Preventing Diabetes in those at
High Risk
What is Pre-Diabetes?
• A term used to identify those who are at high risk of diabetes
• Not borderline
• You have been invited today because you have been identified as
potentially being at a high risk of developing diabetes……
• But HOW???
How am I high risk??
• Blood test results
• HbA1c (42-47mmols or 6.0 – 6.5%)
World Health Organisation has identified this range to classify those at high risk of diabetes
• Impaired Fasting Glucose (glycaemia)
Testing blood glucose level
Up to 6mmols/L is normal
6.1mmols to 6.9mmols/L is high risk
7mmols/L and above can diagnose diabetes
Key note:
Even though you might feel healthy you could still be at high risk of developing diabetes
Why are we here today??
• Good news…..
• Just because you are at high risk doesn’t mean you will necessarily progress to
develop type 2 diabetes (National Institute for Health and Care Excellence)
• 4 out of 5 cases of type 2 diabetes can be prevented by making small changes to
your lifestyle (Diabetes UK)
• Small lifestyle changes include maintaining a healthy weight, eating well and
being active
• This presentation will detail evidence based information about how you can make
these lifestyle changes and reduce your risk of developing type 2 diabetes
What is Type 2 Diabetes?? Why do we want
to prevent it??
• Diabetes is a serious long term condition for which there is no cure. It
occurs when the glucose in the blood is too high and body isn’t able
to use it properly. This can result is a number of serious complications
to health (Diabetes UK).
• Complications of type 2 diabetes include problems with eyesight,
hypos, nerve damage to feet, kidneys DISEASE, cardiovascular disease
and many more.
Eat well
Diabetes UK top tips for eating well
• Eat regular meals. Avoid skipping meals and space your breakfast, lunch and evening
meal out over the day.
• Include carbohydrates each day. Healthier sources include wholegrain starchy foods,
fruits and vegetables, pulses and some dairy foods. As all carbohydrates affect blood
glucose levels, be aware of the amount you eat.
• Cut down on fat, especially saturated fat. Unsaturated fats from olive oil, sunflower oil,
rapeseed oil, nuts and avocados are better for your heart. Try to grill, steam or bake food
rather than frying, and swap creamy sauces for tomato based sauces.
• Eat more fruit and vegetables. Fruit and vegetables will give your body the vitamins,
minerals and fibre it needs. We should all aim to eat at least 5 portions a day. Choose
whole fruits and vegetables rather than juices and smoothies.
• Eat more beans. Kidney beans, chickpeas and lentils are packed with nutrients. Try them
hot in soups or casseroles, cold in salads or in low-fat hummus and dhal.
Eat well
Diabetes UK top tips for eating well
• Dish up the fish. Aim to eat at least two portions of fish, including one of oily fish, a week.
Examples of oily fish include mackerel, sardines, salmon and pilchards.
• Cut down on sugar. A healthy diet can include some sugar – but you may need to reduce the
amount you eat. Choose sugar-free, diet or no-added sugar drinks, and make sure you’re reading
food labels to spot sugar in other foods.
• Cut down on salt. Aim to eat 6g of salt or less a day. 70% of the salt we eat comes from processed
foods – so try to cut back on pre-prepared foods, and try flavouring your food with herbs and spices
instead of salt.
• Drink alcohol in moderation. That’s a maximum of 2–3 units of alcohol per day for a woman and
3–4 units per day for a man. Remember alcohol is high in calories so think about cutting back
further if you are trying to lose weight.
• Be aware of portion sizes. If you are trying to lose weight, you may need smaller portions. Try
using smaller plates or dish up your vegetables first and let them fill up your plate. There can be a
lot of calories hidden in drinks, so try drinking water and get your calories from food instead.
What is the link between weight and diabetes
prevention?
• Being overweight or obese is the main modifiable risk factor for type
2 diabetes (Public Health England (PHE) 2014)
• BMI. Being overweight (BMI above 25) or obese (BMI above 30)
significantly increases your chances of developing diabetes. Also the
longer we are overweight the greater our chances of developing
diabetes become (PHE 2014)
• Waist circumference – Diabetes UK video
• Weight can be a sensitive issue for many of us and maintaining our
weight or losing weight can be a difficult thing to do
If my BMI is raised how much weight should I
lose??
• Research shows us that even small reductions in weight, for example 5-10 %, can improve our
overall health. We know that the more we lose the greater the benefits to our health. Diabetes
UK advise is to aim to make small, sustainable changes to reduce and maintain weight loss with a
long term goal of achieving that healthy BMI of under 25
• NICE guidelines report a realistic target of 5/10% weight loss in 1 year will reduce the risk of type
2 diabetes and also lead to other significant health benefits
Exercise
Start Active Stay active Department of Health 2011
• Even if increasing your activity levels is the only lifestyle
change you make you can still help to reduce your risk of type 2 diabetes (NICE)
More good news….
• Exercise comes in many forms. It’s not just group sports or running that help us to maintain our health.
‘Moderate intensity’ activity such as gardening, housework and walking the dog all count!
• The Government recommends a minimum of 150 minutes of ‘moderate intensity’ activity per week
• We can meet these targets in many ways including breaking down sessions into 10 minute chunks 3 times a
day
• We can also meet the recommendations by doing 75 minutes of ‘vigorous-intensity’ activity spread across
the week
• Or by combining bouts of moderate and vigorous activity. If you can, try to include activity that increases
muscle strength 2 days per week
• Minimise how much time we spend sitting for long periods of time e.g. at a computer or watching TV.
Exercise and the older adult
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Department of Health advice for those over 65
Older adults who participate in any amount of physical activity gain some health
benefits, including maintenance of good physical and cognitive function. Some physical
activity is better than none and more physical activity provides greater health benefits
Older adults should aim to be active daily. Over a week, activity should add up to at least
150minutes (2 1/2hrs) of moderate intensity activity in bouts of 10 minutes or more –
one way to approach this is to do 30 minutes on at least 5 days a week
For those who are already regularly active at moderate intensity, comparable benefits
can be achieved through 75 minutes of vigorous intensity activity spread across the week
or a combination of moderate and vigorous activity
If it is unrealistic for you meet the recommended minimum due to ill health even small
increases in physical activity will be beneficial to your overall health and risk of diabetes
Quick wins
Some small sustainable changes can improve your health and reduce your
risks (NICE)
You could try…
• Taking the stairs instead of getting the lift
• Be more active during breaks at work for example going for a walk
• Walking or cycling instead of using a car for short journeys
• Getting off the bus a stop earlier
• Choosing activities that you enjoy
• Set short term goals and record your progress (could try using a
pedometer) (NICE 2014)
Better Together
• Doing exercise can help us reduce our risks and changing our diet can
help us reduce our risks. Individually making changes to EITHER of
these can reduce our risk factors but…
• Doing exercise AND dietary changes together has been identified as
the most effective prevention of type 2 diabetes in high risk
individuals (PHE 2014).
Some More Evidence
Diabetes Prevention Program (2002)
• 1700 participants who had been identified with impaired glucose
tolerance
• The participants had an average BMI of 34
• The outcome of the study was that the intensive lifestyle changes the
participants made reduced their risk of developing type 2 diabetes by
58%
Risk Monitoring
• How will my risk of developing type 2 diabetes be monitored??
• Repeat blood test once a year either HbA1c or fasting glucose
• Self monitoring by…
• Keeping an eye on your weight / BMI and physical activity levels
References
Diabetes Prevention Program (2002) [online] Available from:
http://care.diabetesjournals.org/content/25/12/2165.short (Accessed 01/05/17)
Diabetes UK (2017) [online] Available from: https://www.diabetes.org.uk/
(Accessed 04/04/17)
National Institute for Health and Care Excellence (2012) Type 2 diabetes: prevention
in people at high risk. [online] Available from:
https://www.nice.org.uk/guidance/ph38 (Accessed 04/04/17)
Public Health England (2014) Adult obesity and type 2 diabetes. [online] Available
from: http://www.noo.org.uk/NOO_pub/briefing_papers (Accessed 13/04/17