Amanda Wilde (Host): Diabetes is increasing in the US and around the world. But despite the risks, you can manage and even prevent diabetes. We'll find out how with Jennifer Newell, certified diabetes care and education specialist at Jefferson Healthcare.

Host: This is To Your Health, a podcast from Jefferson Healthcare. I'm Amanda Wilde. Jennifer, great to have you here.

Jennifer Newell: Thank you. I am happy to be here.

Host: Well, let's start with the definition, so we know we're on the same page. What is diabetes?

Jennifer Newell: Well, diabetes is a condition that causes your blood sugar levels to be too high. It occurs when your body produces little or no insulin or also the insulin that is produced isn't as effective as normal. And we need insulin because it regulates our blood sugar levels. It's an essential hormone needed for the body to be able to use the food that we eat for energy. In type 2 diabetes, there is less insulin production and there is insulin resistance, which means that insulin is less effective.

Host: When you have a high blood sugar, what health problems can that lead to?

Jennifer Newell: Well, diabetes is the leading cause for kidney disease. And vision can also be affected, even leading to blindness. And people with diabetes have a significantly higher risk for heart disease and stroke.

Host: So, how do I know if I'm at risk for getting diabetes? What are the risk factors?

Jennifer Newell: Well, there's multiple risk factors. There is a condition that we call pre-diabetes, meaning that you're predisposed to having diabetes and your blood sugar levels are elevated, but not to the point of diabetes. So, those individuals are at very high risk for developing type 2 diabetes. Also, being overweight, having high blood pressure or high cholesterol. As you age, your risk increases. So if you're 45 years of age or older, that's a higher risk. If you have parents or siblings, a brother or sister with type 2 diabetes, your risk is much higher. And if you are not physically active, if you're not exercising more than three days a week, that also increases risk for type 2 diabetes.

Host: Well, I've read that one in 10 people in the US have diabetes and about one in five don't even know they have it. How do I know if I have diabetes?

Jennifer Newell: Well, that's a great question. And unfortunately, you can have diabetes and have no symptoms or awareness at all. As you said, you know, one in five people don't even know they have it. And untreated diabetes, as we just talked about, can lead to serious problems like kidney and eye disease and increased risk for heart attack and stroke. So, you want to know if you have diabetes and the American Diabetes Association actually recommends that they begin screening at age 45 for the presence of diabetes. And then, if you have symptoms, which the blood sugars have to be pretty elevated in order to have symptoms, those are increased thirst, frequent urination, increased hunger, unintended weight loss, fatigue, blurred vision. Those are some of the more common symptoms of a high blood sugar. But again, not everyone has symptoms. So, it is important to get screened if you're at high risk, and especially if you're above age 45.

Host: So, the key is screening. What is the screening? Is that a blood test?

Jennifer Newell: Yes. There's a simple blood test that is used. It could be a fasting blood test where they actually check your blood sugar level. And then, there's also another test called the hemoglobin A1c, which gives us an estimated average of blood sugar and a value of 6.5 or higher is positive for diabetes, and the fasting reading of 126 or higher is positive for diabetes.

Host: So, screen and monitor those numbers, but let's go back a bit. Can diabetes be prevented? Can you avoid it all together?

Jennifer Newell: Well, you may be able to avoid it all together. But definitely, you're able to decrease your risk and slow perhaps the progression to diabetes. There was a very large study called the Diabetes Prevention Program. This study was conducted from 1996 to 2001, and it showed overwhelmingly that implementing a healthy lifestyle can significantly lower risk for type 2 diabetes. It was really one of the first studies of its kind, and they wanted to show whether lifestyle or a medication called metformin commonly used to treat diabetes would lower risk.

So, what they did was they followed over 3000 individuals for that time period, 1996 to 2001. And they divided these individuals up into three different groups. Everyone in the study was overweight, and they all had pre-diabetes, meaning they were at high risk for developing type 2 diabetes. And the three groups in the study were the lifestyle group and these individuals, their goal was to lose 7% of their body weight, which averaged about 10 to 15 pounds of weight loss. And they also received intensive training on nutrition and were requested to exercise at least 150 minutes a week, about 30 minutes, five days a week of exercise. So, that was the lifestyle group. There was, as I mentioned, the metformin group, which is that medication for treating diabetes. And they were given metformin twice a day and plus also coached in diet and exercise. And then, there was a placebo group that was given a placebo medication. It wasn't an actual real medication, and they were also coached in diet and exercise. At the end of three years, the lifestyle group had a 58% reduction in the onset of type 2 diabetes. There was also a reduction in the metformin group for the development of type 2 diabetes, but the lifestyle group had the biggest reduction in risk.

Host: Wow, that's pretty startling.

Jennifer Newell: Yes, it was. They actually published a few years early because about three years into the study, the results were so overwhelming that lifestyle really made a difference.

Host: So, what does that mean about what I can do to prevent diabetes for myself?

Jennifer Newell: Yes. And that's a good question and I want to emphasize that it is the prevention of type 2 diabetes. And really, the recommendations for lifestyle stem from the results of the Diabetes Prevention Program Study. The good news is, is that even individuals at high risk for type 2 diabetes can significantly lower their risk with simple lifestyle changes. The three pillars for the prevention of type 2 diabetes are weight loss, healthy eating and exercise. When it comes to weight loss, if you're overweight losing at least 7% of your body weight, which is a relatively small amount of weight, about 10 to 15 pounds for the average person that's overweight. So not a lot of weight loss, but enough to make a difference for prevention.

And as far as nutrition goes, really kind of emphasizing building meals around the non-starchy vegetables, you know, things like spinach or salad greens, cauliflower, broccoli, so the non-starchy vegetables. If you can visualize your plate, you know, really looking at half the plate be vegetables; a quarter of the plate, starch; and then, the other quarter of the plate, protein. So, that's a simple way to kind of gauge your portions. Really looking at minimizing added sugars and refined grains, things like soda pop, juice, white bread, white flour, pasta, cereals, so really minimizing the added sugars in your diet. And also, it's important to choose whole foods over highly processed foods, so really looking at shopping the perimeter of a store. For example, buying the vegetables and the meats and avoiding or limiting those processed foods that tend to be in the middle of the store. There's a quote from a health advocate, her name's Kelly Rawlings, that I thought was a little bit helpful. And the idea is, you know, just to consider pausing and asking yourself, "Does this food or drink choice that I'm about to make support my health goals?" So, really just thinking about how your choices are affecting your health

And then lastly, with exercise, really looking at a minimum of 30 minutes, five days a week. So, most days of the week, you want to be active. And in the diabetes prevention program, the most common exercise was walking. So, just taking time to go for a walk most days of the week for 30 minutes. And there are individuals that are challenged and have limited mobility, so really thinking about options where you can do exercise programs from a seated position. There's lots of low impact exercises you could do from a seated position for people with limited mobility. And also, people with really low fitness levels, the idea of maybe just getting up and moving your body for three minutes, for every 30 minutes of sitting. So, these are all ways that you can work up to at least 30 minutes a day of being active, which is really powerful for prevention of type 2 diabetes.

Host: This is really great information. I especially like the doable ways to eat and exercise that you've presented. Jennifer, thank you so much for explaining what causes diabetes and how to be proactive in preventing it.

Jennifer Newell: Thank you very much for having me. It was a pleasure to be here.

Host: That was Jennifer Newell, certified diabetes care and education specialist at Jefferson Healthcare. If you have concerns about your diabetes or want to learn more from Jennifer, contact your Jefferson Healthcare primary care provider. If you found this podcast helpful, please share it on your social channels. You can check out the full podcast library at jeffersonhealthcare.org. This is To Your Health, a podcast from Jefferson Healthcare.