At present, type 1 diabetes cannot be prevented. The environmental triggers that are thought to generate the process that results in the destruction of the body’s insulin-producing cells are still under investigation.
While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviours commonly associated with urbanization. These include consumption of unhealthy foods and inactive lifestyles with sedentary behaviour. Studies from different parts of the world have established that lifestyle modification with physical activity and/or healthy diet can delay or prevent the onset of type 2 diabetes.
Modern lifestyles are characterised by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes.
Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well.
Population based interventions and policies allow healthy choices through policies in trade, agriculture, transport and urban planning to become more accessible and easy. Healthy choices can be promoted in specific settings (school, workplace and home) and contribute to better health for everyone. They include exercising regularly and eating wisely which will help to maintain normal levels of blood glucose, blood pressure and lipids.
There is overwhelming evidence from studies in the USA, Finland, China, India and Japan that lifestyle changes (achieving a healthy body weight and moderate physical activity) can help prevent the development of type 2 diabetes in those at high risk.
The Da Qing Study examined the effect of a 6-year diet and exercise intervention in Chinese individuals with Impaired Glucose Tolerance (IGT) and an average age of 45. The diet intervention alone was associated with a 31% reduction in the risk of developing type 2 diabetes, while the exercise intervention alone showed a 46% reduction. The combined diet and exercise group had a similar 42% reduction in the risk of developing type 2 diabetes during a 6-year follow-up period.
The Finnish Diabetes Prevention Study (DPS)was the first randomized controlled trial to specifically examine the effect of a lifestyle intervention in preventing type 2 diabetes. This study randomly assigned 522 overweight or obese individuals with IGT to either a lifestyle intervention or a control group and followed them for approximately 3 years. The lifestyle intervention provided individualised counseling focused on achieving and maintaining healthy body weight, reducing fat intake, increasing fibre intake and increasing physical activity. After two years, the incidence of type 2 diabetes in the intervention group was less than half that observed within the control group.
The Diabetes Prevention Program (DPP)was conducted in 3234 US adults with IGT. Unlike most previous studies, the cohort was diverse and included a large proportion of women (68%) and ethnic minorities (45%), and compared lifestyle intervention versus drug intervention (metformin) and a placebo control group over 2.8 years. The DPP reported that both lifestyle intervention and metformin had positive effects on the prevention of type 2 diabetes and restoring normal glucose tolerance. The lifestyle intervention was more effective in preventing type 2 diabetes, particularly in older adults.
The Indian Diabetes Prevention Program (IDPP) was a prospective community-based study, that examined whether the progression to type 2 diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than in multiethnic American, Finnish and Chinese populations Results showed that progression of IGT to type 2 diabetes is high in native Asian Indians. Both lifestyle modification and metformin significantly reduced the incidence of type 2 diabetes in Asian Indians with IGT.
IDF recommendations for a healthy diet for the general population
Choosing water, coffee or tea instead of fruit juice, soda, or other sugar sweetened beverages.
Eating at least three servings of vegetable every day, including green leafy vegetables.
Eating up to three servings of fresh fruit every day.
Choosing nuts, a piece of fresh fruit, or unsweetened yoghurt for a snack.
Limiting alcohol intake to a maximum of two standard drinks per day.
Choosing lean cuts of white meat, poultry or seafood instead of red or processed meat.
Choosing peanut butter instead of chocolate spread or jam.
Choosing whole-grain bread, rice, or pasta instead of white bread, rice, or pasta.
Choosing unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil or palm oil.
A particular threat in terms of the associated risk of developing type 2 diabetes is the consumption of high sugar foods, particularly sugar-sweetened beverages, In 2014, the World Health Organization (WHO) issued new recommendations to limit sugar intake. IDF fully supports these recommendations and in response published the IDF Framework for Action on Sugar.