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For Many People with Diabetes, Lifestyle Changes Trump Medications


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Earlier this fall, I attended the Diabetes + Innovation 2013 conference in Washington, D.C., organized by the Joslin Diabetes Center at Harvard Medical School. The event focused on diabetes prevention and treatment and drew leaders from patient, medicine, public health, academia and the business and nonprofit worlds.

Attendees strongly agreed that the greatest weight of diabetes management falls squarely on patients' shoulders and that these responsibilities and tasks can be overwhelming, leaving people with diabetes feeling both different than others and isolated. As Hadley George, a teenaged speaker, shared, "The hardest thing about having diabetes is that you never get away from it."

There are two main types of diabetes. Type 2 diabetes affects 90 percent of diabetics. In the past, type 2 diabetes (when the body becomes insensitive to insulin and has trouble regulating blood sugar) generally occurred in people over age 30. Today, alarming numbers of youngsters have the condition. Although genetics plays a part, the greatest risk factor for type 2 diabetes is obesity.

Type 1 diabetes, which results from an autoimmune reaction that destroys insulin-making cells, usually occurs in lean people under age 30, although sometimes older people develop the disease. Only about 10 percent of diabetics have type 1.

If current trends persist, by 2025, 53 million Americans will have diabetes and it will cost the U.S. $514 billion annually — a 72 percent uptick from 20101.

Primary care is changing but not fast enough.

Many speakers emphasized that primary care physicians (with help from other health care providers such as nurses, diabetes health educators and social workers) should be able to manage the medical aspects of caring for people with diabetes and those defined as prediabetic without many referrals to specialists. However, several speakers also stressed that insurance limitations and time constraints mean that many people with diabetes only see their primary care physician once, twice or a few times each year for visits lasting only minutes.

Food and exercise trump medications.

In a survey of meeting attendees, 77 percent stated that a treatment for diabetes should first emphasize healthy eating at work and at home along with ample exercise before medications are prescribed. Gail Christopher of the W.K. Kellogg Foundation added, "Food is the critical factor in diabetes." Yet millions of people lack access to healthy, affordable food and those who do have access often lack the knowledge, skills and support to prepare healthy meals.

Meeting presenters also repeatedly highlighted the importance of prevention and improving care to reduce patient burden and curtail expected increases in diabetes cases. The three key patient engagement themes were:

  • The main caregiver for a person with diabetes or prediabetes is themselves. Their primary task is making good choices about food and exercise. Diabetes prevention and treatment efforts need to make it easier for people to make healthful choices — not in isolation, but within families and communities. The right choice needs to be the "default choice," speakers said, whether it involves healthy eating at work or at home, exercise or sleep.
  • Behavior change should come first in treatment plans. Studies show that improving eating and exercise habits offer more potential benefit than medication. Healthy lifestyles also reduce a person's risk of heart disease, cancer, mental illnesses and other problems.
  • People have a hard time changing habits. To succeed, they often need lots of support from people besides doctors — caregivers, social workers, nutritionists, etc. Health coaches, especially trained peers, can also contribute greatly, as can online connections and social media.

Attending this meeting confirmed my own commitment to practicing good habits and to working as a communicator to educate more people about the immense value of exercising and healthy eating.

How are you doing with exercising and healthy eating at work, school or home? Take this YMCA quiz to determine your own diabetes risk.

Note: This article is a shorter version of a post originally published by Scientific American.

1 Rowley WR, Bezold C. Creating public awareness: state 2025 diabetes forecasts, Population Health Management. 2012; 15(4):194-200.

More Blog Posts by Milly Dawson

author bio

Milly Dawson, MS, MPH is the founder of the National Healthy Work Institute, a research and consulting firm that  works with employers that are committed to helping employees lead healthier lives. Milly has written two books and for publications including Woman’s Day, Yoga Journal, The New York Times syndicate and diverse medical journals. A former Foreign Service Officer, she earned an MS in psychology at Tufts and her MPH at Johns Hopkins Bloomberg School of Public Health.

Tags for this article:
Diabetes   Evidence-Based Medicine   Participate in your Treatment   Promote your Health   Lifestyle and Prevention   Diet and Nutrition   Obesity   Exercise/Physical Activity  

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