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Healthy Ways to Keep Diabetes at Bay

Exercise, weight loss can prevent or delay onset of the disease

FRIDAY, Nov. 28, 2003 (HealthDayNews) -- As Americans become fatter and continue to ignore the messages to lose weight and exercise regularly, doctors aren't just worrying about the increasing threat of heart disease.

The extra pounds and sedentary lifestyles are putting more people at risk of diabetes.

In the past decade, the prevalence of diabetes has skyrocketed 40 percent -- from 4.9 percent of the population to 6.9 percent. And by 2050, the number of Americans diagnosed with the disease will jump by 165 percent, experts predict.

Those worrisome rates dovetail with a disturbing increase in the number of overweight Americans. In 1999, an estimated 61 percent of U.S. adults were either overweight or obese, health officials estimate.

And those same officials hope to highlight the link between excess weight and diabetes during November, American Diabetes Month.

When diabetes is diagnosed in overweight adults age 30 and older, it's most often type 2, in which the body doesn't make enough of the hormone insulin, which transports sugar from your blood to the cells for fuel. Or the cells ignore the insulin.

In type 1 diabetes, the body doesn't produce insulin at all, so those with this form of the disease must inject insulin to keep their blood sugar levels under control.

But there's a third group of people flirting with trouble -- the estimated 20 million Americans with a condition called impaired glucose tolerance, which often precedes diabetes.

People with impaired glucose tolerance (IGT) have blood sugar levels higher than normal but not high enough to say they have diabetes. As many as 10 of every 100 persons with IGT will develop diabetes each year, according to the Joslin Diabetes Center in Boston.

If you have IGT, expect some strong suggestions from your doctor to improve your health habits. Losing weight, exercising regularly and eating more healthfully might just bring you back from the brink of diabetes.

Embracing a healthy lifestyle is definitely worth the effort, says Dr. Gerald Bernstein, past president of the American Diabetes Association and an associate clinical professor of medicine at the Albert Einstein College of Medicine in New York City. While genetics plays a role in who gets diabetes, he says, "the variables are exercise, diet and age."

By paying attention to exercise and diet and your weight, it's possible to prevent or delay the onset of type 2 diabetes for many years, Bernstein says. And doing so will limit some of diabetes' dangerous complications, such as kidney problems or blindness.

Impaired glucose tolerance also "puts you at risk for cardiovascular disease even if you never get the diabetes," Bernstein says.

Motivating patients is difficult but doable, Bernstein says. He leads by example. When the 70-year-old had an office in uptown Manhattan, he'd regularly take a running break in nearby Central Park.

He also stresses modest lifestyle changes, especially if someone isn't used to exercise. "It doesn't have to be running or anything dramatic," he says. Instead, focus on having an active lifestyle -- take the stairs, park farther from the store.

Adds Dr. Aramesh Saremi, another diabetes expert: "Brisk walking a half hour a day most days of the week is enough."

Saremi is with the Phoenix Epidemiology and Clinical Research Branch of the National Institute of Diabetes and Digestive and Kidney Diseases. He evaluated 1,728 non-diabetic men and women, tracking their physical activity for six years. The more active the person, the less likely they were to develop type 2 diabetes, she reported in the Oct. 1 issue of the American Journal of Epidemiology.

For weight loss, another diabetes expert, Dr. Eugene Barrett, refers his at-risk patients to a dietitian who can help evaluate their diet and suggest changes that will result in fewer pounds and better food choices.

The dietitian can also coach people in "intelligent shopping," such as how to read labels for fat content, says Barrett, president of the American Diabetes Association and a professor of medicine at the University of Virginia Medical School.

The study that most experts say proves the value of lifestyle changes is called the Diabetes Prevention Program. In that study, halted early in 2001 when the benefits of exercising and losing weight became apparent, researchers looked at 3,234 people with impaired glucose tolerance. They compared three groups: One made lifestyle changes such as losing weight and exercising regularly; another group was put on oral diabetes medication; and the third took placebo pills.

During the three-year follow-up, only 14 percent of the exercise and weight loss group developed type 2 diabetes, but 22 percent of the medication group and 29 percent of the placebo group did.

Some people would rather pop a pill and avoid the necessary lifestyle changes. And convincing people to lose weight and exercise regularly can be frustrating, Barrett says.

But then along comes a patient who actually does make healthful changes and delays the onset of the disease. "You feel very good when someone figures it out," Barrett says.

More information

To learn more about diabetes, visit the American Diabetes Association or the Joslin Diabetes Center.

SOURCES: Eugene Barrett, M.D., Ph.D., professor, medicine, University of Virginia Medical School, Charlottesville, Va., and president, American Diabetes Association; Gerald Bernstein, M.D., past president, American Diabetes Association, and associate clinical professor, medicine, Albert Einstein College of Medicine, New York City; Aramesh Saremi, M.D., clinical fellow, Phoenix Epidemiology and Clinical Research Branch of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix; Oct. 1, 2003, American Journal of Epidemiology
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