Diabetes Type 2: Risk Factors and Prevention

What is Diabetes?

Diabetes is a chronic condition characterised by abnormally high blood sugar levels. There are three main types of diabetes:

• Type 1 diabetes – where the body's immune system attacks and destroys the cells that produce insulin.
• Type 2 diabetes – where the body does not produce enough insulin, or the body's cells do not react to insulin.
• Gestational diabetes – where the body is unable to produce enough insulin to absorb such high levels of blood glucose during pregnancy.

Type 2 diabetes is significantly more common than type 1 diabetes. In the UK, type 2 diabetes affects approximately 90% of all adults with this disease.

Causes

The pancreas (a gland behind the stomach) regulates the amount of sugar in the bloodstream by secreting a hormone called insulin. Insulin is released when food is digested. First it enters your bloodstream, and then it transports glucose (sugar) from the bloodstream to cells, where it is broken down to produce energy. 

However, if you have type 2 diabetes your body is unable to convert glucose into energy, either because there is insufficient insulin, or the insulin produced does not work properly.

Risk Factors

There are a variety of risk factors for type 2 diabetes, either one or all of which increase the chances of developing the condition. You can find out your risk through the Klarity App, or via an NHS Health Check, so you can do something about it. According to Diabetes UK, risk factors for type 2 diabetes include:

• Weight: being overweight or obese puts you at a higher risk. 
• Fat distribution: storing fat around your waist/abdomen (instead of your hips or thighs) leads to greater risks.
• Race & ethnicity: being of African Caribbean, Black African, South Asian or Chinese descent poses higher risks. 
• Age: being older increases the risk of type 2 diabetes, especially after age 40 if white, and 25 if of African Caribbean, Black African, South Asian or Chinese descent.
• Family history: having siblings or parents with type 2 diabetes increases the likelihood you may get it too.
• Medical history: if you have a history of, for example, hypertension (high blood pressure), heart attack or strokes, gestational diabetes or severe mental illness, you are at a higher risk of getting type 2 diabetes.

Lifestyle Changes

If you have only recently learned that you are predisposed to the development of type 2 diabetes, the great news is that it can be delayed or even prevented. It is well known that diabetes puts your health at risk, so delaying diabetes for as long as possible is beneficial. Making the changes now means you will reap the benefits for years to come.

Nutrition

If you know you are overweight, one way to avoid type 2 diabetes is to lose weight. Eating a well-balanced healthy diet is a fantastic way to keep your weight under control. Those at elevated risk of having type 2 diabetes may or may not be obese, but it is still important to make healthier food choices. There are even certain foods linked to reducing the risk of type 2 diabetes.

• Decrease sugar and refined carbohydrate consumption: numerous studies have linked diabetes risk to high sugar consumption and refined carbohydrates. Replacing them with foods that have less of an effect on blood sugar can help reduce your risk.^{1, 2, 3} Drinking unsweetened tea and coffee instead of high-calorie beverages is also beneficial in reducing your risk of type 2 diabetes.
  
• Minimise the intake of processed and red meat: studies suggest that cutting back on packaged foods that are high in vegetable oils, refined grains, and additives may help reduce the risk of type 2 diabetes.⁴ They are also linked to health problems, including heart disease, high cholesterol, and obesity.
  
• Choose high-fibre foods: study findings suggest that there are long-term shifts toward a more plant-based diet which could help prevent diabetes.⁵ Therefore, making an effort to include more fruits, vegetables, whole grains, nuts, and vegetable oils in the diet is encouraged. When grocery shopping, keep an eye out for foods that are high in fibre and check the labels. Compare the fibre content of various foods to identify the ones that contain the most.
  
• Watch portion sizes: whether you choose a low-carb diet or not, eating large portions of food can increase your risk of type 2 diabetes, especially if you are overweight. Overeating has been associated with increased blood sugar and insulin levels in people with diabetes. Reducing portion sizes can help prevent this type of reaction. Using smaller plates and bowls can be a great hack as they make your portions appear larger. Weigh the food if you find it hard to gauge portion sizes. 

Physical activity 

While a healthy diet is essential for overall well-being, regular physical activity is the next critical step. Researchers found that moderate exercise increases insulin sensitivity by 51% in prediabetes, while high-intensity exercise increases it by 85%. However, this effect was only observed days after a workout.⁶ 

When we exercise our muscles use excess sugar in the blood, and glycogen that is stored in the muscles and liver. After a workout, the muscles slowly restock their sugar stores by absorbing glucose from the blood. Thus, insulin sensitivity is enhanced by decreasing blood sugar levels. In addition, regular exercise, along with a good diet, can also help improve mood, manage stress, and reduce cholesterol levels and high blood pressure. If you don't know how to get started, here are some tips:

• Finding an activity you like: this is important as you are more likely to stick to an activity if you enjoy it. 
• Start small: becoming more physically active should be a gradual process if you're not already doing it. You could, for example, walk to the office, take the stairs, or walk your dog. Start with a short workout and gradually increase the duration and intensity of your workouts each week.
• Pick a goal: set a goal such as cycling for a month or being active every weekday for 30 minutes. Be specific and realistic.

According to government guidelines, adults should engage in moderate-intensity physical activity (walking quickly, cycling, swimming) for at least 150 minutes per week. Breaking it down into 30 minutes a day, five days a week, may be more manageable. At least 75 minutes of vigorous activity (running, HIIT workouts, cycling fast or up hills) per week is recommended, and this could be broken down into 15-minute sessions, five days a week. 

Sleep 

Lack of sleep makes it difficult to lose weight because it increases your desire for high-calorie, high-carbohydrate foods. Stress hormones are released into the body when you get too little sleep, telling your body to store fat. Exercising regularly helps beat the problem of falling asleep and staying asleep. A relaxing nighttime routine can also help you, so no screens an hour before bedtime, avoid heavy meals and alcohol before bedtime, and keep your bedroom dark and cool. These are just a few of the recommendations.

Overweight/Obesity

Fat can accumulate around organs like the liver and pancreas if you are overweight. Insulin cannot pass through fat, leading to insulin resistance. This means your body's insulin is not working properly, increasing your risk of high blood glucose (sugar). Thus, you should ensure that your overall weight and body mass index (BMI) are within normal ranges. However, even if these values are within normal ranges, having a large waist circumference puts you at risk. The healthy BMI is between 18.5-24.9, and the waist should be less than 80 cm for people assigned female at birth (AFAB) and 94 cm for people assigned male at birth (AMAB). One study has shown that for every kilogram of weight participants lost, their risk of diabetes was reduced by 16%, up to a maximum reduction of 96%.⁷ Unfortunately, there are no quick fixes when it comes to reducing your weight or waist size. Start to combine exercise, nutrition, and a good sleep as mentioned before, to reduce the risk of becoming overweight. 

Smoking 

Several severe health conditions have been linked to smoking including heart disease, emphysema, and various cancers of the lungs, lymphatic system (including the breast), prostate, and digestive tract. According to an analysis of several studies, smoking increased the risk of diabetes by 44% in average smokers and by 61% in people who smoked more than 20 cigarettes daily.⁸ Thus, stopping has been shown to reduce this risk over time. If you find it difficult to quit smoking by yourself, the NHS provides stop smoking services available in local pharmacies.

Alcohol 

Overindulging in alcohol is linked to an increased risk of developing type 2 diabetes, as it is high in calories and can cause weight gain. According to current government recommendations, you should not drink more than 14 units of alcohol per week (the equivalent of 6 glasses of wine), and those units should be spread over 3-4 days. In addition to increasing the risk of type 2 diabetes, binge drinking one or two days a week can have a significant impact on your overall health, such as developing certain types of cancer. The evidence seems to show that moderate drinking is linked to a lower risk of type 2 diabetes.

Conclusion

While you may be at risk due to genetic factors, there are some small changes which can be made to reduce your risk of type 2 diabetes such as maintaining a balanced diet, exercising and reducing alcohol intake. Type 2 diabetes can be reversed, so make the right changes today!