Preventing Diabetes, the Way Forward
Diabetes mellitus is a chronic metabolic disorder. It is associated with a wide
range of complications. However, complication occur due to exposure of an
individual to high blood sugar over a prolonged period of time.
There are substantial evidences now that Type 2 diabetes can be prevented from
occurring as well as that complications of diabetes are either prevented or are
delayed from occurring. Progression of complications too can either be slowed
or halted.
1. Primary prevention
Primary prevention refers to preventing diabetes from occurring. It is known
beyond doubt that certain conditions predispose an individual to contracting
diabetes. Diabetes can be prevented or delayed from occuring if these conditions
are made known to individuals and that they avoid those known risk factors.
1.1. Preventing Type 2
There are certainn modifiable risk factorss that predisposee one to developing Type
2 diabetes. These risk factors are as follows:
• Obesity
• Physical inactivity
• High blood pressure
Otheree risk factorss that can not be modifiedd are age above 40 years; a parent,
sister or brother has diabetes, had diabetes in pregnancy and any women who
gave birth to a large baby (> 4 kg).
Researchh has shown that Type 2 diabetess can be prevented from occurring by
modifying life style and changing some eating habits. This is especially so in
people more than 60 years of age.
1.1.1. Making wise food choices
Youu may not have developedd diabetes but are at risk of gettingg it. What you eat
has a big impact on your health. Make wise food choices to keep your body
weight underr control, normal bloodd pressure and normal cholesterol levels.
You cann eat all typess of food that you were eatingg earlier but follow the following
basic rules:
• Reduce servingg size of the main meals that you eat especiallyy of those
that contain high fat like dessert, meat, cake.
• Increase amount of intake of vegetables containing high fiber. Half of
your meal must contain vegetables
• Eat fruits in moderation
• Limitt your fat intakee to less than 20% of total calorie intake of the
dayy. Somee practical tips of reducingg fat intake are:
- do not eat fried food
- avoid eating fat containing meat,
- remove skin of chicken before cooking,
- avoid eating nuts
- avoid fast food, fried potato wafers etc
• Reduce yourr total calorie intake if you are overweightt. Your diabetic
nurse or dietician will help you plan your meals
• You can eat low caloriee foodd in any amount like green salad without
topping, ‘chinta’, tea without sugar, ‘dau’ and spices to your taste.
• Keepp a recordd of what you eat for the entire day. You will know for
yourself where you are.
1.1.2. Increasing physical activity
Physical inactivity is one of the most important reasons of overweight and obesity.
Physical inactivity also results in insulin normally produced in body to be
insensitive and its action being less efficacious. All these contribute to developing
Type 2 diabetes
Increasing physical activity improves insulin sensitivity and prevents diabetes
from manifesting.
It is important first of all to initiate physical activity. The activity must be
gradually increased, adding a few minutes each day. One must exercise at least
60 minutes each day for all days of a week.
Physical activity can be brisk walking, jogging, playing, gardening, going around
chorten etc.
Physical activity must be continued for life time.
1.1.3. Maintaining a reasonable body weight
Body weight affects health in many ways. Obesity is a contributing factor of
several disease conditions.
Bodyy Mass indexx is a measure of body weight relative to height. BMI can be
used to see whether one is underweight, normal weight, overweight or obese.
BMI is calculatedd by dividing weightt in kilograms by height in meters squared.
BMI = kg/m2
BMI can also be measured by using BMI chart.
Find height in centimeters in the bottom of the chart.
Find weight in kilograms in the right hand side of the chart.
Move along the row and column of weight and height to find the intersecting
point.
The number at the intersection is the BMI. Check whether your BMI is normal
or abnormal.
Riskk of associated disease accordingg to BMI & Waist circumference
Body Mass Index Grade Waist < 40 inches in Waist > 40 inches in
men & <35 inches in men & > 35 inches
women in women
18.5 or less Underweight
18.5 to 24.9 Normal
25 to 29.9 Overweight Increased High
30 to 34.9 Obese High Very High
35 to 39.9 Highly obese Very High Very High
40 or greater Extremelyy obese Extremelyy High Extremely High
If one is overweight or obese, choose sensible ways to get in shape.
• Decrease amountt of food that you generallyy eat.
• Limit amount of fat intake
• Increase your physical activity. Exercise most days of week. Aim at
least 60 minutes of exercise each day.
• Set a reasonable goal of losing at least 500 grams a week and a long
term goal of maintaining your BMI at 24 to 25.
• Avoid crash diet
1.1.4. Other modifiable factors for diabetes prevention
Following are some other modifiable risk factors to diabetes. These must be
looked for periodically and adapt life style measures to prevent contracting them.
This is more so after 40 years of age.
Hypertension
Check blood pressure at every opportunity. Persons with high blood pressure
develop diabetes. If one already has hypertension, keep it under good control by
adapting life style change and medications.
Cholesterol
Check cholesterol and triglyceride at least once a year after 40 years of age.
These add to the risks of complications of diabetes.
Diabetes in pregnancy
If one had diabetes in pregnancy or gave birth to a baby more than 4 kg weight,
one has high risk of developing diabetes. Check blood sugar at least once a year.
Follow other life style modification measures.
Alcohol
Moderate or stop alcohol intake. If one is a non user, do not start drinking alcohol
in any form.
Diabetes in family
If one has any one in the family (mother, father, brother or sister) who has
diabetes, one is at increased risk of getting the disease. Be extra cautious, maintain
normal body weight, remain physically active, keep a check of eating habit and
undergo periodic medical check up.
- avoid eating fat containing meat,
- remove skin of chicken before cooking,
- avoid eating nuts
- avoid fast food, fried potato wafers etc
• Reduce total calorie intake if one is overweight. The diabetic nurse or
dietician will help plan meals
• Eat low calorie food in any amount like green salad without topping,
‘chinta’, tea without sugar, ‘dau’ and spices to taste.
• Keep a record of what is eaten for the entire day. This is a way knowing
ones eating.
* 1.2. Preventing Type 1 diabetes
There are limited measures of preventing Type 1 diabetes because definite
preventive agents for causation of the disorder are not always identified. It is
important to immunize all children with primary series of vaccines in their first
year of age. Encourage exclusivee breast feeding for the first six monthss of life.
1.3. Approaches to primary prevention
Primary prevention can be achieved by the following approaches
17.1.3.1. Population approach
Awareness on diabetes and its risk factors can be made through approaches like
informing population through mass media, group education, school health, school
curriculum etc.
1.3.2. High risk approach
Populations at risk are identified and stratified at increased risk of progression
based on age, BMI, family history. These individuals must be aware of diabetes
and benefits of weight loss and physical activity. It must also be understood that
risk factors of Type 2 diabetes are also the risk factors of other non-communicable
diseases.
2. Secondary prevention
Identifying diabetes and preventing microvascular as well as macrovascular
changes in diabetes is secondary prevention. Studies have shown that upto 50%
of diabetics at detection already have microvascular changes. Early detection of
diabetes and initiation of treatment prevent micro as well as macrovascular
changes from occurring and halt its progression if these have already occurred.
It is important to ensure targets of glycaemic control.
3. Tertiary prevention
Institution of aggressive therapy in persons who already have diabetes to
minimize consequences of diabetes is tertiary prevention. This ensures
containment or delay of progression of complications that ultimately reduces
morbidity, disability and mortality due to diabetes.
Table 17.2 : Strategies for Tertiary prevention
Lower limb amputation Daily self foot examination
Foot examination at every clinic visit
Appropriate foot wear
Renal Failure Meticulous blood pressure control
Control of hyperglycemia
Use of ACE inhibitors and ARBs
Low protein diet if indicated
Cardiovascular disease Control of hypertension
Control of dislipidemia
Stop smoking
Diabetes is increasing in epidemic proportions world wide. This is more so for
the developing countries. It is estimated that most of the urban centers in the
South East Regional countries have more than 10% of people with diabetes.
The proportions may not have reached such heights in Bhutan but however,
diabetes is certainly on a rise. The good news is that secondary and tertiary
prevention are highly effective. However, the approach must be primary
prevention. More efforts must be invested now to increase awareness of the
disease, its long term complications, risk factors and lifestyle changes required
thereof in the would be diabetics who ultimately adopt life-style that are averse
to the development of the disease. The path is arduous but it is real.
Thanks For Watching
