related complications.
While there is yet no conclusive evidence to suggest that type 1 diabetes can be prevented, primary prevention of type 2 diabetes is potentially possible.
Lifestyle changes aimed at weight control and increased physical activity are important objectives in the prevention of type 2 diabetes. The benefits of reducing body weight and increasing physical activity are not confined to type 2 diabetes, they also play a role in reducing heart disease, high blood pressure, etc.
Involves the early detection and prevention of complications, therefore reducing the need for treatment.
Action taken early in the course of diabetes is more beneficial in terms of quality of life and is more cost–effective, especially if this action can prevent hospitalization.
There is now conclusive evidence that good control of blood glucose levels can substantially reduce the risk of developing complications and slow their progression in all types of diabetes. The management of high blood pressure and raised blood lipids (fats) is equally important.
Diet and Weight Loss
For most people with diabetes, diet control is the key to managing this complicated disease. Patients should meet with a professional dietitian to plan an individualized diet that takes into consideration all health needs.
General rules for healthy eating apply to everyone: limit fats (particularly saturated fats and trans–fatty acids), protein, and cholesterol, and consume plenty of fiber and fresh vegetables. All people with diabetes should aim for healthy lipid and control of blood pressure. For obese patients who cannot control weight using dietary measures alone, weight–loss drugs may be tried.
Exercise helps tower blood glucose and increases insulin sensitivity, it also helps lower blood pressure, improve cholesterol levels, decrease body fat and reduce the risk of cardiovascular disease. Aerobic exercise is best. Regular exercise even of moderate intensity, improves insulin sensitivity. Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program. Because diabetics may have silent heart disease, they should always check with their physicians before undertaking vigorous exercise.
Monitoring Blood Glucose
Patients should aim for pre–meal glucose levels of between 80 and 120 and bedtime levels of between 100 and 140. Usually, a drop of blood obtained by pricking the finger is applied to a chemically treated strip. The glucose level is read on a standard meter or a small, portable digital device.
Insulin lowers blood sugar levels.
People with type 1 diabetes require multiple daily insulin injections for survival.
People with type 2 diabetes may require oral hypoglycaemic drugs to lower their blood sugar and some may need insulin injections at some point.
It is important to achieve the right balance of the above elements. Too much or too little of either can impact upon how you feel. Achieving this balance is a life–long commitment on the part of the person with diabetes.
Studies undertaken in the United Kingdom by the National Institute of Diabetes and Digestive and Kidney Diseases (DCCT) and the Diabetes Trial Unit at Oxford University (UKPDS) have shown conclusively that effective control of blood glucose in an effort to keep blood sugar levels as close to normal as possible is beneficial in preventing and delaying the progression of complications of diabetes. The results showed that good control of blood sugar and blood pressure led to massive reductions in the development of complications:
- Up to a 76% reduction in the risk of developing eye disease.
- Up to a 50% reduction in the risk of developing kidney disease.
- Up to a 60% reduction in the risk of developing nerve disease.
- More than a 33% reduction in strokes.
- Up to a 33% reduction in death from long–term complications.
As the developing world is expected to bear the brunt of the escalating diabetes epidemic in the future, diabetes prevention is proving especially urgent and difficult in developing countries.
In most developing countries, health policies and services need to put more emphasis on non–communicable diseases such as diabetes, but in many of these countries (as well as in developed ones) decision–makers lack awareness of diabetes and the political will to invest in prevention.
The resources required for future research need to be found. Standards in diabetes monitoring and surveillance need to be set in countries where progress has been limited.