Can Type 2 Diabetes be Prevented and Reversed? Article by Dr Ofelia Dirige

Posted on April 21, 2018

CAN TYPE 2 DIABETES BE PREVENTED AND REVERSED?

Dr. Ofelia V. Dirige, Kalusugan Kalakasan Ctr Hlt Wellness

Diabetes is a growing epidemic in the United States including San Diego, California. It brings with it both individual and extraordinary economic burden. It is a disease in which the body ‘s blood glucose or sugar level is too high. Normally, the body breaks down food into glucose and carries it to the cells throughout the body. The cells use a hormone called insulin to turn glucose into energy. The two main types of diabetes are type 1 (formerly called juvenile diabetes or insulin-dependent diabetes) and type 2 (formerly called adult-onset, or insulin dependent diabetes). Type 2 is the most common form and accounts for 90-95% of all diagnosed cases. In type 1 diabetes, the body does not make enough insulin and this causes the body’s blood sugar to rise. In type 2 diabetes, the body’s cells do not use insulin properly, a condition called insulin resistance. The body reacts by making more insulin and over time, the body cannot make enough insulin to control its blood sugar (1).

The high blood glucose damages nerves and blood vessels so that people with diabetes are at higher risk for complications such as heart disease, stroke, blindness, kidney disease, nerve problems, gum infections and loss of toes, feet or legs. The total medical costs and lost work and wages for people with diagnosed diabetes is estimated to be $245 billion. The risk of death for adults with diabetes is 50% higher than for adults without diabetes and medical expenses for people with diabetes are two times higher than people without diabetes. People with diabetes are also at higher risk for health complications as mentioned above (2).

Another term or health condition that is coming to the forefront is “Prediabetes.” This is a health condition in which the blood glucose level or sugar is higher than normal, but not high enough to be diagnosed as type 2 diabetes. According to the Center for Disease Control (CDC), people with prediabetes are more likely to develop diabetes within 5 years and more likely to have a heart attack (2).

 

HOW MANY ARE AFFECTED BY DIABETES

Diabetes affects an estimated 29.1 million Americans of all ages- or more than 1 out of every 11 people and another 86 million have prediabetes. One out of 4 do not know they have diabetes and 9 out of 10 do not know they have prediabetes. Without weight loss or moderate physical activity, 15-30% of people with diabetes will develop type 2 diabetes within 5 years. It is a major cause of heart disease and stroke and is the seventh leading cause of death in the United States (2). It is very common in Asian Americans including Filipino Americans and is the fourth common cause of their death.

In California, the majority (55%) of adults and almost one quarter (23%) of teens now have either diabetes or prediabetes. In the next 5 years, 1.9 million more Californians are expected to be diagnosed with diabetes, costing California an additional $15 billion in annual health care costs. Tragically, the burden of diabetes falls on low income communities and much of the costs will be paid by Medi-Cal (3).  In San Diego, 8% have diabetes and as many as 46% of adults are on the path to type 2 diabetes making a total of 54% (4).  A UCLA study (5) in 2016 showed that there are higher prediabetes rates among young Asian Americans (31%) including FilAms than among young white adults (29%).

 

HOW CAN YOU KNOW IF YOU ARE AT RISK FOR DIABETES

Many people who have prediabetes or diabetes don’t know they have it. The only way to find out is to get one’s blood sugar tested at least every three years starting at age 45. The American Diabetic Association (ADA) developed a Diabetes Risk Test and CDC, the Prediabetes Screening test to know if you are at high risk for prediabetes. A sample of the test is found in the websites of the ADA(6) and CDC (7) that you may fill out to find your risk for prediabetes. Your risk is higher if you have the following characteristics:

  • Age (45 yrs or older)
  • Gender- Men are more likely to be prediabetic than women.
  • Family history- parent, sister or brother are diabetic.
  • Ethnicity- Asian, Pacific Islander, African American, Latino, American Indian, multiracial.
  • Gestational diabetes- If a woman, had been diagnosed with gestational diabetes.
  • Overweight (See table of height and weights). Asian Americans including Filams are  at increased risk at lower body weights than the general public (about 15 lbs lower).
  • High blood pressure- above 140 or 90 (current cut-off point is 130)
  • Have high triglyceride level (250 or more)
  • Physically active fewer than three times a week
  • Education- Those with less than a high school education had higher prediabetes that those with more than high school education (5).
  • Individuals from low income and food-insecure households are high risk for prediabetes.

The good news is that you can manage your risk for type 2 diabetes. If you are high risk, the first step to do is to see your doctor who can tell you for sure if you have prediabetes and if additional testing is needed.

 

PREVENTION OF DIABETES THROUGH LIFESTYLE MODIFICATION

Yes, diabetes can be  prevented! The best evidence for diabetes prevention is the research obtained from the Diabetes Prevention Program (DPP) that is an intensive and behavioral lifestyle intervention that lowered the risks of type 2 diabetes by 58% in 3 years (8). The program shows how to make better food choices, be more physically active and find helpful ways to cope with problems and stress. The goal is to achieve and maintain a minimum of 7% weight loss through a healthy, low-fat, low calorie diet and 150 minutes of physical activity per week similar in intensity to brisk walking.  It is a goal-based intervention and all participants are given the same weight loss and physical activity goal but individualization was permitted to achieve the goals.

There is a structured curriculum that consists of 16 one-hour sessions at which participants meet with a trained lifestyle coach in a classroom setting. The lifestyle coach teaches about healthier eating, physical activity and gradual behavior change that will reduce their risk of diabetes.  After the initial 16 sessions, participants meet monthly to work on maintaining their progress. This program lasts for one year.

The DPP enrolls people who have prediabetes into this low-cost lifestyle program designed to be administered outside the traditional setting of clinics and hospitals. To be eligible, a person must not have been previously diagnosed with diabetes, must be at least 18 years of age, have a body mass index (BMI) of at least 25 and have either a hemoglobin A1c value between 5.7-6.4% or experienced gestational diabetes during pregnancy. In person sessions are provided by trained coaches, community health workers and promoters because they are most able to support life changes in way that are most culturally and linguistically meaningful.

 

DIABETES PREVENTION PROGRAMS IN SAN DIEGO

The San Diego DPP is a CDC-led, evidence-based lifestyle change program designed to prevent or delay the development of type 2 diabetes among at-risk San Diegans. Starting 2015, the County of San Diego Health and Human Services Divisions of Public Health Services (PHS) and Aging & Independence Services (AIS) began offering the DPP in San Diego as part of the CDC-funded Prevention Initiative administered through the Live Well SD Healthy Works (9). For more information about this program contact kyra.reinhold@sdcounty.ca.gov or visit PreventDiabetesSD.org.

The Skinny Gene Project (SGP) is also a CDC-led lifestyle intervention program based in San Diego that specializes in working wit Filipino Americans. Currently, it is the only non-traditional based program in San Diego that has been approved by CDC. They are currently recruiting participants to the program who can then be lifestyle coaches. Kalusugan Kalakasan Center for health and Wellness and SGP has organized a group interested in diabetes prevention to meet and plan a strategy on how to inform the FilAm population about the DPP program.  Among the members are the Samahan Health Center, SD Lions Club, and some interested individuals. For more information on the Skinny Gene Project  or to participate in the program, contact ayamorihana@gmail,com or alyssamonge@gmail .com for Kalusugan Ctr for Heath & Wellness. There are 10 other groups in the SD County that offer DPP programs and are awaiting full recognition from CDC.

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References:

  1. Combination of Five Lifestyle Factors Reduces Diabetes Risk. National Heart, Lung and Blood Institute. U.S. Department of Health and Human Services.
  2. Combination of Five Lifestyle Factors Reduces Diabetes Risk. National Heart, Lung and Blood Institute. U.S. Department of Health and Human Services.
  3. A Snapshot. Diabetes in the United States. National Diabetes Statistics report: estimates of diabetes and its burden in the U.S, 2014. US. Department of Health and Human Services, Centers.
  4. Elojaune G Cofer. First ever state funding in California for the Diabetes Prevention Program. Public Health Advocates.
  5. Prediabetes- A generation in jeopardy. Prediabetes and Diabetes by County. UCLA Center for Health Policy and research, March 2016.
  6. Jonathan Dale. Majority of Californians ae prediabetic or diabetic. What do we do? http://alliancehealthcarefoundation.org/
  7. American Diabetes Association website: www.diabetes.org or call 1-800- 342-2383.
  8. Center for Disease Control: www.cdc.gov/diabetes/prevention
  9. John Anderson, Meghan Riley and TD Everette. How Proven Primary Prevention Can Stop Diabetes. The Voice of Women in Diabetes. American Diabetes Association, Clinical Diabetes, 2012 Apr; 30 (2); 76-79.
  10. San Diego Diabetes Prevention Program