Introduction
Type 2 diabetes mellitus is distinguished by insulin resistance and a relative disorder in insulin secretion. The production and development of the disease is not completely understood and we find genetic factors as well as environmental factors affecting the insulin release. The disease is increasingly common and basically caused due to obesity and sedentary lifestyle. The chronic metabolic disorder affects both the insulin secretion and insulin action. It is the suppressed hepatic glucose production as well as lower insulin-mediated glucose uptake by the muscles that contribute equally to postprandial hyperglycemia.
The dominance of risk factors
Nearly 400 million people worldwide are affected by diabetes and its occurrence is rising in almost every country. The prevalence of diabetes ranges from 6 to 13 % in the United States (Li et al., 2011). We find a fast rise in the incidence of type 2 diabetes especially in the past few years, according to the National Health and Nutrition Examination Survey. There is a growing concern over the marked increase in childhood obesity and the pervasiveness of diabetes is expected to increase considerably in the coming years. India, Polynesia, China and other Pacific islands too show the prevalence of pre-diabetes (Collins et al., 1994).
Abnormal Metabolism in Glucose
The ability to predict the development of type 2 diabetes is still limited, but one can document abnormal glucose metabolism many years before the onset of diabetes. The risk of developing type 2 diabetes is spread across all strata of abnormal glycemia. It is estimated that about 25 percent of these subjects progress to diabetes gradually (Nathan et al., 2007). The additional risk factors for diabetes include family history and obesity.
The rate of succession from IGT or impaired glucose tolerance to overt diabetes differs among different populations. As per the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, individuals with fasting glucose values that are higher as compared to the normal range too stand a risk of developing type 2 diabetes (Nichols, Hillier, & Brown, 2008). An increased risk of diabetes has been found in those with fasting glucose levels less than 81 mg/dL. Subjects with abnormalities in impaired glucose tolerance or impaired fasting glucose tests carry an increased risk of progressing to diabetes.
Clinical Risk Factors
Individuals with a family history carry two to three-fold increased chances of developing diabetes. The risk is even higher among Asians, African Americans, Hispanics as compared to whites (Shai et al., 2006). With increasing body weight, the risk increases as obesity induces resistance to uptake of insulin-mediated peripheral glucose. Another major determinant of the risk of insulin resistance is the distribution of excess adipose tissue. Those subjects with abdominal obesity are at a higher risk.
Lifestyle and behavioural factors such as alcohol consumption, diet, smoking, physical activity, sleep duration too play a role in the risk of diabetes (Reis et al., 2011). A sedentary lifestyle promotes weight gain and lowers energy expenditure. Cigarette smoking has been linked to the risk of type 2 diabetes as it may impair insulin sensitivity. Quantity and quality of sleep too leave an impact on type 2 diabetes mellitus. We find an association with an increased incidence because of the difficulty in initiating and maintaining sleep. Dietary patterns too influence the risk of type 2 diabetes mellitus. Some of the food habits that have been associated with an increased risk of diabetes are consumption of red meat, sugar, processed foods etc. A healthy diet made of fresh fruits, vegetables, whole grains and nuts lowers the risk. Sugar-sweetened beverages have been associated with obesity in children.
Medical Conditions
Women who have had gestational diabetes carry a higher risk for developing type 2 diabetes. Heart failure and other cardiovascular diseases too have been linked to an increased risk of type 2 diabetes. Several studies have found a relationship between Hyperuricemia and higher levels of serum uric acid to a higher risk of developing type 2 diabetes (Niskanen et al., 2006). Patients with the metabolic syndrome too have been found to be at principally high risk for type 2 diabetes. Levels of endogenous sex hormones too may influence the risk of type 2 diabetes in men and women.
Prevention of Diabetes
One can prevent the onset of type 2 diabetes and lower the risks, according to studies. One can lower the risks by being active and losing weight. People need to change their lifestyle and dietary habits. There is evidence that people who quit smoking also lowered the risk of developing type 2 diabetes. If you have pre-diabetes, the first step to follow is to induce some lifestyle changes, before the condition develops into full-blown diabetes. Choose a diet made of fresh fruits, vegetables and take less of meats, sweets and processed foods. Follow an active exercise for at least 30 minutes a day. Go for a walk or jogging or join a hobby like gardening and dancing. Quit unhealthy habits like alcohol consumption and smoking and take your medicines in time and as prescribed by your doctor.
Three Major Prevention Programs for Patients with Diabetes
The National Diabetes Prevention Program
The prevention program encourages teamwork among community-based organizations, federal agencies, employers, health care professionals, academia, etc. to delay the onset of type 2 diabetes and help raise awareness regarding the same. The inaugural partners of the Program, UnitedHealth Group and YMCA played an instrumental role in expanding the reach of this program and encouraging other organizations to be a part of it ("CDC Awards Grant to Diabetes Prevention and Control Alliance to Expand National Program to Prevent Type 2 Diabetes," 2012). This program makes people aware and helps them lower the risk of developing type 2 diabetes. It encourages them to make modest behaviour and lifestyle changes. Participants of the program get a lifestyle coach to guide them and to motivate participants to share their experiences for dealing with challenging situations.
The NHS Health Check Programme
The number of people with Type 2 diabetes is fast rising in UK, just like the rest of the world. With nearly 4 million people living with the condition, billions of pounds are spent on the disease as well as combating with its complications (Downey, 2009). The NHS Health Check programme carries a huge potential to identify people with Type 2 diabetes and give support and lifestyle interventions to lower their risks. However, Diabetes UK is not too happy with the efforts and is disappointed in the poor and patchy implementation of the program.
YMCA's Diabetes Prevention Program
The objective of YMCA’s Diabetes Prevention Program is to help you remain free of diabetes as well as lead a healthier lifestyle (Ackermann, 2013). The program works with patients to make the necessary changes so as to reduce the risks of this condition. One learns about and is encouraged to adopt healthy eating and life style habits. One gets support and encouragement from their fellow classmates and the expert lifestyle coach at the YMCA’s Diabetes Prevention Program.
References
Ackermann, R. T. (2013). Working with the YMCA to implement the Diabetes Prevention Program. American journal of preventive medicine, 44(4 Suppl 4), S352. doi: 10.1016/j.amepre.2012.12.010
CDC Awards Grant to Diabetes Prevention and Control Alliance to Expand National Program to Prevent Type 2 Diabetes. (2012). Managed Care Business Week, 20.
Collins, V. R., Dowse, G. K., Toelupe, P. M., Imo, T. T., Aloaina, F. L., Spark, R. A., & Zimmet, P. Z. (1994). Increasing prevalence of NIDDM in the Pacific island population of Western Samoa over a 13-year period. Diabetes Care, 17(4), 288-296.
Downey, J. (2009). Implementing the NHS Health Checks programme. Diabetes and Primary Care, 11(4), 206.
Li, C., Balluz, L. S., Okoro, C. A., Strine, T. W., Lin, J. M., Town, M., . . . Valluru, B. (2011). Surveillance of certain health behaviors and conditions among states and selected local areas --- Behavioral Risk Factor Surveillance System, United States, 2009. MMWR Surveill Summ, 60(9), 1-250.
Nathan, D. M., Davidson, M. B., DeFronzo, R. A., Heine, R. J., Henry, R. R., Pratley, R., & Zinman, B. (2007). Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care, 30(3), 753-759. doi: 10.2337/dc07-9920
Nichols, G. A., Hillier, T. A., & Brown, J. B. (2008). Normal fasting plasma glucose and risk of type 2 diabetes diagnosis. Am J Med, 121(6), 519-524. doi: 10.1016/j.amjmed.2008.02.026
Niskanen, L., Laaksonen, D. E., Lindstrom, J., Eriksson, J. G., Keinanen-Kiukaanniemi, S., Ilanne-Parikka, P., . . . Uusitupa, M. (2006). Serum uric acid as a harbinger of metabolic outcome in subjects with impaired glucose tolerance: the Finnish Diabetes Prevention Study. Diabetes Care, 29(3), 709-711.
Reis, J. P., Loria, C. M., Sorlie, P. D., Park, Y., Hollenbeck, A., & Schatzkin, A. (2011). Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med, 155(5), 292-299. doi: 10.7326/0003-4819-155-5-201109060-00006
Shai, I., Jiang, R., Manson, J. E., Stampfer, M. J., Willett, W. C., Colditz, G. A., & Hu, F. B. (2006). Ethnicity, obesity, and risk of type 2 diabetes in women: a 20-year follow-up study. Diabetes Care, 29(7), 1585-1590. doi: 10.2337/dc06-0057
