Today is World Diabetes Day and this year it is centred on the theme of healthy living and diabetes. To mark this, we take a look at some of the recent research and discussions on risk factors and lifestyle interventions associated with type 2 diabetes*.
The rise in the global burden of diabetes is expected to challenge healthcare systems. Already, it is estimated that 29.1 million people in the US have the condition. Diabetes is one of the four main non-communicable diseases and the World Health Organization (WHO) action plan includes a global strategy for its prevention and control. This is an important aim, as diabetes is known to lead to many co-morbid conditions, which in turn leads to significant burden on health and healthcare systems.
To achieve their objectives it is necessary to target the risk factors for diabetes and promote healthy lifestyles. Identifying patients at risk for diabetes involves recognising the signs and symptoms and this has been highlighted in recent research.
There are several factors that increase risk of developing diabetes including fat distribution, excess weight, physical inactivity and family history. In an opinion article published in BMC Medicine Naveed Sattar and Jason Gill discuss fat distribution and indicate that obesity is a major risk factor for diabetes by reviewing current evidence on the ecotopic fat hypothesis for the disease.
They suggest that insulin-resistance and beta-cell dysfunction can potentially be reversed if ectopic fat around the liver and pancreas is removed by surgery or diet. The authors emphasise that:
“The challenge now is to take advantage of such observations and translate into clinical improvements. Considerable ongoing work is needed to develop such clinical translation, which is crucially important given the rising levels of type 2 diabetes worldwide, which will further rise given the continued rise in obesity worldwide.”
Linked with fat, weight is another risk factor for diabetes and increases of weight and waist circumference are significantly associated with the incidence of diabetes. This study also showed that an increase in waist circumference appears to be a stronger risk factor for the progression of diabetes than weight gain. Interestingly, waist circumference is usually measured by the individual and these values calculated by self-measurement, are higher than those measured objectively. This suggests that overestimation should be taken into account when using self-measured waist circumference as a marker of abdominal adiposity and risk of diabetes.
Other, lesser know risk factors are also being explored. A recent systematic review and meta-analysis showed that if an individual’s spouse has a history of diabetes, this is associated with an increase of 26% in their own diabetes risk, suggesting that recognition of the shared socio-environmental factors mediating such risk could improve diabetes detection.
Changes to our lifestyles are known to affect health outcomes, and physical activity is of key importance in managing diabetes. Devices such as pedometers or accelerometers have become increasingly popular over the years, with the aim of helping users to adhere to healthier lifestyles. A recent meta-analysis of randomized controlled trials indicates that step counters can indeed be useful , as these are associated with an increase in physical activity in patients with diabetes. However, further research is needed to assess whether these devices can lead to improvements in glycemic control.
Addressing lifestyle behaviors in patients with diabetes is also essential in low- to middle- income countries. In Latin American countries such as Mexico, Argentina, Chile and Brazil healthcare systems are straining to cope with chronic diseases such as diabetes.
Armando Arredondo from the National Institute of Public Health in Mexico highlights the need for more resources to be allocated to preventive medicine, and discusses ways in which this may be achieved in these settings, saying that:
“In the context of ongoing reforms in the health systems of Latin American countries, and taking into account the state of the art of medicine, universal coverage for health care will be effective only if it meets the health needs in all phases of the natural history of disease: prevention, detection, treatment and rehabilitation, particularly in the case of chronic health problems.”
The research we look at here is part of a bigger trend showing the importance of targeting key risk factors to help reverse or improve detection of diabetes. It is essential to focus on healthy lifestyle behaviors including physical activity to enable effective management of the illness. However, this is going to be a challenge in low and middle income countries where resources are limited and thus more difficult to implement in health systems.
The WHO action plan aims to promote partnerships for the prevention and control of diabetes and to integrate these into policies across government departments. Hopefully this will shape global strategies to ultimately reduce the burden of this serious non-communicable disease.
* As we only focus on type 2 diabetes here we have used the term diabetes to refer to it.
You can find research and related content about World Diabetes Day from both BioMed Central and Springer at https://www.springer.com/diabetesday
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