Understanding Diabetes

with Jordan Sennett, M.D., Endocrinologist, Advanced Healthcare

Posted: Nov. 1, 2004

A diagnosis of diabetes can be a life-changing experience for the non-diabetic family members and friends of a newly diagnosed person. For some, it may be a reminder that they're at risk of developing the disease. Others may not know about their risk factors, but want to prevent it from happening.

Jordan Sennett, M.D., an endocrinologist at Advanced Healthcare, acknowledges their concerns.

He pointed out the staggering number of people who either have the disease or are at increased risk of developing it. More than 18 million Americans have diabetes, and an estimated 16 million others between the ages of 40 and 74 have a condition known as pre-diabetes.

Pre-diabetics have elevated blood sugar levels, but they're not high enough to be classified as full-blown diabetes. Pre-diabetics are at greatly increased risk of developing the disease.

Jordan Sennett, M.D., Endocrinologist, Advanced Healthcare "Keep your weight under control. The risk of diabetes increases with increased body weight, because obesity causes increased resistance to insulin."

But anyone who hasn't been diagnosed with the full-blown disease has the ability to minimize or, in some cases, eliminate their risk of diabetes.

That's important, Dr. Sennett said, because the number of adults diagnosed with the disease has increased 61 percent since 1991 and it's the sixth leading cause of death in the United States. Each year, 200,000 people die from diabetes or its complications.

Who is at risk?
Diabetes risk factors that can't be controlled are a family history of diabetes, race and birth weight. For Caucasians, the incidence of diabetes is 7.2 percent of the population. Hispanic Americans have a slightly higher rate of 9 percent; 11.2 percent of African-Americans are diabetic and the rate is as high as 35 percent for some Native American tribes.

"There's an inverse relationship between birth weight and the increased risk of type 2 diabetes," Dr. Sennett said. Or, to put it differently, the smaller the baby, the greater the risk.

The two most commonly known controllable risk factor for diabetes are smoking and obesity, Dr. Sennett said.

Smoking
The relative risk of developing diabetes for people who smoke one-pack of cigarettes a day or more can be up to three times that of the population at large. Estimates from the Physicians Health Study from 1990 were that 10 percent of type 2 diabetes is attributable to smoking.

"Smoking increases the blood glucose concentration after an oral glucose challenge," Dr. Sennett said. "Smoking may impair insulin sensitivity, and it's been linked to increased abdominal fat distribution."

People who tend to gain weight in the abdominal area, rather than those who carry excess fat in the thighs and buttocks, are at increased risk of developing diabetes.

The benefits of quitting cigarettes, in terms of reducing the risk of diabetes, take approximately five years to become apparent, but it takes fully 20 years for the risk to revert to that of someone who never took up cigarettes in the first place.

Obesity
A faster and extremely effective way to minimize the risk of developing diabetes, Dr. Sennett said, is to avoid becoming overweight.

"Keep your weight under control. The risk of diabetes increases with increased body weight, because obesity causes increased resistance to insulin."

Medical researchers are still working on figuring out exactly how and why that link exists. One theory is that fatty acids released from adipose tissue rise in the bloodstream and cause the insulin resistance.

In a newly diagnosed type 2 diabetic, Dr. Sennett said, insulin levels are frequently higher than they are in a healthy non-diabetic. The difference is that in the diabetic, the insulin isn't working properly.

What you eat, whether overweight or not, can also increase or decrease the risk of diabetes.

Research findings
Dr. Sennett cited a study in which 42,000 male health professionals ate a diet of red meat, processed meat, high-fat dairy products, sweets and desserts. That diet was associated with an increased risk of diabetes, independent of excess weight or regular exercise. Those who ate a more prudent diet, consisting mostly of vegetables, fruit, fish, poultry and whole grains, posted a modest reduction in risk.

Other studies have shown that long-term coffee consumption if someone drinks more than four or five cups per day can reduce the risk (no word on whether that coffee was taken with cream and sugar), and that overweight subjects who eat more dairy products lower their risk of metabolic syndrome, a pre-diabetic condition. Dairy products, however, may increase cholesterol.

For women, there seems to be a correlation between decreased risk of diabetes and consumption of nuts. A study of 83,000 women who ate five or more one-ounce servings of nuts or peanut butter per week had a slightly lower risk.

Exercise also has been shown to decrease the risk of developing diabetes.

In a Swedish study of men with impaired glucose tolerance, half were put into a diet and exercise program and the other half were informed of their condition but not given more than recommendations to follow. When the study had concluded, 76 percent of the exercise and diet group had improved their tolerance, while 67 percent of the control group had deteriorated.

A similar study done in the United States examined a diabetes prevention program. Individuals in a diet and exercise program lost an average of 15 pounds, which was 7 percent of their body weight during the first year. After three years, only 14 percent of the experimental group had become diabetic; 29 percent in the placebo group had developed diabetes. A third group in the study was treated with Metformin, a drug designed to lower insulin resistance. The diabetes rate in that group after three years was 22 percent.

For Dr. Sennett, the conclusion is clear and simple. "Diet and exercise work better than Metformin in preventing diabetes," he said.

For information on diabetes education classes at Advanced Healthcare, call 888-709-2080 or 262-512-2880.

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