Dr. M. Wasim Ghori (Medical Director Heart & Diabetes Clinics, Mumbai, India)
Diabetes is one of the most prevalent lifestyle disorders in India. At present, nearly 62 million people are living with diabetes and the number is expected to go to 80 million by 2025. This also makes India one among the top three nations with highest number of diabetics. The rising prevalence of diabetes is a warning sign for Indian health care system to be alert and get ready with adequate diabetes management.
The etiology of type 2 diabetes is complex and is associated with non-modifiable risk factors such as age, genetics, race and ethnicity. Lifestyle factors such as being overweight, unhealthy eating patterns, lack of physical activity, smoking habits and other sedentary behaviours are also the major contributing factors for most lifestyle disorders. However, these are reversible or modifiable risk factors. The negative impact of unhealthy lifestyle on diabetes clearly suggests that controlling these factors can reduce the disease burden. Clinical data reports that lifestyle modification interventions such as diet changes, exercise and weight loss can reduce diabetes risk by 50 to 60%. Let’s look at the influence of some of the lifestyle factors on diabetes and how controlling it can reduce the risk.
Dietary Habits
Indian experts had observed long ago that diabetes was more prevalent among rich people who consumed oil, flour and sugar in excessive amounts. Studies all over the world have reported a strong association between high intake of carbohydrates & fats and development of diabetes. Increased consumption of meat, sweets, fried foods, carbonated drinks and diet soft drinks that contain glycated chemicals contribute to the increased the risk of insulin resistance and type 2 diabetes. On the other hand, diet that is rich in whole grains, fruits & vegetables contains high amount of nutrients, fibre and antioxidants which acts a protective barrier against diabetes. A typical dietary pattern that comprises of high consumption of whole grains, fruits and vegetables, fish, nuts, and legumes; moderate consumption of poultry and minimal consumption of refined grains, red/processed meats and sugar-sweetened beverages is considered ideal for diabetes management.
Diet rules for diabetes management based on health guidelines
- Consume carbohydrate only in the form of starch (polysaccharides) such as, rice, beans, bread, potatoes etc.
- Avoid refined sugars such as glucose, sucrose, and their products (soft drinks, sweets, toffees, etc.)
- Minimise the consumption of butter, lard, egg yolk and other foods high in saturated fats.
- Limit salt intake.
- Restrict high-protein intake and shell fish if you have kidney problems.
- Avoid smoking.
- Increase intake of fruits, vegetables, legumes and whole grains.
Weight Management
Excess weight is one of the established risk factors of developing diabetes. Studies reveal that obese men have 7-fold and obese women have 12-fold higher risk of having type 2 diabetes, compared with individuals in the healthy weight range. Obesity increases the chances of inflammation and insulin resistance in the body which is a trigger to type 2 diabetes. Experts have identified that the location of excess body fat also influences the occurrence of diabetes. Individuals who have fat deposition around the waist or abdomen are more likely to be at risk than those who carry more weight in their hips and thighs. Evidence also suggests that fat cells are more resistant to insulin than muscle cells, indicating that being overweight puts you at risk of diabetes.
Considering increased diabetes risk with excess fat, weight control becomes important in management of most lifestyle disorders. The benefit of weight loss in prevention of diabetes has been confirmed through several important clinical trials. The well-known Diabetes Prevention Program study revealed that weight loss can reduce or delay the onset of T2DM in obese individual who shows high blood sugar levels. The American Diabetes Association recommends people who have high blood sugar levels, or HbA1c 5.7–6.4% to reduce their body weight by 7% through increased physical activity and diet control.
Physical activity
Exercise is an integral part of diabetes management along with diet and medications. In fact, one recent study reported that skipping exercise even for a couple of days can worsen your diabetes. In people with diabetes sedentary behaviour increases the risk of diabetes by almost 14%, while exercise such as walking at least for 1 hr/day decreases the risk of diabetes by 34%. Studies also suggest that when you burn 500 calories your risk of diabetes goes down by 6%. Exercise increases sensitivity to insulin, improves metabolism, and reduces body fat. WHO recommends at least 150 minutes of exercise to every adult aged 18 to 65 years including those with diabetes and heart disease.
Smoking
Cigarette smoking results in increased insulin resistance and affects insulin secretion in people with and without diabetes. People who continue to smoke even after being diagnosed with diabetes have a very high risk of developing diabetes related complications. Studies report that smoking increases the risk of death by 48%, coronary heart disease by 54%, stroke by 44% and myocardial infarction by 52%. The diabetes management guidelines have therefore included smoking cessation as a part of effective treatment strategy. Smoking cessation can result in better blood sugar control, which is seen as improvement in HbA1c.
For a person with diabetes who continues to smoke, making too many lifestyle changes at a time can be difficult. Diet control, exercise routine, weight management, and smoking cessation at the same time can be overwhelming. This is where the behaviour change program can help. Individually tailored smoking cessation programmes may lead to improved outcomes. The health care professionals too can play an important role in counselling patients to stop smoking.
Take home message
Diabetes management demands certain changes to everyday lifestyle to make it healthier. In fact, lifestyle changes such as eating healthy diet, starting with a regular exercise routine, losing weight forms the initial treatment for diabetes. You may be given some medication but still need to continue with lifestyle changes to get better outcomes. Results from studies on diet and exercise interventions provide promising data for the effective management of Type 2 diabetes. The role of lifestyle changes is also clearly highlighted in the recent diabetes management guidelines. It appears to be of paramount importance that health care professionals put a lot of emphasis on adhering to a healthy lifestyle and maintaining it throughout.
“This World Diabetes Day, let us join hands to raise awareness of the impact that diabetes has on the family and to promote the role of the family and lifestyle modifications in the management, care, prevention and education of the condition”.
