Diabetes and Lifestyle

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Diabetes and Lifestyle
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1990

Source Mokdad et al., Diabetes Care
2000231278-83.
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1991-92
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1993-94
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995-96
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1997-98
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1999
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Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2000
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Diabetes Prevalence

• 8 of the U.S. Population
• 10.5 million diagnosed in US, 5.5 million are
  undiagnosed
• 800,000 new cases per year
• Type II (adult onset) now seen among children
• Incidence increasing

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What is it?

• Diabetes is defined as a group of metabolic
  diseases characterized by high blood glucose
  (hyperglycemia) resulting from defects in insulin
  secretion, action or both

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Health Problems of Diabetes

• Long-term damage of eyes, kidneys, nerves, heart,
  and blood vessels
• Heart disease, stroke, blindness, hypertension,
  kidney disease, nervous system disease,
  amputations, dental disease, complications during
  pregnancy

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Types of Diabetes

• Type I, mainly children, immune problems destroy
  the pancreas and insulin in non longer produced.
  All persons with Type I will need insulin
  injections.
• Type 2. Adult onset diabetes. Most dont need
  insulin, lifestyle related

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Nurses Health Study

• 84,941 Nurses followed for 16 years
• Low risk determined as
• BMI
• 30 exercise/day
• 5gram of alcohol/day
• No tobacco use
• High intake of cereal fiber and poly fat,
• Low intake of trans fats an high glycemic index
  foods

Hu, FB. N Engl J Med 345(11)790-797, 2001
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• 3300 new cases of diabetes
• 2.3 of women were low risk on all variables

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Quintiles for diet score
Relative risk
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Weekly Exercise
Relative risk
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BMI
Relative risk
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Quintiles for Cereal fiber
Relative risk
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• Other researchers using different subjects and a
  different research design found the same exact
  relationship between fiber and diabetes

Liu, S, Am J Public Hlth, 2000,901409-1415
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Quintiles for Trans fats
Relative risk
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Quintiles for Glycemic Load
Relative risk
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• 91 percent of all cases of type 2 diabetes can be
  attributed to habits and behaviors that are not
  considered low risk
• Low risk women had a diabetes relative risk of .09

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Diabetes Intervention

• 5 year study
• 3,234 non-diabetic persons with elevated glucose
  
• Three groups
• placebo
• medication
• lifestyle change

Diabetes Prevention Program Research Group NEJM
2002346393-403
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After 2.8 years the study was halted
Number of new diabetes cases/100 persons
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• The lifestyle intervention group reduced the
  incidence of diabetes by 58
• The lifestyle group had a 71 reduction in
  diabetes incidence for persons older than 60

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Gastrointenstinal Events
Number of gastrointestinal events per 100
participants
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Deaths
Number of deaths per 100 participants
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Can Diabetes be Reversed?

• Benefits of lifestyle interventions are based
  upon the degree of insulin sensitivity. The
  worse you are less effect lifestyle will have.

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Insulin Sensitive vs Resistant
Relative risk
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The bad news

• The worse your diabetes, the less a healthy diet
  and physical activity can do
• There is no death-bed repentance
• Primary prevention is the best solution, albeit
  the hardest for people to accept

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What should we eat to avoid diabetes?

• Low saturate fat and trans fats
• High levels of vegetables, fruits
• High levels of cereal fiber
• Low fat dairy
• Fish, other lean meat
• Unsaturated vegetable oils
• Foods with a low glycemic load

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Glycemic Index Calculation
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• Low-starch vegetables - Lettuce, all greens,
  broccoli, cauliflower, summer squash, tomatoes,
  cucumber, celery, eggplant, peppers, mushrooms,
  onions. 
• Meats, seafood, cheese - All Meats, all seafood,
  all cheeses, eggs. This is the protein group.
• Fruits- The higher glycemic fruits are mangoes
  and bananas. Fruits have a higher glycemic index
  than vegetables because of their sugar content.

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• Grains and starchy vegetables - All grains,
  anything made from grain (breads, crackers,
  cereals, etc.), winter squash, carrots, parsnips,
  potatoes (potatoes are higher in their glycemic
  index when baked as opposed to other cooking
  methods),  legumes. 
• Milk, yogurt, cottage cheese and other dairy
  products - Yogurt has beneficial acidophilus but
  buy it plain and add your own fruit for a
  reasonable snack or dessert.
• Fats and oils - Vegetable oils (try to use cold
  pressed and not canola oil), butter (not
  margarine), nuts and seeds. A small amount of
  animal fat is okay.

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What Determines the Index?

• How swollen the grains are, mashed potatoes
  boiled in water
• How much the food has been processed
• How much fiber it contains
• How much fat is consumed with the food

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What is the significance of Glycemic Index?

• Low GI means a smaller rise in blood sugar and
  can help control established diabetes
• Low GI diets may help people lose weight and
  lower blood lipids

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The index and hunger

• Rapid drop in glucose can stimulate hunger,
  decrease satiety, and increase food consumption
• Study of overweight boys fed high index foods for
  breakfast snacked twice as much during the morning

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• Low GI diets can improve the body's sensitivity
  to insulin
• High GI foods can help re-fuel carbohydrate
  stores after exercise

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Dont get too excited.

• Much more research is needed
• If you are eating a healthy diet you are already
  eating a low glycemic index diet