Type 2 Diabetes: Prevalent, Pricey and Preventable
The incidence of type 2 diabetes in the U.S. is skyrocketing, largely due to the increased rates of overweight and obesity.
- Currently, 9.3 percent of the U.S. population has diabetes.
- About one-quarter of people with diabetes don’t know they have it.
- The prevalence of diabetes is predicted to double or triple1 by the year 2050—to one in three people—if current trends continue.
- 37 percent of the adult population have pre-diabetes, based on fasting glucose levels, which puts them at high risk of developing full-blown diabetes.
Read more on diabetes statistics in CDC’s 2014 National Diabetes Statistics Report.2
Health professionals play a key role in helping prevent and manage type 2 diabetes by accurately diagnosing the disease, educating patients and clients about it, and developing feasible and actionable plans to attain blood sugar control.
Diabetes Prevention: Why does it matter?
Diabetes is the seventh leading cause of death in the United States. Diabetes has far-reaching implications to people personally through compromised health and productivity, and to society through elevated medical expenses.
Complications of diabetes include:
- Heart disease and stroke
- Retinopathy leading to blindness
- Kidney disease
- Dental disease
- Complications of pregnancy
- Nervous system damage leading to amputations
It is estimated that diabetes costs the nation a total of $245 billion each year. About 70 percent of this total is direct costs associated with medical expenses, and 30 percent is indirect costs in the form of disability and lost productivity.
Children are not immune from developing type 2 diabetes; in fact, it is predicted that one in three children born in the year 2000 will develop diabetes in their lifetime. Minorities and older adults are also at high risk of developing diabetes.3
Diet and Diabetes: What Can Be Done?
Type 2 diabetes can be prevented, managed and in some cases even reversed by following a healthy meal plan, engaging in regular physical activity, losing extra weight and sometimes taking medications.4
If you could help your pre-diabetic patients avoid diabetes—and your diabetic patients manage the disease—simply by adopting a healthy lifestyle and diet, wouldn't you?
There is no one perfect diet for everyone with diabetes. Food—especially carbohydrate—consumption needs to be balanced with exercise and medications to manage blood sugar levels. Often, however, people with diabetes become overly fixated on “counting” carbohydrates, which may inadvertently lead them to choose processed, packaged foods that label grams of carbohydrates. Clients should be encouraged to consume whole, natural foods as much as possible for their higher nutritional quality, even if the exact carbohydrate amount is unclear.
Choosing nutrient-dense foods from all food groups is important to get enough high-quality nutrients without too many calories. In general, a healthy diet5 will include a wide variety of foods such as:
- Whole grains
- Dairy products
- Lean meats, beans and poultry
People with diabetes should also consume regular meals and snacks throughout the day to keep blood sugars levels constant. Breakfast, often deemed the ‘most important meal of the day,’ is even more important for diabetics. Research shows that the effects of skipping breakfast persist throughout the day, and simply eating a morning meal will help reduce swings in blood sugar after lunch and dinner.6,13,14 The American Diabetes Association provides some quick and healthy breakfast ideas5 in addition to the recipes available here.
Read up on the many myths
Sugar and Diabetes
A common misconception is that sugar causes diabetes, however it is not so simple. Type 2 diabetes is caused by both genetics and lifestyle factors, such as being overweight. Research has shown that drinking sugary drinks is linked to obesity and type 2 diabetes,7 so the American Diabetes Association recommends people avoid beverages like regular soda, fruit punch, energy and sports drinks and sweetened teas.
Complex carbohydrates, however, can and should be a part of a healthy meal plan. Portion size is key for diabetics as carbohydrates are broken down into simple sugars in the gut. Whole grain breads, cereals, pasta, rice, starchy vegetables, fruits, milk and yogurt all provide carbohydrates and other nutrients important to any diet. While the bulk of a diabetic’s diet should be composed of nutritionally-dense foods, sweets and desserts can also be included in moderation.
The DASH Diet and Diabetes
The Dietary Approaches to Stop Hypertension (DASH) eating plan may be an efficacious diet to help diabetics control their blood sugar levels. A meta-analysis found that following the DASH diet improves insulin sensitivity and glycemic control, regardless of whether subjects lost weight.8 This diet is comprised of fruits, vegetables and low-fat dairy foods, with reduced saturated and total fat. The DASH diet has also been shown to lower blood pressure and risk of heart disease and stroke.9 Common complications of diabetes include high blood pressure and heart disease, making this diet particularly efficacious.
Dairy and Diabetes
Research is finding that milk and dairy products may reduce risk of type 2 diabetes. The Dietary Guidelines for Americans states “Moderate evidence … indicates that intake of milk and milk products is associated with a reduced risk of … type 2 diabetes …” and research continues to back this up. A 2013 meta-analysis of 17 cohort studies found that higher consumption of dairy foods was associated with a lower risk of type 2 diabetes.10
Another meta-analysis found a 14 percent lower risk in people who consumed the highest amount versus the lowest amount of dairy foods.11 Adding one serving of dairy per day reduced risk by 5 percent and adding one serving of low-fat dairy reduced risk by 10 percent. It is not clear what component of dairy is protective, but experts conjecture it may be the calcium, magnesium and/or vitamin D. Three servings of milk and milk products per day are recommended for everyone over age 9 years. Read more about the association of milk and dairy foods and diabetes prevention.
Fiber and Diabetes
Fiber-rich foods may help control blood sugar levels by slowing the absorption of sugar from the gut.12 Fiber is found in whole grains such as breakfast cereals; oatmeal; brown rice; whole-wheat bread, bagels, pita bread, pasta and tortillas; and in a wide variety of fruits and vegetables. At least 25 grams of fiber per day is recommended to people with, or at risk of developing, diabetes.
Research continues to fine-tune advice on how to best prevent and manage type 2 diabetes, but it is clear that diet and lifestyle play a significant role in the disease … and with the burgeoning incidence and dire future projections, this will be a key strategy.
This motivational infographic on reducing risk of diabetes makes a great handout.
Additional resources on Diabetes:
American Diabetes Association Fast Facts (2015): http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/Documents/Fast_Facts_9-2015.pdf
- Boye, JP, et al. Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality, and prediabetes prevalence. Popul Health Metr. 2010 Oct 22;8:29. doi: 10.1186/1478-7954-8-29. Accessed online 11/4/2015.
- Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014. Accessed online 11/4/2015.
- National Diabetes Education Program. Various publications. Accessed online 11/4/2015.
- Gregg EW, Chen H, Wagenknecht LE, et al. Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes. JAMA. 2012;308(23):2489-2496. doi:10.1001/jama.2012.67929. Accessed online 11/4/2015.
- American Diabetes Association.
- Jakubowicz D et al. Fasting until noon triggers increased postprandial hyperglycemia and impaired insulin response after lunch and dinner in individuals with type 2 diabetes: a randomized clinical trial. Diabetes Care. 2015 Oct;38(10):1820-6.
- Hu, FB. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013 Aug;14(8):606-19. doi: 10.1111/obr.12040. Epub 2013 Jun 13. Accessed online 11/4/2015.
- Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: a systematic review and meta-analysis on controlled clinical trials. Nutrition. 2013 Jul-Aug;29(7-8):939-47. doi: 10.1016/j.nut.2012.12.021. Epub 2013 Mar 6. Accessed online 11/4/2015.
- Siervo M, et al. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on cardiovascular risk factors: a systematic review and meta-analysis. Br J Nutr. 2014 Nov 28:1-15. [Epub ahead of print] Accessed online 11/4/2015.
- Aune D, Norat T, Romundstad P, Vatten LJ. Dairy products and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. Am J Clin Nutr. 2013 Oct;98(4):1066-83. doi: 10.3945/ajcn.113.059030. Epub 2013 Aug 14. Accessed online 11/4/2015.
- Tong X, Dong JY, Wu ZW, Li W, Qin LQ. Dairy consumption and risk of type 2 diabetes mellitus: a meta-analysis of cohort studies. Eur J Clin Nutr. 2011 Sep;65(9):1027-31. doi: 10.1038/ejcn.2011.62. Epub 2011 May 11. Accessed online 11/4/2015.
- Mayo Clinic website. Accessed online 11/4/2015.
- Maki KC et al. The Effects of Breakfast Consumption and Composition on Metabolic Wellness with a Focus on Carbohydrate Metabolism. Adv Nutr. 2016 May 16;7(3):613S-21S.
Kobayashi F et al. Effect of breakfast skipping on diurnal variation of energy metabolism and blood glucose. Obes Res Clin Pract. 2014 May-Jun;8(3):e201-98.