There are several factors that may contribute to a person’s risk of developing type 2 diabetes. These include:
• Pre-diabetes;
• Being overweight or obese;
• Advanced age;
• Having high blood pressure and/or high cholesterol;
• Physical inactivity;
• Having a family history of diabetes;
• Belonging to certain high-risk ethnic populations (e.g. Aboriginal, African, Hispanic, Asian);
• A history of gestational diabetes; and/or
• Having other conditions which may include vascular disease, polycystic ovary syndrome, acanthosis
nigricans or schizophrenia.
Pre-diabetes
Pre-diabetes is a key risk factor for type 2 diabetes. It is a risk condition where blood glucose (sugar) levels are elevated, but are not high enough for a diagnosis of diabetes. Blood glucose is the main sugar found in the blood and the body’s main source of energy. Pre-diabetes is diagnosed by measuring impaired fasting glucose or impaired glucose tolerance.
The Public Health Agency of Canada estimates that pre-diabetes affects roughly 5 million Canadians over age 20. The burden of pre-diabetes is expected to grow significantly over the next decade – due to the aging of the population, the increase in obesity, and other demographic changes. The prevalence among adults over age 20 is expected to increase to 6.3 million by 2016 – an increase of over 1 million new cases. Among those aged 40 to 74 who would likely benefit most from screening and early detection, the prevalence is expected to increase from about 3 million (22%) in 2004 to 4.3 million by 2016.
Why is pre-diabetes important?
If left untreated, over half of those with pre-diabetes will be diagnosed with type 2 diabetes within 8 to 10 years and face elevated risk of cardiovascular disease and other diabetes-related complications.
Reducing the risk of diabetes
The risk of developing type 2diabetes can be greatly reduced through lifestyle choices. People can minimize the risk of diabetes by losing excess weight, managing diet and exercising. Some lifestyle factors that should be considered are outlined below.
Body Mass Index
The Body Mass Index (BMI) is a simple method of indirectly estimating adiposity (excess fat). Excess body weight is a risk factor for developing type 2 diabetes. Weight loss of 5% to 10% has been shown to significantly reduce the risk of diabetes.
BMI is a widely accepted way of assessing overweight or obesity in most people aged 20 to 65 (exceptions include people who are very muscular, athletes, and pregnant or nursing women).
• According to World Health Organization (WHO) guidelines, for adults over 20 years old, BMI
falls into one of the following categories:
Below 18.5 = Underweight;
18.5–24.9 = Normal;
25.0–29.9 = Overweight/Pre-obese
30.0–39.9 = Obese; and
Above 40.0 = Very obese
Waist circumference
The BMI assessments do not take into account where fat is stored – the risk of developing type 2 diabetes
is higher if fat is stored around the abdomen (rather than the hips and thighs). Medical assessments of people with diabetes should include both height and weight measurements, a calculation of BMI and a measurement of waist circumference to assess a person’s degree of abdominal fat. Excessive upper body fat, or abdominal obesity, is a strong independent predictor of metabolic co-morbidities (e.g. hypertension). Cut-off values for waist circumference vary among expert guidelines: Health Canada identifies waist circumference values of 102 cm (40 inches) in men and 88 cm (35 inches) in women as being associated with substantially increased abdominal fat accumulation and health risks.1
Eating a healthy, balanced diet
Eating foods that are rich in fi bre and lower in fat and adding more fruits and vegetables can help people control their diet and maintain or lose weight. In addition to monitoring the types of food that are eaten, people should also monitor portion size while still ensuring that they meet healthy nutrient intakes.
Increasing physical activity
Increasing physical activity can help control weight and reduce the likelihood of developing type 2 diabetes.
Managing high blood pressure, cholesterol and glucose
Diabetes and high blood pressure are often found together. Up to three-quarters of people with undiagnosed diabetes have high blood pressure. Studies show that management of blood pressure, cholesterol and glucose can substantially reduce the risk of developing complications and slow their progression. A health care provider (e.g. physician, nurse, pharmacist) can assist with strategies to monitor and manage blood pressure, cholesterol and glucose.
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