A couple in their early thirties gushed at the sight of their lovely first-born, tickled pink with that perfectly delicate smile. The mother, who had gestational diabetes (pregnancy-related diabetes), almost wept while recalling her difficult pregnancy. But it was all over, she thought. Although the baby was bigger than usual, he had a complete set of fingers and functioning vital organs.

The same baby grew to become an overweight kid. During his pubescent years, the doctors found he had type 2 diabetes. These days, it seems no one is too young to develop diabetes as long as one possesses the risk factors. An ounce of prevention is better than a pound of cure, so goes the old adage. Yet people still subconsciously, or even consciously, opt for the latter choice. “Real prevention must start at birth. You can never be early in preventing but you can be too late,” Philippine Diabetes Association (PDA) vice-president Dr. Editha Arceo-Dalisay said.

Preventable Disease
According to the 2006 data of the International Diabetes Foundation, diabetes afflicts about 246 million people worldwide. Only about 50 percent are aware of their condition. A significant chunk live without an inkling that they have diabetes or that they are likely candidates to have diabetes.

The World Health Organization predicted diabetes prevalence would hike from roughly 2.8 million in 2000 to 366 million in 2030. Considering the rate of newly-diagnosed diabetics every year, the foretold figure is not far-fetched. However, many would be surprised to know that this fatal disease, which directly causes 3.8 million deaths annually, is preventable.

The nature of the disease itself shows it can be prevented. According to the American Diabetes Association, too much fat around the waist accelerates a person’s chance of developing insulin resistance, a known precursor to diabetes. The pancreas of a person with insulin resistance secretes more insulin than what is essential. But gradually, insulin production is impaired. Insulin secretion fails to meet the needs of the body after taking meals.

“[Type 2] diabetes occurs when body produces insulin that cannot be taken up by the body, muscles, and fat. This condition is called insulin resistance and one of the factors resulting to this is obesity. One has to avoid being fat through adapting healthy lifestyle,” explained Dr. Honolina Gomez of the Philippine Center for Diabetes Education Foundation (PCDEF).

Published studies have in fact shown it is possible to delay and even prevent diabetes through modifications in lifestyle. The Diabetes Prevention Program (DPP) aimed to find out whether diet and exercise or a diabetes drug could prevent the onset of type 2 diabetes in people with impaired glucose tolerance (IGT). The subjects were grouped into three. One group underwent a diet and exercise program while the other group received metformin. The third group was given placebo (sugar pill).

Results of the three-year major trial showed lifestyle modification and metformin reduced onset of diabetes by 58 percent and 31 percent, respectively. The study suggests weight loss obtained from diet and exercise improves the capacity of muscle cells to utilize insulin and enables better handling of glucose.Similar results were also found in the Finnish Diabetes Prevention Study. The 522 randomly assigned “middle-aged overweight subjects with IGT” were divided into intervention and control groups.Changes in lifestyle were found to be more effective in preventing the disease.

“All of these studies would show that if you do lifestyle modification, including dietary and intense physical activity, you can actually delay the progression of diabetes. The use of medications like metformin also show that these can help delay the course of diabetes,” according to Dr. Josephine Carlos-Raboca, president of the Philippine Society of Endocrinology and Metabolism (PSEM). She said subjects included in the study had pre-diabetes, the stage wherein blood sugar is not exactly normal yet not high enough to be considered diabetic.

All-out Prevention
The preventable kind of diabetes, type 2, is also a hereditary one. The scenario given earlier in the article hints at when prevention ought to start. Children of parents with diabetes, even gestational diabetes, are automatically at risk of having the disease. Obesity coupled with lack of physical activity is likewise a risk factor. According to Dr. Dalisay, highrisk individuals can prevent diabetes through either pharmacologic or nonpharmacologic methods.

Non-pharmacologic or lifestyle intervention
Dr. Dalisay said this just translates to promoting healthy lifestyle. “I ask the patients to look into their food, the way they eat, basically reducing the calories and fats and increasing fiber in their diet. I also encourage them to view exercise as typical activity.” In the DPP study, those under this group were given intensive training in modifying diet, exercise, and behavior. Specifically, the study aimed to lose seven percent of the patients’ body weight by means of eating less fat and calories, and doing exercise for 150 minutes a week.

“With lifestyle intervention, the effect is still there on the patients even after the study,” she added. In communicating with her patients, Dr. Gomez makes it a point to be specific. She demonstrates how much fruit can be eaten (e.g., a handful orthat of the size of her fist) and how one can exercise in installments for a day (“I tell them to clean their cars for ten minutes”). Dr. Dalisay considers changes in lifestyle the cheaper and more effective way of preventing diabetes. “In a country like ours where financial aspect is a very important consideration in treatment, the concept of lifestyle intervention is very enticing. One doesn’t even have to go to a gym or enroll in exercise programs.” However, the cheaper way is also the more difficult to do for, patients, she added. Indeed, it’s easy to instruct patients to avoid feasting on fatty food and to eat green leafy vegetables instead; however, compliance is never guaranteed. “Food is comfort for us, for Filipinos,” Dr. Dalisay continued. “As much as possible, I avoid saying “bawal ito, bawal yan”.
I try not to present my advice in such a negative way. Motivation is the hardest thing. Some patients would ask for a medication because it’s more convenient, just one pop a day.” When it comes to exercise, Dr. Dalisay encourages patients to look for a physical activity or hobby that would double as a form of exercise. She cites badminton and dancing as good examples of activities that are popular, fun to do, and keep patients fit.

Weight loss is the fruit of proper diet and exercise. According to the American Diabetes Association, “losing just five percent of body weight can improve blood sugar control and can reduce the risk of cardiovascular diseases.”

Pharmacologic
Another option for prevention is through the use of drugs such as metformin, acarbose, rosiglitazone and pioglitazone. Last year, results of a major study showed diabetes drugs are also effective in altering the course of diabetes. In the Diabetes Reduction Assessment with ramipril and rosiglitazone Medication (DREAM), it was found that rosiglitazone can significantly reduce risk of diabetes by 62 percent if coupled with proper diet and exercise. Only 10.6 percent of subjects who took rosiglitazone developed diabetes while 25 percent of subjects in the control group did.

Medical experts are quick to stress that drugs are only secondary to diet and exercise. Dr. Gomez noticed that those patients whom she asked to take medications did lose weight, but only for a certain period of time. “They [those prescribed with diabetes drug tend to gain weight again unless you change their behavior and gear them towards healthy lifestyle,” she said. “There are some individuals who really have a hard time doing exercise so you have to supplement them with a drug. They go hand in hand,” she added.

On the same note, Dr. Dalisay explained drug management or pharmacologic treatment is the next best thing for those who cannot comply with lifestyle modification. “There are a lot of cheap metformin preparations to be taken everyday that can delay diabetes for about. 15 years. The leeway period is not that bad,” she said.

Lay Education
Diabetes organizations play a significant role in spreading the good news: diabetes can be prevented. The PCDEF leads the yearly “Diabetes Awareness Week” in July and promotes prevention of diabetes and its complications through healthy lifestyle and mass screening programs. The kickoff activities are held simultaneously in various shopping malls.

The PSEM holds regular lay fora where they teach lifestyle modification to lay people. The society usually coordinates with different related organizations on this. “We don’t just talk about diabetes. We also show them how they can prevent obesity by increasing physical activity,” Dr. Raboca said. Truly committed to diabetes awareness and prevention, PDA is likewise active in educating the patients and their relatives through lay fora and annual convention.

“Education is a powerful tool for diabetes prevention. They won’t have motivation to adapt a healthy lifestyle if they don’t know what diabetes is all about and how they can prevent it,” according to Dr. Dalisay. Dr. Gomez, who is also a member of the American Association of Clinical Endocrinologists-Philippine Chapter, participates in the group’s activities for the lay. “We tell people that even if they don’t have family history of diabetes, they can still develop it if they lead a sedentary lifestyle and have weight problems,” she said. Dr. Gomez also has her hands full in manning the St. Thomas Diabetes Center at the University of Santo Tomas Hospital. Last March, she started a series of free lectures on diabetes. Before the fora, they gave patients pre-tests. By July, the last month of the lecture series, they would get the HbAlc of the patients to see how the lectures helped in keeping their blood sugar in check.

An ounce of prevention is better than a pound of cure, so goes the old adage. This is often heard but often taken for granted. Studies have shown us diabetes prevention is possible. Medical experts say it pays to invest in preventing diabetes as early as possible. As with the cliche, “the early bird catches the worm,” one who prevents diabetes early gets a worm: a lifetime free of diabetes.

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