Question

Type 2 diabetes is by far the most common form of the disease, yet it's largely preventable. Its prevalence in the population is at an all-time high and projected to rise even higher. Why is this happening, and what needs to be done to turn the tide?

Answer 1

The global prevalence of type 2 diabetes is rising steadily. The recent report from CDC confirms that more than 100 million US adults are now living with diabetes or prediabtes. Diabetes was considered as the seventh leading cause of death in US in 2015. In the past years, type 2 diabetes was predominantly a disease of the middle-aged and older people; however, in the recent decades, the age of onset had decreased. Type 2 diabetes had been reported in adolescents and children worldwide. Diabetes is a chronic disease condition and associated with devastating long-term complications including visual impairment, kidney failure, erectile dysfunction, amputation, heart attack, and stroke. These complication can be fatal and significantly reduce the life expectancy. The factors leading to increased prevalence of diabetes can discussed under the following two headings:

1. Individual level risk factors: Aging, obesity, hypertension, lifestyle, genetic predisposition, and prediabetes could contribute to the increase in prevalence of type 2 diabetes. Each of these factors are linked with each other in contributing to the development of diabetes.  

• Obesity:Obesity and over nutrition are considered to be leading cause of diabetes in the current population. There is no specific food type that can cause diabetes, but refined sugars and fats are the major sources of nutrient excess. It is believed that whatever makes us overweight is what causes the diabetes. It is very easy to gain weight in our modern environment of high-calorie and supersized fast foods. Excess calories and a sedentary life style, lead to the development of central obesity or abdominal obesity, which is the most metabolically harmful type.   
• Genetic factors/Ethnicity: People with a strong family history of diabetes have a higher chances of developing diabetes. Certain groups such as African Americans, Native Americans, Hispanic Americans, and Asian Americans, have a greater risk of developing type 2 diabetes than non-Hispanic whites.    
• Age: The risk for diabetes increase as one grows older, especially after 45 years of age. That is because, people tend to exercise less, lose muscle mass, and gain weight as they age.
• Hypertension and lipid disorder: There is an increase in the prevalence of hypertension and lipid disorders, which is again due to a combination of obesity and lifestyle changes. Research shows that prehypertension and hypertension are significantly associated with the development of diabetes. High blood pressure is considered as a significant predictor for diabetes. Hypertension, lipid disorders, and diabetes were found to have share common risk factors, including obesity, lipid profile, and BP; moreover, they commonly occur together in individuals.    
• Lifestyle changes: In modern environment, lifestyle is an important factor, which affect the health condition of an individual. Sedentary lifestyle, working habits, lack of exercise or proper rest, eating junk foods, smoking, alcohol consumption are all known to contribute to the onset of diabetes. The food of the current population include more of high-fat and carbohydrate rich diet, which can contribute to central obesity and metabolic dysfunction.  
• Prediabetes/undiagnosed diabetes: Lack of knowledge regarding the early signs of prediabetes, failure to perform regular health screening, and poor awareness regarding the devastating complications, are also causing the rise in number of population diagnosed with diabetes.   

2. Environment risk factors: Recent researches have also concluded the urbanization and transition from a predominantly rural to urban population accompanied the increase in prevalence of diabetes. The transition means that a greater proportion of population might be exposed to obesogenic environment such as more sedentary work, higher use of car, and lower levels of physical activity. Urbanization has also lead to exposition of pollutants, such as nitrogen dioxide and particulate matter less than 2.5 mm, which are found to be associated with the incidence of type 2 diabetes.

Preventing the increase in prevalence of type 2 diabetes: Lifestyle modification, creating awareness among the population, and pharmacological interventions can significantly reduce the prevalence of diabetes. Lifestyle modification including eating healthy food, exercise or physical activity, non-sedentary life etc can have a greater impact on reducing the incidence of diabetes among the population. Especially, the younger generation should be educated on the importance of following a health life style and its effect of the general health. A large-scale effort should be taken to create awareness among the general population regarding the early signs of prediabetes and the need for regular,periodic health check-ups. Early identification of prediabetes and accordant lifestyle changes can prevent the development of diabetes and its chronic life-long complications.