The WHO global report (2016) estimates that 8.5% of the worldwide adult population have diabetes with some 80% of Type 2 diabetics (T2Ds) classified as overweight.
Despite health-related behavior changes being difficult to achieve, personal responsibility, in terms of lifestyle modification and self-management, is key to safely managing/reversing Type 2 diabetes mellitus.
Most pharmacological interventions preventing T2DM is indirectly through weight loss.
The Mediterranean diet aids in weight loss encourages healthy eating and the food is well proportioned, favoring whole over-processed food. With its focus on fruits, vegetables, whole grains, legumes, olive oil, and seafood, it helps maintain normoglycaemia and has been associated with a reduced risk of diabetes.
The Paleolithic or ‘Paleo’ diet is based on foods believed to have been eaten regularly during the stone age and includes lean meat, fish, shellfish, fruits, vegetables, roots, eggs, and nuts but excludes grains, dairy products, salt, or refined fats and sugar.
Paleolithic diet improves glucose tolerance, independent of weight-loss, after 12 weeks. Consumption of a Paleolithic diet for three weeks significantly reduces weight, body mass index (BMI), waist circumference (WC) and systolic blood pressure (SBP).
The Atkins diet is low in carbohydrate and high in protein and fat, restricting dieters to 20 g of carbohydrate until glycemic control is attained. The effects of low carbohydrate and low-fat diets were compared in obese and diabetic patients. After one year, weight loss was similar between groups, but effects on dyslipidemia and glycemic control were more favorable with a low-carbohydrate diet.
Plant-based nutrition offers advantages in the prevention and management of T2DM. Vegetarians have approximately half the risk of developing diabetes as non-vegetarians. Non-vegetarians were 74% more likely to develop diabetes over a 17-year period than vegetarians. A low-fat, plant-based diet with little or no meat may help prevent and treat diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance.
Low-fat vegan diet with a diet based on the American Diabetic Association guidelines found that people on the low-fat vegan diet reduced their Hba1C levels by 1.23 points compared to a reduction of only 0.38 points associated with the ADA guidelines. In addition, 43% of people on the low-fat vegan diet could reduce their medication, compared with 26% of those on the ADA diet.
Over 50% of people with diabetes, mostly Type 2, experiment with nutritional supplements, herbal treatments, and other non-vitamin, non-mineral pills and capsules.
Inadequate evidence for the use of vitamins and mineral supplements in diabetes management has led the ADA to not endorse their use. However, some evidence seems to exist that supplementation with certain vitamins and minerals can improve glycaemic control and reduce the risk of macro- and microvascular complications.
Gut flora in patients with T2DM differs from that in non-diabetics. Factors affecting gut flora and T2DM include genetics, use of medications (e.g. Antibiotics), and diet. Additionally, the consumption of probiotic bacteria such as those found in yogurt and other fermented milk products can beneficially alter the composition of the gut flora to which factors such as obesity, insulin resistance, fatty liver disease and low-grade peripheral inflammation are less well correlated.
The benefit of exercise in preventing diabetes has been demonstrated in several studies.
Physical activity, reported a lower risk of developing diabetes with regular, moderate physical activity compared with being sedentary. The benefits persisted after adjustment for BMI, suggesting an independent effect of exercise on glucose metabolism.
Either weight training or aerobic exercise, for at least 150 minutes per week, was associated with a lower risk of developing Diabetes Mellitus compared with no physical activity.
Stress is an independent risk factor for T2DM, with a 2.3 fold risk of developing diabetes over 3 years.
Lifestyle changes and pharmacological interventions act both directly, and indirectly through weight loss, to prevent the development of Diabetes Mellitus. Lifestyle changes address the issue at its’ heart and are safe though difficult to achieve and maintain.
MBBS, MD, PG Diploma in Diabetes (South Wales,UK)
Specialist Internal Medicine
Aster Clinic, Karama (Union Medical Centre)