Diabetes complications are falling while number of cases continues to rise

Two reports released this week shed light on the current state of type 2 diabetes in this country, and their conclusions are both promising and sobering. First, the good news: An article in The New England Journal of Medicine shows that rates of diabetes-related problems like heart attack, stroke, and lower-limb amputation are down by more than 50% over the last two decades.

Now the bad news: during the same time period, the number of people with diabetes has soared, according to a report in the Annals of Internal Medicine. In the early 1990s, 5.5% of adults had diabetes. By 2010, the number had nearly doubled, to 9.3%. That translates into about 21 million American adults living with diabetes.

Although Americans are doing a better job of controlling their diabetes, they're falling far short at preventing it. "The major reason why the prevalence of diabetes is going up is an increase in the number of people who are overweight and obese," explains Dr. Osama Hamdy, medical director of the Obesity Clinical Program at the Harvard-affiliated Joslin Diabetes Center and author of The Diabetes Breakthrough, a newly published book from Harvard Health Publications.

Nearly 70% of Americans are overweight or obese. And unless something is done to reverse this trend, millions more could edge closer to diabetes.

The obesity–diabetes connection

To describe how being overweight contributes to type 2 diabetes, Dr. Hamdy uses an automotive analogy. "You have more tissue in your body, so you require more glucose [sugar]. Just as if you have a bigger car, you need more gas," he says. Insulin—the hormone that moves glucose from the blood into the tissues for use and storage—is like the key to that car.

The more sugar that enters the blood, the more insulin is needed to drive it to its intended destination. The pancreas can pump out extra insulin to meet the need, but over time, the body becomes increasingly less sensitive to it and the pancreas eventually reaches its insulin-producing limit. "Then you get diagnosed with type 2 diabetes," Dr. Hamdy says.

The upside is that the process can be reversed. When you lose weight, you have less tissue, which means you need less sugar—and therefore less insulin. "You become more efficient, like a hybrid car," says Dr. Hamdy.

In his own research, he's found that losing just 7% of your body weight can improve insulin sensitivity by about 57%—more than diabetes drugs can usually do. "What we have seen is that once people start to lose weight in the very early stages of diabetes, they can actually reverse the entire course of the disease," Dr. Hamdy says.

Minor changes, big results

The ability to reverse diabetes might seem dramatic, but the lifestyle changes needed to achieve it aren't. The cornerstones of diabetes prevention—diet and exercise—can be easily incorporated into even the most hectic schedule.

Take exercise, for example. "Most people don't know that if you do short bouts of exercise it is even more efficient than if you do longer bouts," says Dr. Hamdy. People who can't carve out time to get to the gym could actually see greater results just by incorporating three 10-minute exercise sessions into their everyday routine.

Here's a sample schedule:

• In the morning when you wake up, stretch for 10 minutes.
• After you eat lunch, take a brisk 10-minute walk.
• After dinner, strength train with light hand weights or an exercise band for 10 minutes.

Those three 10-minute sessions provide stretching, aerobics, and strength training—all essential components of a well-rounded workout. And if you do them every day, they add up to 210 minutes of activity a week.

An unhealthy diet can also be transformed with a couple of basic fixes. One is to divide your plate into three sections:

• Fill one with lean protein—fish, legumes, beans, tofu, or skinless chicken
• Fill another with green vegetables—spinach, broccoli, kale, or Brussels sprouts
• Fill the third with whole grains—whole-wheat bread, brown rice, quinoa, etc.

The other part of the diet fix is learning how to listen to hunger and satisfaction cues to control portion sizes. Dr. Hamdy recommends assessing your hunger based on a five-point scale:

1. Starving
2. Hungry
3. Ok—satisfied
4. Full
5. Stuffed

The goal should be to sit down to a meal when you're hungry, and stop eating when you're satisfied.

Preventing diabetes can be done, but it takes a real commitment to change. And until more people are willing to change their eating and exercise habits—and pass those habits on to their children—the obesity and diabetes rates will continue to rise.