Decades of research have found that two things matter most when it comes
to stopping diabetes in its tracks: losing weight (even a small loss can
have a big impact)—or maintaining a healthy weight if you’re
already there—and regular physical activity. Together these two
can prevent type 2 diabetes from happening in the first place and reverse
it if you’re prediabetic or even diabetic, in some cases.
Obesity can trigger the condition because excess fat seems to interfere
with the body’s metabolism and can lead to insulin resistance—the
inability of the body to use the insulin it produces. Studies have shown,
too, that physical activity can improve and even reverse diabetes by helping
glucose be more efficiently used by cells; this is because exercise can
improve insulin sensitivity. Muscle tissue also uses glucose better than
fat does, which is why building and using muscle through regular exercise
helps to keep blood sugar on an even keel.
Even if you’ve already been diagnosed with diabetes, it’s definitely
not too late to turn things around. Weight loss (or maintenance) and exercise
still matter a lot, and you may need medication to help the pancreas produce
more insulin and prevent the complications of glucose build-up.
The Diabetes Prevention Program (DPP), a large clinical trial funded by
the National Institutes of Health, looked specifically at what works best
to stop or prevent diabetes in people at risk for developing the disease.
The DPP came away with several findings: most important, that intensive
lifestyle changes, especially weight loss and regular exercise, reduced
the development of type 2 diabetes by 58%. By comparison, the study found
that metformin, often the first diabetes drug given, says Dr. Ro, lowered
diabetes risk by just 31%.
Here are some guidelines that will help lower your risk of developing type
2 diabetes or prediabetes, or keep your blood sugar in check if you’ve
already been diagnosed (bonus: they’ll also keep your weight down):
DIET & EXERCISE
“We can’t blame any particular food for triggering diabetes,
but the easy availability of processed and convenience foods and the access
to refined carbohydrates [such as crackers, breads, cookies, candy and
pasta] has led to an excess intake of calories, fat and sugar. And that’s
leading to the weight gain and the prevalence of obesity,” says
Rodriguez-Brindicci, adding that these foods are not bad in themselves,
but the amounts in which many of us eat them is a problem. “That,
added to the decrease in levels of physical activity, is definitely leading
to the rise in type 2 diabetes.”
Dani Rodriguez-Brindicci, MS, RD, recommends working with a nutritionist
or diabetes educator to find realistic ways to modify your diet “and
develop a meal plan that works best for you.” It’s also worth
taking a hard look at the beverages you’re drinking; many contain
sugar that can drive up glucose. Sugary sodas and coffee drinks are obvious
offenders, but sports and energy drinks, juices and smoothies are often
just as bad.
When it comes to exercise, the DPP found that being moderately active for
150 minutes a week was enough, combined with a low-calorie, low-fat diet,
to drop diabetes risk significantly. That equates to just 30 minutes per
day, five days per week, of an activity like brisk walking. And if you
can work out longer or more vigorously, that’s even better.
MEDICATION
While metformin is often the first choice for newly diagnosed type 2 diabetics
and some prediabetics, there are many medications that can be used to
treat type 2 diabetes, says Dr. Ro. Some improve the body’s sensitivity
to insulin; others promote insulin secretion from the pancreas; and still
others slow the body’s metabolism of carbohydrates.
“The choice of medication depends on the patient and how bad their
diabetes is,” Dr. Ro says. “Some will need insulin right away
because blood sugars are so high and oral medications will not be enough
to achieve adequate control.”
Insulin therapy is necessary, she adds, if the pancreas isn’t able
to produce enough insulin or if existing kidney or liver problems prevent
someone from using oral medications safely.
While insulin has typically been given through injections or a pump device,
the Food and Drug Administration recently approved Afrezza, a fastacting
form that’s inhaled. Over the past few years, Dr. Ro says there
have been major breakthroughs in the treatment of diabetes, including
new classes of medications called GLP-1 agonists and SGLT-2 antagonists
that not only control blood sugar but are effective in promoting weight loss.
“Every patient with diabetes should receive an individualized treatment
regimen based on their specific needs,” stresses Dr. Ro. “You
should talk with your doctor to see which medications would best help
control your diabetes.”
BARIATRIC (WEIGHT LOSS) SURGERY
Surgery can be an important tool for those who are both very overweight
and have type 2 diabetes. Weight-loss surgery (technically known as bariatric
surgery) has a lot of benefits, but there’s one that’s probably
not so well-known.
“There’s a secondary but significant impact on diabetes from
the surgical procedure: hormonal changes that improve insulin resistance,” says
Aileen Takahashi, MD, medical director of
bariatric surgery at Torrance Memorial. “In order to be a candidate for surgery, besides
meeting all the medical criteria, the person has to accept that they must
change their habits after the surgery is over. That means they must exercise
regularly, and they have to improve their eating habits. If they don’t,
then they won’t be successful with the weight loss, and the surgery
is just a waste.”
But if a patient can make these changes, adds Dr. Takahashi, they’re
likely to make an excellent candidate for a successful surgery. “What
I tell the patients is that exercise and eating properly are the ways
to lose the weight. Surgery can help control your appetite, and then when
you do eat you’re satisfied with less. So if you have that help,
then it’s easier to stay on track with proper eating habits.”
There are several kinds of bariatric surgery, and three of these procedures
are performed by surgeons at Torrance Memorial: gastric bypass surgery,
a less-invasive procedure called the gastric sleeve and gastric band surgery.
Dr. Takahashi says to reverse type 2 diabetes, the best choices are gastric
bypass or sleeve gastrectomy because these are metabolic operations, meaning
they change hormonal levels that relate to glucose metabolism. (The gastric
band, on the other hand, doesn’t lead to hormonal changes, so if
you want to reverse type 2 diabetes and you choose gastric band surgery,
weight loss becomes crucial.)
Prior to surgery, Dr. Takahashi says patients must attend pre-surgery classes
at the hospital and support groups where they learn about different types
of bariatric surgery and how to keep off weight long-term through better
eating habits and physical activity.
“These are all-important to improve health and will lead to overall
better glucose control,” says Dr. Takahashi. (See “Which Weight-Loss
Surgery Is Right for You?” on page 38 for more on the types of bariatric
surgery performed at Torrance Memorial.)
Even if improving your blood sugar and getting your type 2 diabetes under
control is the main reason you choose to have bariatric surgery, the operation
can offer other big health benefits. If the extra weight is kept off,
your risk of cardiovascular disease will drop, and the surgery can ease
symptoms of incontinence, joint and back pain, sleep apnea and reflux
disease—and may even lower the risk of cancers that have been linked
to excess weight, such as breast cancer.