By McKenzie Shenk, Cedarville University PharmD Student
Diabetes mellitus has effected the human population for centuries; however only in recent decades have large strides been made in prevention and treatment.1 Both types of diabetes mellitus – type I and type II – can be manageable for patients with various medication regimens and lifestyle choices once they have been diagnosed. Research has also contributed to understanding of how type II diabetes (T2D) can be prevented. (Type I diabetes is an autoimmune disease, which means your immune system attacks your pancreas cells, so it generally cannot be prevented.2, 3 For more information about type I diabetes, check out this website. Even as our knowledge of T2D and its treatment and prevention has grown, the prevalence and incidence of T2D continues to rise.4
BBC, a well-respected international news and broadcasting organization based out of Great Britain, recently summarized some research that relates to T2D prevention.5, 6 The research showed that eating certain fruits decreased the participants’ chances of getting diabetes. The fruits with the best results were blueberries, apples and grapes. The study also showed that replacing three serving/week of fruit juice with whole fruit lowered the risk of T2D by 7%.2 The study reiterates that reducing the risk of T2D depends upon a well-balanced, healthy diet in addition to physical activity.
In light of this study, my recommendations to diabetic patients will not change nor does the standard of care change. It is generally understood that healthy lifestyle choices are beneficial on many levels. By eating right and exercising, patients can loose weight or maintain a healthy weight, T2D can be prevented and lower need for medications, and risk for other diseases like heart failure and high cholesterol also decreases. Patients have the choice whether or not they want to change how they are living to make healthier choices. As a pharmacist, I can only recommend and encourage patients to continue to make healthier choices. I need to present patients with the facts, which will allow them to make informed choices.
Like with any study, this research has limitations. First, as the BBC article recognized, the study depended upon self-reported fruit consumption.5 People do not always remember exactly what they eat. People could also try to sound healthier than they actually are and therefore not be entirely accurate. In addition, there is inevitable variability between people, some making healthier decisions than others, often referred to as the “healthy user bias”. The researchers recognized these limitations and controlled for some of these variables in their statistical analyzes. Also, in the study design the researchers tried to minimize bias by doing a prospective study and excluding subjects with other chronic diseases. This choice also limits the generalizability of the data to people with multiple chronic disease states. However, it is important to recognize that the outcomes of the study continue to support the growing body of evidence that eating whole fruit in general contributes to reducing risk of T2D.
While the BBC article does not present other references, much literature is available regarding the correlation between healthy lifestyle choices and prevention of diabetes. In general, the research shows that eating leafy greens and fruit help prevent diabetes.7, 8, 9 Studies have shown that diets with low glycemic indexes help prevent diabetes.10, 11, 12 Glycemic index (GI) refers to the effect different foods have on blood glucose levels. Fruits, such as berries, have lower GIs, while bananas and pineapples have higher GIs, yet the study showed that bananas were helpful in reducing the risk of T2D. 2, 6
A significant study in understanding diabetes prevention was The Diabetes Prevention Program.13, 14 The Program tested various methods for prevention of T2D, not limited to fruit consumption. The results showed that intensive lifestyle changes were the best way to prevent T2D. These changes included losing weight with healthy eating and exercise habits in addition to exercising at least 150 minutes per week.13 The other option was using the medication metformin; however, this preventative measure was not as effective as lifestyle modifications.
Statistics show that by 2020, 1 in 3 Americans will have T2D.4 There is a correlation between socioeconomic status, ethnicity, and insurance status and prevalence of T2D.15,16 Many of individuals at risk come from minority groups which continue to grow in the US, contributing to the larger percentage of Americans with diabetes.4, 16 This is a significant issue facing our society, and you need to be aware of your risk for T2D. But there is hope. By taking preventative measures such as changing diet and exercise lifestyles, you do not have live under the prospective shadow of a life-long disease. Consult your doctor or pharmacist if you have any concerns about T2D or making lifestyle changes.
As I think about my future practice in pharmacy, I should consider how to work with my patients who are at risk for T2D. How can I help my patients be more successful in preventing diabetes? How can I encourage and support them in making healthy choices? How can I work to implement healthy life choices into my own life?
- Sattley, M. The history of diabetes. Diabetes Health. 2008(Nov 1996):October 12, 2013.
- Muraki, I.; Imamura, F.; Manson, J. et al. Fruit consumption and risk of type 2 diabetes: Results for three prospective cohort studies. BJM. August 29 2013:October 12, 2013.
- What is diabetes? BBC Science Web site. http://www.bbc.co.uk/science/0/21704103. Published April 19, 2013. Updated 2013. Accessed October 13, 2013.
- Allen, J. Half of americans adults are headed for diabetes by 2020, UnitedHealth says. ABC News Web site. http://abcnews.go.com/Health/Diabetes/diabetes-half-us-adults-risk-2020-unitedhealth-group/story?id=12238602. Published November 25, 2010. Updated 2010. Accessed September 15, 2013.
- Blueberries, not fruit juice, cuts type-2-diabetes risk. BBC News Web site. http://www.bbc.co.uk/news/health-23880701. Published August 29, 2013. Updated 2013. Accessed September 10, 2013.
- Carter, P.; Gray, L.; Troughton, J.; Khunti, K.; Davies, M. Fruit and vegetable intake and incidence of type 2 diabetes: Systematic review and meta-analysis. British Medical Journal. Accessed: October 12, 2013.
- Montonen, J.; Järvinen, R.; Heliövaara, M.; Reunanen, A.; Aromaa, A.; Knekt, P. Food consumption and the incidence of type II diabetes mellitus. European Journal of Clinical Nutrition. 2013:59(3):441.
- Schwarz. P.; Reddy, P. eds. Prevention of diabetes. 1st ed. United Kingdom: John Wiley and Sons; 2013. http://books.google.com/books?hl=en&lr=&id=5A1mrowD4RYC&oi=fnd&pg=PP1&dq=prevention+of+diabetes&ots=dMe856xCyl&sig=8JmG86gdc98dLgf70pS5nPYAqbQ#v=onepage&q&f=false.
- Preventing diabetes. Harvard School of Public Health Web site. http://www.hsph.harvard.edu/nutritionsource/diabetes-prevention/. Updated 2013. Accessed October 12, 2103.
- Thoma,s D.; Elliot, E.; The use of low glycaemic index diets in diabetes control. British Journal of Nutrition. 2010;104(6):797.
- Marsh, K.; Barclay, A.; Colagiuri, S.; Brand-Miller, J. Glycemic index and glycemic load of carbohydrates in diabetic diet. Current Diabetes Reports. 2011;11(2):120.
- Jenkins DJA, Srichaikul K, Kendall CW, et al. The relation of low glycaemic index fruit consumption to glycaemic control and risk factors for coronary heart disease and type 2 diabetes. Diabetologia Clinical and Experimental Diabetes and Metabolism. 2010:October 12, 2013.
- Diabetes Prevention Research Group. The diabetes prevention program. Diabetes Journal. 1999;22:623-34.
- Ratner R. An update on the diabetes prevention program. Endocrine Practice. 2006;12:20-24.
- Center for Disease Control and Prevention. Diabetes report card 2012. National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation. Web site. http://www.cdc.gov/diabetes/pubs/pdf/diabetesreportcard.pdf. Updated 2012. Accessed October 18, 2013, 2013.
- Ali, M.; Bullard, K,; Imperatore, G.; Barker, L.; Gregg, E. Characteristics associated with poor glycemic control among adults with self-reported diagnosed diabetes — national health and nutrition examination survey, united states, 2007–2010. June 2012;61:October 12, 2013. 32-36.
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