Diabetes adds a financial burden to the health care system. The medical cost for a person with diabetes is thought to be two to three times greater than for someone without it.
Metabolic syndrome is a collection of conditions that increases the risk of developing type 2 diabetes. They include a large waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol levels, high blood pressure, and a high fasting blood glucose level.
According to the Canadian Diabetes Association, metabolic syndrome can be diagnosed when three or more of the following risk factors are present.
|Triglycerides||greater than 1.7 mmol/L|
|High-density lipoprotein (HDL)||
|Blood pressure||greater than 130 mmHg systolic and/or greater than 85 mmHg diastolic|
|Fasting blood glucose||greater than 5.6 mmol/L|
Increasing age, family history, being overweight or obese, unhealthy eating, and physical inactivity all contribute to developing metabolic syndrome. Those with it are at risk of type 2 diabetes and cardiovascular disease. The Canadian Health Measures Survey (2007 to 2009) estimated that 15 per cent of Canadians met the conditions of metabolic syndrome.
Diabetes also takes a toll on quality of life. The personal cost of diabetes includes increased risk of complications like heart disease, stroke, kidney disease, and blindness. Diabetes is thought to shorten life by five to 10 years.
How can you know if you are at risk for type 2 diabetes? Often, the term pre-diabetes is used to describe those with a high risk of developing it. These people have a higher than normal fasting blood glucose and/or glucose tolerance. In pre-diabetes, blood glucose levels are near but not quite high enough to be called full-onset diabetes.
In the next eight to ten years, about four per cent of people with normal blood glucose will develop type 2 diabetes. Of those with pre-diabetes, 30 per cent will develop the disease. Pre-diabetes affects about five million
Canadians over the age of 20. The number is expected to increase as our population ages and obesity rates rise.
Identifying the risk factors for type 2 diabetes early may prevent the disease and its complications. The condition can be prevented or greatly delayed if early warning signs are found. As well, those at risk need to take an active role in changing their lifestyle.
Screening for type 2 diabetes should be done every three years in those over age 40. It should begin even earlier if there is a family history of type 2 diabetes or if you have other risk factors. These risk factors include:
One of the most encouraging studies on preventing type 2 diabetes is the Diabetes Prevention Program (DPP) study published in 2002. It involved 3234 people who were overweight and pre-diabetes. The study found that lifestyle intervention reduced their risk of developing diabetes by 58 per cent. The lifestyle intervention group fared far better than the group who took the prescription medication metformin at 850 milligrams, twice daily. (Metformin helps to lower blood glucose levels.) The group using medication reduced their diabetes risk by only 31 per cent.
Those in the lifestyle intervention group received counselling and support on diet, exercise and behavior change. They ate less fat and fewer calories. They exercised for a total of 150 minutes each week. Their goal was to lose seven per cent of their body weight and to maintain that loss. Fifty-eight per cent of this group did not develop type 2 diabetes. As well, they were less likely to develop metabolic syndrome. Their high blood pressure decreased, and their cholesterol levels improved.
Many other studies have found similar results. Physical activity, weight loss, and lifestyle changes, such as reducing stress and stopping smoking, greatly reduce the risk of developing type 2 diabetes.
The Canadian Diabetes Association 2008 Guidelines recommend aerobic and resistance exercises. For aerobic exercise, the suggested amount is 150 minutes at a moderate to vigorous intensity, each week. Spread it out over at least three days, and do not go more than two days in a row without exercise. Resistance exercises are recommended three times per week. If you have not been active, consider taking an ECG stress test before starting an exercise program any more vigorous than brisk walking.
Exercise helps the body to release endorphins. These hormones increase the sense of well-being and reduce hunger. Exercise also makes the body’s metabolic engine rev at a high rate. This burns more calories faster, making weight loss easier to manage.
The body mass index (BMI) measurement is one of the most recognized methods of assessing body weight (see sidebar). A normal BMI is between 18.5 and 24.9. In this range, there is the least risk of developing health problems. A BMI of 25 or greater means an increased risk of health problems. These include diabetes, cardiovascular disease, and certain cancers.
Extra weight is a significant diabetes risk. Body composition is equally important, particularly waist circumference. This indicates how much fat is deposited around the abdomen. Some bodies store more fat in this area, rather than in the hips, buttocks, and thighs. When this happens, there is a greater link to metabolic issues like diabetes.
A modest weight loss of five to ten per cent of initial body weight can greatly improve blood glucose, blood pressure, and cholesterol levels. As well, as weight is lost, waist circumference is also reduced. A dietitian can provide nutrition counselling to assist with a safe, healthy and gradual weight loss that can be maintained.
Weight loss and exercise are key to preventing type 2 diabetes. Reducing stress and stopping smoking are also important. When the body is stressed, cortisol hormones are released. These hormones promote abdominal fat being deposited. This, in turn, increases waist circumference, adding to increased diabetes risk.
Smoking can increase blood glucose, impair the body’s sensitivity to insulin, and encourage abdominal obesity. The combination of smoking and diabetes is particularly dangerous. It increases the risk of more serious complications of diabetes, including cardiovascular disease, kidney disease, and neuropathy (nerve damage). Quitting smoking will make breathing easier, improve circulation, and increase lung capacity. Exercise will feel like less work and be more enjoyable. Within a year of quitting smoking, the heart attack risk related to smoking is cut in half.
If you need a BMI calculation or help with diet and exercise, ask your pharmacist for more information. Your Safeway Pharmacy can provide you with information and resources to help you get started and maintain a healthy lifestyle. You can play an active role in preventing type 2 diabetes.