Diabetes is a growing epidemic in the United States and around the world. Over one-third of the American population has a blood glucose level above the normal range. Of the United States’ 323 million people, approximately 30 million have diabetes, while another 84 million have prediabetes. Given that one in three Americans is affected, everyone needs to be aware of the risk factors for developing diabetes. It is essential to know how to be proactive to delay and prevent the onset of Type 2 diabetes and its associated complications. Prediabetes and diabetes can lead to both physical complications and financial burdens when not properly treated and controlled. If you have prediabetes, you are at a greater risk of developing Type 2 diabetes, heart disease, and stroke. Both the American Diabetes Association (ADA) and the Centers for Disease Control and Prevention (CDC) have developed tests to evaluate your risk for developing prediabetes and diabetes. To take the risk test, visit the ADA’s website at diabetes.org or the CDC’s website at cdc.gov/diabetes. Here we take a look at what diabetes is and specific risk factors for developing it, as well as diagnostic criteria for prediabetes/diabetes and ways to delay or prevent diabetes. We will further explore how you can help educate family, friends, co-workers, and others about their risk for developing diabetes and ways to reduce their risk.
Prediabetes is an elevation in blood glucose levels that is higher than normal but not high enough to be diabetes. Diabetes is a disease in which the pancreas does not make enough insulin or the insulin made by the pancreas cannot be used correctly, also known as insulin resistance. Insulin is necessary to move our primary source of energy, carbohydrate, into our cells. Carbohydrate is a nutrient that turns into glucose. When people do not make enough insulin or their body cannot use the insulin produced, they start to develop high blood glucose levels, leading to prediabetes or diabetes.
Many factors can increase an individual’s risk for developing prediabetes or diabetes. These factors include being overweight/obese, having a family history of diabetes (especially a first-degree relative such as a parent or sibling), sedentary lifestyle, age, and race. Certain races and ethnicities have a higher risk of developing diabetes, including African American, Native American, Alaska Native, Hawaiian, Pacific Islander, Asian American, Hispanic, or Latino. When looking at risk factors for Type 2 diabetes, one should consider which are modifiable (in other words, what one can change) and which are non-modifiable risk factors (what one cannot change).
Laboratory testing for prediabetes and Type 2 diabetes should be considered when risk factors are present. These tests can be ordered by a primary-care provider. Factors that increase the risk for prediabetes and/or Type 2 diabetes include a body-mass index (BMI) greater than or equal to 25 kg/m2 or Asian Americans with a BMI equal to 23 kg/m2 or greater. People over the age of 45, women with a history of gestational diabetes, people with a history of heart disease or stroke, high blood pressure, low HDL cholesterol, or high triglycerides, and women with polycystic ovary syndrome are at increased risk as well.
Diagnosing prediabetes and diabetes is done by analyzing blood in a clinical laboratory, such as the one in your health-care provider’s office. These tests include a fasting blood glucose (FBG), an oral glucose tolerance test (OGTT), and an A1C test. An FBG is done after a person has not consumed any calories from food or drink for at least eight hours. An OGTT looks at your body’s ability to absorb glucose after two hours. The A1C can be taken at any time and estimates your blood glucose for the past three months. Prediabetes is diagnosed if a person’s FBG is 100 to 125 mg/dL, two-hour OGTT is 140 to 199 mg/dL or A1C falls between 5.7 and 6.4%. A diabetes diagnosis occurs if a person’s FBG is greater than or equal to 126 mg/dL, two-hour OGTT is greater than or equal to 200 mg/dL and A1C is greater than or equal to 6.5%.
There are many steps you can take to delay or prevent prediabetes and diabetes. Specifically, strive to be physically active with exercise and be as close to a healthy weight as possible.
Tips for better nutrition include eating less and/or having smaller portions of your favorite foods. One way to decrease portion size is using a smaller plate, like a salad plate instead of a dinner plate. Using the plate method can also help with portion control because it requires half of your plate to contain non-starchy vegetables like green beans, tomatoes, carrots, and salad greens, a quarter of your plate to contain a protein such as chicken, eggs, turkey, or beef, and the remaining quarter of your plate to contain a carbohydrate such as a dinner roll, pasta, rice, corn, black beans, or potatoes. The plate method works by only encouraging one plate serving per meal (no seconds, please). Food preparation is also crucial for healthy eating. Try to eat more foods that are steamed, baked, or grilled, and leave off high-fat sauces, gravies, and condiments such as butter, regular salad dressing, and mayonnaise. Finally, think about your snacks and drinks throughout the day. Planning ahead can help you eliminate extra calories and stick to your healthy eating plan. Nutritious snacks include raw vegetables, low-fat cheese, or small pieces of fresh fruit. Drink plenty of water and sugar-free drinks, such as unsweetened tea or coffee, instead of regular soda and other sugar-sweetened beverages.
Increased physical activity will also reduce your risk of developing prediabetes and Type 2 diabetes. Physical activity decreases insulin resistance, which will increase insulin sensitivity. Before engaging in any physical activity, always talk to your primary care provider about starting an activity plan. Most adults should participate in at least 150 minutes of moderate activity per week. Examples of moderate exercise include walking, jogging, swimming, hiking, aerobic dancing and heavy cleaning (i.e., mopping or vacuuming). Adults should additionally perform some resistance and flexibility exercises two to three times per week. Physical activity and exercise make you feel better by giving you more energy, toned muscles and assistance with needed weight loss. Try to be physically active more days than not, and do some type of activity (i.e., standing, stretching or walking) every 30 minutes to reduce prolonged periods of being sedentary.
Weight management is another risk reducer. A normal BMI is defined between 18.5 to 24.9 kg/m2. Anyone considered overweight or obese can still reduce their personal risk of developing diabetes with a modest weight change of five to 10 percent of their current body weight. For example, a person weighing 200 pounds can reduce the risk of developing diabetes by losing 10 to 20 pounds. Weight-loss achievement occurs with decreased calorie consumption through healthy eating and increased physical activity. To learn more about BMI and to calculate yours, go to cdc.gov/healthyweight/assessing/bmi/index.html.
Finally, you can reduce your risk for prediabetes and Type 2 diabetes by developing healthy coping techniques for everyday stress. Everyone has both physical and emotional stress in their lives. Healthy coping includes daily well-being habits of nutritious eating, increased activity, and getting enough sleep. Lack of sleep can affect the body’s ability to process glucose. Stress-relieving activities include doing things that are fun for you, perhaps spending time with friends and family, working on a hobby, watching television, listening to music, reading a book, and anything else that reduces stress in your life.
Start by talking with your family and friends about risk factors. Know your personal family history of diabetes. Tell other family members if you or someone else in the family has Type 2 diabetes because this increases their risk for the disease. Get screened for diabetes and encourage others to get tested—it could save their lives. Form support groups that promote healthy lifestyles through nutritious eating and increased physical activity. Start a walking or bicycle riding group. Get trained as a lay health coach to educate and help others. After training as a lay health coach, use your knowledge to inform others about risk factors for developing diabetes and resources available to prevent it. Other places to consider helping people learn more about prediabetes and Type 2 diabetes include places of worship, hair salons, barber shops, family reunions, and support groups.
Many national organizations and local agencies have resources and classes to help reduce your risk. Take one of the prediabetes and Type 2 diabetes risk-assessment tests. Then schedule a visit with your primary-care provider to find out if you have prediabetes. Look for licensed and certified diabetes educators in your area to learn more about education programs. Find a CDC-recognized diabetes prevention program near you.
Here are several resources to learn more about delaying and preventing diabetes:
National Diabetes Prevention Programs (DPP)
Find a list of DPPs in your area at cdc.gov/diabetes/prevention.
American Association of Diabetes Educators
Find a list of diabetes educators at diabeteseducator.org/patient-resources/find-a-diabetes-educator.
Academy of Nutrition and Dietetics
Find a list of local dietitians at eatright.org.
American Diabetes Association
Find helpful material on healthy eating and physical activity at diabetes.org.
USDA Choose My Plate
Find ideas on building a healthy plate at choosemyplate.gov/MyPlate.
In your area
Check your local government’s website for safe, paved walking paths and trails to increase physical activity.
Want to learn more about diabetes prevention? Read “Preventing Diabetes: A Window of Opportunity,” “Preventing Diabetes: Steps You Can Take,” and “Preventing Diabetes: More Steps You Can Take.”
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