Diabetes Prevention: 7 Dangerous Misconceptions

You’ve probably heard that diabetes incidence is soaring.  Is this mainly a concern if diabetes runs in your family? Or is it if you’re overweight – and if so, how overweight is overweight enough to put you at risk? Some people have told me they’d rather not know they’re more likely to develop diabetes, because they’d rather not live with the worry hanging over their head.

Well, research has brought important news.  With 79 million Americans estimated to have prediabetes – more than one in three adults — holding on to misconceptions about prediabetes and diabetes prevention puts your health at risk.

Misconception #1:  Diabetes risk is all about family history

People with a family history of type 2 diabetes do have greater odds of developing the disease, but multiple large studies show that a healthy lifestyle can substantially cut risk, or at least help people live more years without diabetes.

When diabetes “runs in the family”, it may mean that inherited genes affecting insulin function make you more likely to develop diabetes. Many researchers think that African Americans, Hispanic/Latino Americans, American Indians, Asian Americans, and Pacific Islander Americans are especially likely to have inherited a “thrifty gene” which helped ancestors long ago survive periods of famine.  In today’s food environment, the gene that once would have been helpful may now put people at a higher risk for type 2 diabetes.

• If diabetes seems to run in your family, and genetics makes you more vulnerable than others to an unhealthy lifestyle, it’s all the more important that you take action early to create a healthy lifestyle.  So far, studies suggest that lifestyle changes aimed at diabetes risk seem to have at least as much or more effectiveness among those at higher genetic risk.
• If diabetes does not seem to run in your family, don’t think you’re off the hook. Plenty of people have been the first in their family to develop diabetes. Researchers have developed models predicting who will develop diabetes, and family history is just one element in these models.  And even the best models don’t predict with 100 percent accuracy.

Misconception #2: Prediabetes means potential for future risk, not risk now.

Prediabetes means blood sugar levels that are higher than normal, but not high enough to be diagnosed as type 2 diabetes.  It can be identified by abnormal fasting blood sugar or by normal fasting blood sugar but abnormal response to a carbohydrate test load.  A blood test showing A1C values of 5.7% to 6.5% shows that regardless of what your fasting blood sugar is, your blood sugar has been abnormally high too often over the past few months.

• If you have prediabetes, you are 5 to15 times more likely to develop type 2 diabetes than people with normal blood sugar levels.
• Risk of heart disease and stroke does not begin with diabetes; if you have prediabetes, you are already at increased risk.
• Type 2 diabetes is linked with increased risk of several cancers.  No statistical link to prediabetes has been established yet, but the metabolic conditions that link diabetes to cancer development are those that are present long before diabetes is diagnosed.

Misconceptions #3a and #3b: I’m too old to change my risk. OR I’m too young to worry about diabetes.

Risk of diabetes and prediabetes increases as we get older, apparently due to both decreased ability to produce insulin as needed and decreased ability of the body to respond to insulin (referred to as insulin resistance). About half of all American adults aged 65 years and older have prediabetes. Some may wonder whether lifestyle in middle age and beyond really affects diabetes risk; studies show that it does.

• A multi-center federal study tracked 4,883 men and women age 65 and older for ten years.  After adjusting for age, sex, race, education and income, the combination of five lifestyle factors accounted for nearly 90 percent of new cases of diabetes.
• In the landmark Diabetes Prevention Program (DPP) study, those ages 60 to 85 at the start of the program tended to be slightly less responsive to the drug metformin than those ages 25 to 44. However, these older adults showed an even greater drop in diabetes development in response to a program of lifestyle change than younger adults.  This increased effectiveness of the program seemed to be largely, but not entirely, because older adults followed the program better – they lost more weight and waist size and exercised more – than younger and middle-aged adults.
• Perhaps the less-senior adults in the Diabetes Prevention Program lifestyle changes were more distracted by other life obligations than those in the oldest age group.  Or perhaps they still, despite being identified as having prediabetes, felt that their age kept them less vulnerable to serious health problems and were less motivated to change. That’s unfortunate, as all too many in this younger age group discovered when they did develop diabetes.

Misconception #4:  Diabetes? That’s for my doctor to manage, not me.

Of course, your doctor is vital in monitoring and caring for your health.  However, in the Diabetes Prevention Program, lifestyle change was shown to be more effective than medications for the first few years, and in the longer-term, at least as effective. When your doctor advises that it’s time for metformin or other medical treatment, don’t hold back.  But in the interest of promoting overall health and controlling health care costs, the DPP and other studies are showing lifestyle as key factors.

If you don’t feel confident about making changes in your eating and activity habits, help that’s been proven effective is available. Ask your doctor for a referral to a registered dietitian, or a diabetes prevention program in your local community.

Misconception #5:  I’m so overweight, there’s no way I can lose enough weight to make a difference.

Even if you’re far above a weight classified as healthy by standards such as body mass index (BMI), study after study shows that if you are overweight, a five to seven percent weight loss is enough to make a difference.   In the Diabetes Prevention Program, the strongest predictor of program effectiveness was weight loss, which averaged 10 to 20 pounds.

Changing habits is always a challenge. But a combination of changed eating habits and increased exercise has been shown in studies to make this target achievable; aim to get there in about six months.  If you think you’ve changed your habits but haven’t lost any weight in two months, it’s time to re-evaluate.   The DEPLOY study explored the ability of programs based in community organizations such as the YMCA to foster not only diabetes prevention knowledge but also goal-setting, self-monitoring and problem-solving.  After four to six months, participants lost an average of 12.5 pounds, exceeding the goal of five percent of initial weight.  This group lost three times as much weight as a control group receiving standard diabetes prevention advice.

Misconception #6: There’s no point in exercising if it doesn’t make me thin.

It’s natural, after making the effort to work physical activity into your daily lifestyle, to want the gratification of seeing numbers on the scale.  However, most studies show that physical activity is a major factor in avoiding weight gain (or re-gain after weight loss), but on its own can produce limited short-term weight loss.

But that’s not the point!  A recent analysis of available research suggests that 8.3 percent of type 2 diabetes in the U.S. can be attributed to lack of enough physical activity. Studies show that – regardless of weight loss – physical activity directly reduces the insulin resistance that is behind prediabetes.  This reduction of insulin resistance only lasts two to 72 hours, so the American Diabetes Association recommends getting physical activity at least every other day, if not every day. Each time you get out and take a walk or get other activity, you are making a difference.  Saving up good intentions for the weekend is not as effective as doing something today.

Misconception #7:  So many conflicting diet claims make it too confusing to know what to do.

The goal isn’t a “diet”.  The goal is healthy eating habits.  Changes in what and how much you eat is critical to cut 500 or so calories a day to achieve the five to seven percent weight loss target we discussed.

Healthy food choices may also offer direct help: 

• Fruits, vegetables, whole grains and dried beans provide antioxidants that fight inflammation linked to this disease, and provide fiber that may also help reduce risk.  Aim for at least two-and-a half cups (preferably three-and-a-half to five cups) of fruits and vegetables daily.
• Choose modest-sized servings of whole grains to replace refined grains.
• Higher consumption of dried beans and peas is linked in an analysis of multiple studies with lower blood sugars and less insulin resistance.
• Limit processed meat and sugar-sweetened drinks, since evidence suggests frequent use may increase risk of diabetes.

Based on these priorities, it’s better to pick one or two changes and work to make them habits than to try for an effort you can’t keep up…and certainly better than doing nothing.

Today’s Take-Home Message: If you have trouble creating or maintaining a healthier lifestyle on your own, you’re not alone.  In each of these studies, those in a program that shared tips and showed people how to set goals and solve problems did better than those simply given written information.  So check with your local hospital or community centers to see what’s available.  If no program exists, request that they start one.

Sign up to receive Smart Bytes®  so you don’t miss further information about the effectiveness of the programs now being launched as part of the National Diabetes Prevention Program.

Most important: change your mind set about prediabetes.  It’s not a sign that someday you’ll need to change your habits.  It’s a sign that you’re already overdue, and that you have an opportunity now to make a major change in your health risks.

Resources

Are you at risk for prediabetes? Take this screening quiz from the Centers for Disease Control and Prevention (CDC).

The CDC also has information for groups at special risk of diabetes.

References

Tabak AG et al. Prediabetes: a high-risk state for diabetes development. Lancet, 2012.  379:2279-2290.

Mozaffarian D et al. Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older Adults: The Cardiovascular Health Study. Archives of Internal Medicine, 2009. 169(8): 798.

Diabetes Prevention Program Research Group, Crandall J, et al.  The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes.  J Gerontol A Biol Sci Med Sci. 2006 Oct.  61(10):1075-81.

Diabetes Prevention Program Research Group, Knowler WC, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study.  Lancet. 2009 Nov 14.  374(9702):1677-86.

Ackermann, RT et al.  Translating the Diabetes Prevention Program into the Community: The DEPLOY Pilot Study. American Journal of Preventive Medicine, 2008.  35(4):357-63.

Lee IM et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.  Lancet. 2012 Jul 21. 380(9838):219-29.

Esposito K, et al.  Prevention of type 2 diabetes by dietary patterns: a systematic review of prospective studies and meta-analysis.  Metab Syndr Relat Disord. 2010 Dec.  8(6):471-6.

Psaltopoulou T et al.  The role of diet and lifestyle in primary, secondary, and tertiary diabetes prevention: a review of meta-analyses.  Rev Diabet Stud. 2010 Spring.  7(1):26-35.

Micha R et al. Red and processed meat consumption and risk of incident coronary heart disease, stroke, and diabetes mellitus: a systematic review and meta-analysis. Circulation 2010. 121(21):2271-83.

Sonestedt E, et al.  Does high sugar consumption exacerbate cardiometabolic risk factors and increase the risk of type 2 diabetes and cardiovascular disease?  Food Nutr Res. 2012;56. doi: 10.3402/fnr.v56i0.19104.

Malik VS, et al.  Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis.  Diabetes Care. 2010 Nov;33(11):2477-83.