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Reducing the Risk of Type 2 Diabetes 

Although type 1 diabetes cannot be prevented or cured, there are opportunities to reduce the risk of developing type 2 diabetes and related complications. “Fortunately, many of the risk factors for type 2 diabetes are modifiable,” says Joanne Jung, pharmacy practice leader, Willis Towers Watson. 

“It is important to note,” says Quiambao, “that we may not be able to prevent all type 2 diabetes. Given that some of its non-modifiable risk factors include age, ethnic background and genetics, one can still develop type 2 diabetes despite leading a healthy lifestyle. However, the development of type 2 diabetes can be delayed and managed, given the right knowledge and support.” 

The number of Canadians with type 2 diabetes is increasing dramatically because of the aging population, rising obesity rates, increasingly sedentary lifestyles, and the higher risk of diabetes in Indigenous people and new Canadians.96 

“We may not be able to prevent all type 2 diabetes.”

– Krisel Quiambao

A. Risks for Developing Type 2 Diabetes97 
  1. African, Arab, Asian, Hispanic, Indigenous or South Asian descent 
  2. Age ≥40 years 
  3. Low socioeconomic status 
  4. Physically inactive 
  5. Overweight 
  6. Abdominal obesity 
  7. Smoking 
  8. Previous diagnosis of gestational diabetes 

 

B. Prediabetes98, 99, 100, 101 

Prediabetes is when glucose levels are higher than those of a person without diabetes or prediabetes, but not high enough to be diagnosed as type 2 diabetes. It is estimated that 6 million Canadians have prediabetes, and if left untreated, more than 50% of them will develop type 2 diabetes within 8 to 10 years. Type 2 diabetes can be delayed or prevented by reducing blood sugar levels, which can often be accomplished with lifestyle changes such as following a healthy diet, exercising regularly and losing weight. According to experts, a loss of 5%–7% of body weight can reduce the risk of type 2 diabetes by almost 60%.

A loss of 5%–7% of body weight can reduce the risk of type 2 diabetes by almost 60%.

Research shows that for many people, making major lifestyle changes works better than taking metformin (a drug to treat diabetes) to help delay or prevent type 2 diabetes for up to 10 years, and at 15 years, major lifestyle changes were about equal to taking metformin.102

Prediabetes can be part of metabolic syndrome, which is when high blood sugar is associated with high blood pressure, high levels of LDL cholesterol (the “bad” cholesterol) and triglycerides, low levels of HDL cholesterol (the “good” cholesterol), and excess fat around the waist. People with metabolic syndrome are at significant risk of developing type 2 diabetes.103, 104 

Prediabetes May Fly Under the Radar105, 106 

People may have prediabetes for years but show no symptoms. It may go undetected until serious health problems show up. It’s important for people with risk factors to get their blood sugar tested and consult a physician. 

Risk factors for developing prediabetes include: 

  • Having overweight or obesity 
  • Being 45 years or older 
  • Having a parent or sibling with type 2 diabetes 
  • Being physically active fewer than 3 times a week 
  • Ever having gestational diabetes or giving birth to a baby that weighed more than 9 pounds 
  • Descending from one of the following high-risk groups: African, Arab, Asian, Hispanic, Indigenous, South Asian 

Positive lifestyle interventions have been shown to prevent or delay the onset of type 2 diabetes by more than 50%.

Research indicates that positive lifestyle interventions that include healthy eating, physical activity and other components (e.g., counselling, smoking cessation, stress reduction, group therapy, behaviour modification) have been shown to reduce the risk of or delay the onset of type 2 diabetes by more than 50%, with the benefits extending beyond the active intervention stage.110, 111 

Reducing the Risk of Developing Type 2 Diabetes112

There are several interventions that can reduce the risk of developing type 2 diabetes: 

 

  1. Nutrition therapy and counselling
  2. Dietary changes
  3. Moderate weight loss
  4. Physical activity
  5. Pharmacotherapy for individuals with prediabetes
 

  1. Bariatric surgery
  2. Targeted programs for high-risk groups, including African, Arab, Asian, Hispanic, Indigenous and South Asian populations

Diabetes and Obesity

Individuals with obesity are three to seven times more likely to develop type 2 diabetes.

“Diabetes and obesity are commonly seen together,” says Tanner. “Diabetes cannot be fully managed without also considering the management of overweight and obesity.”

Individuals with obesity are three to seven times more likely to develop type 2 diabetes, and those with severe obesity have up to 20 times the risk compared with those of a healthy weight.107

Canadian Adult Obesity Clinical Practice Guidelines108, 109

The Canadian Adult Obesity Clinical Practice Guidelines reflect “the current scientific understanding of the development and maintenance of obesity and its effect on health.” The objective of clinical practice guidelines is to summarize the current scientific and expert knowledge and provide practical recommendations to guide healthcare providers, but they may also provide guidance for benefit plan and workplace program design. Some highlights that might be of interest to benefit plan managers:

  • Obesity is “a chronic disease characterized by excessive or abnormal body fat that impairs health.” 
  • “Obesity treatment should focus on improving health, not weight loss alone.” 
  • “Healthcare professionals should support patients ‘where they are at’” and offer individualized treatment that “support(s) them in their own journey to health.” 
  • "There is no treatment that will work for everyone. Selecting a treatment must be done in collaboration with the patient, address root causes of obesity, and focus on achieving improved health.” 

To find out more about the Canadian Adult Obesity Clinical Practice Guidelines, read: https://obesitycanada.ca/guidelines/ 

For more information and resources about obesity, check out the Obesity Canada website: https://obesitycanada.ca/ 

 

Consider Early Intervention

It’s easier to assist employees in delaying progression of diabetes when they are in the early stages or even have prediabetes. “Many employers only consider diabetes as a serious issue that needs to be tackled once someone is already using a lot of medications or insulin,” says Quiambao. “This perspective will end up costing both employers and employees more in the future. It would be great for people to have support, programming and benefits when they are at risk or at the prediabetes stage.”

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96 https://www.conferenceboard.ca/hcp/Details/Health/mortality-diabetes.aspx 

97 http://guidelines.diabetes.ca/cpg/Chapter4 

98 https://www.diabetes.ca/DiabetesCanadaWebsite/media/Advocacy-and-Policy/Diabetes-360-Recommendations.pdf 

99 https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing- My-Diabetes/Tools%20and%20Resources/prediabetes-fact-sheet.pdf?ext=.pdf 

100 https://www.diabetes.ca/recently-diagnosed/prediabetes-toolkit 

101 https://www.diabetes.ca/managing-my-diabetes/stories/are-you-at-risk-of-prediabetes- 

102 https://www.healthlinkbc.ca/health-topics/abp5563 

103 https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing- My-Diabetes/Tools%20and%20Resources/prediabetes-fact-sheet.pdf?ext=.pdf 

104 https://www.diabetes.ca/health-care-providers/clinical-practice-guidelines/chapter-3#panel-tab_FullText 

105 https://www.cdc.gov/diabetes/library/features/truth-about-prediabetes.html 

106 https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/prediabetes/ 

107 https://secure.cihi.ca/free_products/oecd-diabetes-report-2015_ en.pdf 

108 https://obesitycanada.ca/cpg/obesity-clinical-practice-guidelines-why-and-how-we-did-them-and-whats-new/ 

109 https://obesitycanada.ca/guidelines/