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Preventive Measures
Research studies in the United States and abroad have found that lifestyle changes can prevent or delay the onset of type 2 diabetes among high-risk adults. These studies included people with IGT and other high-risk characteristics for developing diabetes. Lifestyle interventions included diet and moderate-intensity physical activity (such as walking for 2 ¨ö hours each week). For both sexes and all age and racial and ethnic groups, the development of diabetes was reduced 40 to 60 percent during these studies that lasted 3 to 6 years.
Studies have also shown that medications have been successful in preventing diabetes in some population groups. In the Diabetes Prevention Program, a large prevention study of people at high risk for diabetes, people treated with the drug metformin reduced their risk of developing diabetes by 31 percent. Treatment with metformin was most effective among younger, heavier people (those 25 to 40 years of age who were 50 to 80 pounds overweight) and less effective among older people and people who were not as overweight. There are no known methods to prevent type 1 diabetes. Several clinical trials are currently in progress.
Glucose control - Research studies in the United States and abroad have found that improved glycemic control benefits people with either type 1 or type 2 diabetes. In general, for every 1 percent reduction in results of A1C blood tests, the risk of developing microvascular diabetic complications (eye, kidney, and nerve disease) is reduced by 40 percent.
Blood pressure control - Controlling blood pressure can reduce cardiovascular disease (heart disease and stroke) by approximately 33 to 50 percent and can reduce microvascular disease (eye, kidney, and nerve disease) by approximately 33 percent. In general, for every 10 millimeters of mercury (mmHg) reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12 percent.
Control of blood lipids - Improved control of cholesterol and lipids (for example, HDL, LDL and triglycerides) can reduce cardiovascular complications by 20 to 50 percent.
Preventive care practices for eyes, kidneys, and feet - Detection and treatment of diabetic eye disease with laser therapy can reduce the development of severe vision loss by an estimated 50 to 60 percent. Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent. Detection and treatment of early diabetic kidney disease can reduce the development of kidney failure by 30 to 70 percent.
Appropriate nutritional supplementation - Adding adequate amounts of high grade nutritional supplements shown to be of benefit in diabetes may help improve daily glucose control, stabilize carbohydrate metabolism and prevent further complications from diabetes due to the glycosylated end products caused by elevated glucose levels.
Routine exercise - low glycemic index diet - Routine exercise directly helps improve glucose metabolism by increasing the activity of glucose transport protein, independent of the action of insulin. Combined with an appropriate low glycemic diet, exercise has been shown to be nearly twice as effective as a leading anti-diabetic medication. A recent study was halted prematurely due to the profound superior benefit of diet and exercise over the prescription medication. It would behoove practitioners and clinicians caring for diabetic patients not to underestimate the significant impact that diet and exercise has on diabetes morbidity. Too often health care providers neglect this all important aspect of care and education. If you are not proficient at providing a quality educational experience for your diabetic patients, please refer them to a facility that can implement this critical component of their total care plan. |