A groundbreaking study published in The Lancet has revealed that over 800 million adults across the globe are currently managing diabetes. The prevalence of this chronic condition stood at approximately 14% in 2022. Alarmingly, the research indicated that nearly 60% of adults aged 30 and above who have diabetes were not receiving the necessary treatment last year.

As World Diabetes Day approaches, it is crucial to deepen our understanding of diabetes, focusing on prevention strategies, health implications, diagnostic methods, available treatments, and the lifestyle adjustments that can benefit both those living with diabetes and those looking to prevent it. To shed light on these topics, I had the opportunity to engage in a conversation with wellness expert Dr. Leana Wen, an emergency physician and adjunct associate professor at George Washington University, and a former health commissioner of Baltimore.

Why is the prevention of diabetes so critical, and what are the potential health consequences of this condition?

Dr. Leana Wen: Diabetes is a chronic ailment that carries significant health implications. According to the US Centers for Disease Control and Prevention (CDC), it is the eighth leading cause of mortality in the United States. It is also the primary cause of kidney failure and blindness in adults. Individuals with diabetes are two to four times more likely to develop cardiovascular diseases compared to those without the condition. Furthermore, it is a leading cause of lower limb amputations.

How widespread is diabetes, and are there specific groups that are more susceptible?

Wen: To address this, it's important to recognize that there are three main types of diabetes. Type 1 diabetes is thought to be triggered by an autoimmune response that halts insulin production, a hormone vital for regulating blood glucose levels. Individuals with type 1 diabetes must administer insulin daily. While most cases are diagnosed in childhood, some can occur later in life. Risk factors include a family history of type 1 diabetes. Currently, there is no known prevention for this form of diabetes.

Type 2 diabetes is the most prevalent form, accounting for 90% to 95% of all diabetes cases in the US. In this type, the body becomes insulin-resistant, leading to elevated blood sugar levels. Unlike type 1, which develops rapidly, type 2 diabetes typically progresses over several years, often going unnoticed until a diagnostic test is conducted. This form is usually diagnosed in individuals over 35, although there has been a recent increase in cases among younger demographics, including children and adolescents. Risk factors for type 2 diabetes include obesity, a sedentary lifestyle, and certain ethnicities such as African Americans, American Indians, Hispanics/Latinos, and Asian Americans/Pacific Islanders. A family history of type 2 diabetes in first-degree relatives is also a risk factor.

The third type, gestational diabetes, is diagnosed during pregnancy in women without a history of chronic diabetes. It usually resolves postpartum, but it increases the risk of the mother developing type 2 diabetes later in life and the child developing type 2 diabetes as well.

What preventive measures can individuals take to avoid developing diabetes?

Wen: To prevent the most common form, type 2 diabetes, it's essential to first understand your risk of prediabetes, a condition that precedes a diabetes diagnosis. The CDC offers a helpful calculator to quickly assess your risk. Those at higher risk should consult with their healthcare providers about diabetes and prediabetes screening, while those at lower risk should aim for healthy lifestyle choices to prevent these conditions. These include engaging in at least 150 minutes of physical activity per week; even less can be beneficial, as studies show that half the recommended amount can reduce the risk of chronic diseases. It's also crucial to minimize the consumption of ultraprocessed foods and opt for whole foods like fruits, vegetables, nuts, and legumes, and to eliminate sugary drinks. For guidance on dietary choices, individuals can seek referrals to nutritionists from their physicians. Maintaining a healthy weight also plays a role in reducing the risk of diabetes. Hypertension and high cholesterol often accompany diabetes, so it's important to monitor these conditions as well. The same lifestyle changes that help reduce the risk of diabetes also mitigate the risk of these other health issues, collectively increasing the risk of heart attacks and strokes.

How is diabetes diagnosed?

Wen: Diabetes can be diagnosed through several tests. An A1C test measures average blood sugar levels over the past few months, while random or fasting blood sugar tests can also be conducted. These tests are widely accessible and should generally begin at age 35. Depending on individual risk factors, some may need to start earlier. Physicians can order these tests; if not already done, it's worth discussing during your next medical appointment.

Once diagnosed with prediabetes or diabetes, what treatment options are available?

Wen: To prevent prediabetes from advancing to diabetes, individuals should aim to lose excess weight, increase physical activity, and adopt healthier eating habits. They should also address medical conditions like hypertension or high cholesterol that can exacerbate diabetes risk. Those with a diabetes diagnosis should collaborate with their healthcare provider to determine the most suitable treatments, which may include various medications adjusted based on response and side effects. Lifestyle modifications should continue to be a priority.

What lifestyle changes can benefit everyone, including those diagnosed with diabetes and those looking to prevent it?

Wen: We've already discussed the importance of exercise, especially for those with sedentary jobs; additional exercise is necessary to counteract prolonged sitting. Diet, maintaining a healthy weight, and managing other medical conditions are also crucial. Another key change is quitting smoking, as smokers are 30% to 40% more likely to develop type 2 diabetes.Quitting smoking can not only reduce the risk of diabetes, but also reduce the risk of heart disease and stroke for people who have been diagnosed with diabetes.Lastly, understanding your personal risk factors is essential, as it may dictate more frequent and earlier screenings based on your risk profile. Consider discussing diabetes with your healthcare provider during your next visit to assess your risk and determine the steps you can take to prevent and manage diabetes.