Overview of Diabetes

Diabetes is a group of diseases that are characterized by high blood sugar values. There are two main types of diabetes: Type 1, in which the body is not capable of producing enough insulin, and Type 2, the body is unable to use insulin properly (American Diabetes Association, 2019; El Sayed et al., 2023).  People diagnosed with diabetes and have elevated blood glucose levels over time can lead to:

• Heart disease
• Kidney disease
• Nerve damage
• Lower-extremity amputations
• Blindness

According to the CDC, as of 2019, 11.3% of the US population was estimated to have diabetes, primarily type 2, and 8.5 million adults are unaware that they have this disease. In recent years, it has been estimated that, on average, people diagnosed with diabetes have 2.3 times higher medical costs compared to people that are not diagnosed with diabetes (El Sayed et al., 2023). This publication describes the modifiable risk factors for diabetes, primarily type 2, and tips to reduce your risk for diabetes.

Risk Factors for Developing Diabetes

Overweight or Obese

Being overweight or obese increases your risk for diabetes. Discuss your current weight and how your weight has changed over time with your healthcare provider. Losing just 7% of your body weight can cut your risk of type 2 diabetes in half (Knowler et al. 2002). Your waist circumference is also important. Keeping your waistline less than 35 inches for women and less than 40 inches for men lowers the risk of diabetes (National Heart, Lung, and Blood Institute, n.d.).

Dietary Habits

Based on recent studies, the eating patterns that may be helpful in reducing your risk for developing diabetes includes: Mediterranean or low calorie/low fat (American Association of Diabetes, 2019; Bloomfield et al., 2016; Estruch et al., 2018; Salas-Salvadó et al., 2016). Consuming whole grains, legumes, nuts, fruits, and vegetables (≥3 serving/week) as well as minimal consumption of refined processed foods, red meats and sugar-sweetened beverages (≤1 serving/day) may decrease your risk of developing this disease (Afshin et al., 2014; Chen et al., 2014; Chiuve et al., 2012; Mozaffarian, 2016; Mursu et al., 2014). 

Lifestyle

• Lifestyle behaviors that may increase your risk for diabetes include:
• Lack of physical activity. The current recommendation is to have a goal of at least 150 mins of moderate intensity physical activity per week that is similar in intensity to brisk walking (Knowler et al., 2002) .
• Smoking may increase the risk of type 2 diabetes. Recent studies have shown that the years following smoking cessation may represent a time of increased risk for this disease (American Association of Diabetes, 2019; Hu et al., 2018; Oba et al., 2012).
•  Drinking more than 1 alcoholic beverage per day for women or more than 2 per day for men.

Beverage amounts equal to one serving (USDA 2015):

• 5 ounces of wine
• 12 ounces beer
• 8 ounces of 7% alcohol malt liquor
• 1.5 ounces of distilled spirits or liquor

Reduce Your Risk for Diabetes

A healthy lifestyle can reduce your risk for type 2 diabetes and help those with diabetes live a healthier life. Start today with these tips!1

1. Focus on maintaining a healthy weight or losing weight gradually toward your optimal weight range.

Skip diets! Focus on making lasting lifestyle changes that you can continue for life.

2. Follow the Diabetes Meal Plate (Hamilton 2015) for maintaining blood glucose levels.

A diet high in unrefined carbohydrates (whole grains, vegetables, beans) and fiber (found only in plant foods) can help you improve your blood glucose levels (McMacken and Shah 2017). Fill ½ of a 9-inch plate with non-starchy vegetables such as leafy greens or carrots, ¼ with whole grains or starchy foods such as peas or potatoes, and the remaining ¼ with lean proteins such as chicken or beans. Have a piece of fruit and dairy on the side. For further inspiration see the recipe ideas below.

3. Exercise can improve your blood glucose levels.

Include at least 150 minutes of moderate physical activity at least 5 days per week. Try to include strength training (weights, yoga, resistance bands) 2–3 times per week.

4. Be sure to talk with your doctor about your goals and plans for change.

Your doctor may need to adjust your medications as you make lifestyle changes.

5. Aim to sleep 7–9 hours each night.

People who sleep for at least 7 hours per night maintain their body weight and have better control of their blood glucose levels (Watson 2015).

6. Start simple. Set a goal each week to make small changes towards health.

Try a goal such as eating at least one piece of fruit or ½ cup of beans daily for a week.

References

Afshin, A., Micha, R., Khatibzadeh, S., & Mozaffarian, D. (2014). Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis. American Journal of Clinical Nutrition, 100(1), 278. doi.org/10.3945/AJCN.113.076901

American Association of Diabetes (2019). Prevention or delay of Type 2 diabetes: Standards of medical care in diabetes—2019. Diabetes Care, 42(Supplement_1), S29–S33. doi.org/10.2337/DC19-S003

Bloomfield, H. E., Koeller, E., Greer, N., MacDonald, R., Kane, R., & Wilt, T. J. (2016). Effects on health outcomes of a Mediterranean diet with no restriction on fat intake: A systematic review and meta-analysis. Annals of Internal Medicine, 165(7), 491–500. https://doi.org/10.7326/M16-0361/SUPPL_FILE/M16-0361_SUPPLEMENT.PDF

Centers for Disease Control and Prevention. 2022. Diabetes Risk Factors. Atlanta: Centers for Disease Control and Prevention, US Department of Health and Human Services. https://www.cdc.gov/diabetes/basics/risk-factors.html. Accessed October 9 2023.

Chen, M., Sun, Q., Giovannucci, E., Mozaffarian, D., Manson, J. A. E., Willett, W. C., & Hu, F. B. (2014). Dairy consumption and risk of type 2 diabetes: 3 cohorts of US adults and an updated meta-analysis. BMC Medicine, 12(1), 1–14. https://doi.org/10.1186/S12916-014-0215-1/FIGURES/3

Chiuve, S. E., Fung, T. T., Rimm, E. B., Hu, F. B., McCullough, M. L., Wang, M., Stampfer, M. J., & Willett, W. C. (2012). Alternative dietary indices both strongly predict risk of chronic disease. Journal of Nutrition, 142(6), 1009. https://doi.org/10.3945/JN.111.157222

El Sayed, N.A., Aleppo, G., Aroda, V.R., et al., on behalf of the American Diabetes Association. Summary of revisions: Standards of care in Diabetes-2023. Diabetes Care, 1;46(Suppl 1):S5-S9. doi: 10.2337/dc23-Srev.

Estruch, R., Ros, E., Salas-Salvadó, J., et al. (2018). Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. New England Journal of Medicine, 378(25), e34. doi.org/10.1056/NEJMOA1800389/SUPPL_FILE/NEJMOA1800389_DISCLOSURES.PDF

Hamilton, L. 2015. What Is the Plate Method? Diabetes Forecast. http://www.diabetesforecast.org/2015/adm/diabetes-plate-method/what-is-the-plate-method.html. Accessed April 17, 2020.

Hu, Y., Zong, G., Liu, G., Wang, M., Rosner, B., Pan, A., Willett, W. C., P.H., Dr., Manson, J. E., P.H., Dr., Hu, F. B., & Sun, Q. (2018). Smoking cessation, weight change, Type 2 diabetes, and mortality. New England Journal of Medicine, 379(7), 623. doi.org/10.1056/NEJMOA1803626

Knowler, W. C., Barrett-Connor, E., Fowler, S.E., Hamman, R.F., Lachin, J.M., et al. and the Diabetes Prevention Program Research Group. 2002. Reduction in the incidence of Type 2 Diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 346 (6), 393–403. doi: 10.1056/NEJMoa012512

McMacken, M., and S. Shah. 2017. A plant-based diet for the prevention and treatment of Type 2 Diabetes. Journal of Geriatric Cardiology 14 (5): 342–354. doi:10.11909/j.issn.1671-5411.2017.05.009. 

Mozaffarian, D. (2016). Dietary and policy priorities for cardiovascular disease, diabetes, and obesity. Circulation, 133(2), 187–225. doi.org/10.1161/CIRCULATIONAHA.115.018585/FORMAT/EPUB

Mursu, J., Virtanen, J. K., Tuomainen, T. P., Nurmi, T., and Voutilainen, S. (2014). Intake of fruit, berries, and vegetables and risk of type 2 diabetes in Finnish men: The Kuopio Ischaemic Heart Disease Risk Factor Study. American Journal of Clinical Nutrition, 99(2), 328–333. https://doi.org/10.3945/AJCN.113.069641

National Heart, Lung, and Blood Institute. n.d. Aim for a Healthy Weight. https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm. Accessed June 12, 2020.

Oba, S., Noda, M., Waki, K., Nanri, A., Kato, M., et al. (2012). Smoking cessation increases short-term risk of Type 2 diabetes irrespective of weight gain: The Japan public health center-based prospective study. PLoS ONE, 7(2). doi.org/10.1371/JOURNAL.PONE.0017061

Salas-Salvadó, J., Guasch-Ferré, M., Lee, C. H., Estruch, R., Clish, C. B., and Ros, E. (2016). Protective effects of the Mediterranean diet on Type 2 diabetes and metabolic syndrome. Journal of Nutrition, 146(4), 920S-927S. doi.org/10.3945/JN.115.218487

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015. 2015–2020 Dietary Guidelines for Americans. 8^th Ed. Washington, DC.

Watson, N. F., and E. Tasali. 2015. Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society." Sleep, 38 (6): 843–844.