"Preventing" the Development of Diabetes?

Healthy Living Physical Activity
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I believe that, as of the time of my writing this post, there exists no such thing as a “cure” or a way to “reverse” diabetes, regardless of type. While optimal treatment involves many variables, including but by no means limited to, early and correct diagnosis, educated and mindful use of medications and high-tech devices, and the implementation of a healthy diet and regular exercise, diabetes can only be treated, not cured.

My purpose in starting this topic is to open a conversation surrounding the belief that diabetes, particularly Type 2, can somehow be prevented from developing in the first place, by following a “healthy lifestyle” (the meaning of which is an entirely separate and contentious topic on its own). My opinion is that diabetes cannot be prevented. Such a belief serves to further “The Blame Game” and more than implies that PWD are somehow responsible for the development of their own disease.

I now open the floor to [likely passionate and heated] discussion on this topic.

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@rgcainmd I think it is fair to operationalize the word “preventing” so that we are all on the same page. Communication involves the encoding and decoding of what is expressed. As you have opened this thread and are a licensed clinician would you be willing to share your definition of “preventing” “prevent” “prevention” and whether your are operationalizing it for clinicians or laypeople?

Thank you.

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To me, prevention is an action that inhibits or ceases something from happening, for example stopping the onset and development of a chronic medical condition.
What does operationalize mean?
And since we’re talking about prevention, here’s a one-liner for the day from a Scottish comedian: “I was in a band we called The Prevention because we hoped people would say we were better than The Cure”

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As Rose says, this topic will probably spark some impassioned debate. Here’s my $0.02:

The question cannot be answered.

Since we don’t truly understand the detailed etiology of T2—it is essentially a diagnosis by exclusion—we are, in effect, guessing when we say that this or that protocol or lifestyle adjustment does or does not “prevent” diabetes from developing. There are numerous examples people can quote one way or the other, but you can’t prove a negative; if someone hasn’t developed it yet, that does not support peering into the future and prophesying that they never will. But more fundamentally . . .

The plural of “anecdote” is not “evidence”.

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@truenorth That is truly my bad 8(( In a nutshell “operationalize” means to define the word so that when we use the word we are all ascribing the same meaning to the word. For example, Michael Jackson said “You know I’m bad.” We’ve operationalized “bad” as meaning that MJ is the “bomb” on or “top of his game.”

I am very reluctant to use the word “prevent” if the ground rules have not been laid. I will not assume that we have “defined” or operationalized the word in the same manner. As a clinician speaking to another clinician I assume that s/he understand how “prevent” “preventing” “prevention” has been operationalized within the clinical setting. In the clinical world it has a specific meaning. Hence, I think it is very important to know who your audience is when we use dynamic language like the word “prevent” “preventing” “prevention” with different audiences. I understand why there is confusion and why people living with diabetes are so passionate about the word.

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I firmly believe that type 2 diabetes can be prevented in many cases. I believe that the discussion is framed incorrectly though-- that the problem is not in the individuals but in our society as a whole and the individuals are the victim.

@David_dns has suggested he thinks their may be a link to environmental pollution. While I don’t really see the link myself, I think that environmental pollution offers an excellent parallel analogy. Individuals don’t tremendously pollute the environment on an individual basis, but each and every one of them is a part of the society that does.

As the way we’ve lived our lives, eaten, and worked has changed, over the past several generations, diabetes rates particularly type 2 have skyrocketed. I don’t need to be a researcher to see that. I don’t need to be a meteorologist to declare that it’s raining either.

The individual feels blamed in all of this, which sucks, and they shouldn’t— they’re not making choices to sit at a computer all day for a living instead of herding cattle and building things like their grandfather did-- that’s the world they live in, they didn’t make those choices, those were the choices before them.

It’s a tough situation but there is a path to improvement-- if the entire world comes together and acknowledges that the sedentary lifestyles and employment patterns of the modern world paired with the types of foods we are eating in an ever-more industrialized planet are negatively affecting our health-- maybe we can start doing something about it together…

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I just want to make clear that this is not a conversation or discussion exclusively between you, jojeegirl, and myself, but rather a topic that is open to all members of this Forum, as I believe I indicated in my original post. That being the case, I don’t see the need to “operationalize” the meaning of the word prevent. As the membership of this Forum consists of peoples from all walks of life (including, but not limited to, professionals holding a myriad of degrees, academicians, blue- and white-collar workers, the retired, the unemployed, homemakers, students, government employees, people who flip my burgers at McDonald’s, and, for all I know, persons who are homeless or people who support themselves through criminal activities), I believe a “lay” definition of the word prevent will more than suffice. Following is a definition from Cambridge Dictionaries Online:

prevent
verb [T] US /prɪˈvent/

› to stop something from happening or someone from doing something:
The police tried to prevent him from leaving.
Can this type of accident be prevented?
preventable
adjective US /prɪˈven·tə·bəl/
›
Fortunately, the suffering caused by ulcers is entirely preventable.
prevention
noun [U] US /prɪˈven·ʃən/
›
crime prevention
(Definition of prevent from the Cambridge Academic Content Dictionary © Cambridge University Press)

So, with this definition in mind, I will repeat my original question:

Can diabetes, particularly Type 2, be prevented from developing in the first place by following a “healthy lifestyle”, i.e. eating a diet that contains a moderate amount of carbs, healthy fats, healthy sources of protein, dietary fiber, limited in content that is processed, and containing all the recommended amounts of vitamins and minerals (or however a reasonable person would define a “healthy diet” without the need to “operationalize” the definition) and adhering to an exercise plan that includes both aerobic and resistance (muscle-building) exercise (meaning what most people would consider as being non-sedentary and not extreme, again without the need to “operationalize” the definition).

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So, I think there are more questions that necessarily pop up:

  1. Does “prevention” mean forever? Does it mean that, by following a diet and exercise plan such as you’ve described, the person would never display diabetic symptoms?

  2. Or does prevention mean using lifestyle choices to avoid medications to treat diabetic symptoms? If that is the case, have PWD who treat with only diet and exercise actually prevented diabetes? What is the difference between a PWD controlling with diet and exercise vs a person “preventing” diabetic symptoms with diet and exercise?

  3. How do we know who needs to adopt this particular healthy lifestyle? Is it once blood sugar levels are already elevated into the so called “pre-diabetic” range? Or would it have to be before ANY symptoms show?

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Hey everyone! 8)) I can’t help but respond from the perspective of a health educator. It is part of my skill set.

May I share something with you all so that you might understand my internal frame of reference?

Many years ago I read a book named The 7 Habits of Highly Effective People by Stephen R. Covey. One of those habits was “seek first to understand, then be understood.” The foundation for “seek first to understand, then be understood” empathic communication.

Stephen Covey stated that empathic communication is powerful because “it give you accurate data to work with. instead of projecting [my] own autobiography and assuming thoughts, feelings, motives and interpretation, you’re dealing with the reality inside another person’s head and heart You’re listening to understand. You’re focusing on receiving the deep communication of another human soul.”

It is with the above internal frame of reference that I respond to the discussion question.

I believe if “lay people” have an idea how a clinician “operationalizes” a word or a term and the clinician understands how the layperson is “operationalizing” the word or term, it can serve to be a preventive measure in reducing the likelihood of me or my audience “assuming thoughts, feelings, motives and interpretations.”

When I share my head and my heart, it is my hope that you will not have to guess about my position… As such here is how I am operationalizing “prevention” for the sake of this conversation as per Taber’s Medical Dictionary:

Primary prevention: Limiting the spread of illness to previously unaffected patients or populations.
Primary prevention (nursing): Nursing care aimed at general health promotion. This included whatever intervention is required to provide a health-promoting environment at home, in the schools, in public places, and in the workplace by ensuring good nutrition, adequate clothing, and shelter, rest and recreation, and health education (including sex education, and for the aging, realistic plans for retirement). Changes in lifestyle through behavior therapy, though difficult, must be attempted with respect to those areas known to represent major health risk factors (i.e., smoking, obesity, sedentary lifestyle, improper diet, alcohol and drug abuse, etc.

Secondary prevention: Limiting the impact or the recurrence of an illness in patients already afflicted with it.

Tertiary prevention: Nursing care for patients with incurable diseases, and patients instruction concerning how to manage those conditions and diseases. Parkinson’s disease, multiple sclerosis, and cancer are conditions the lend themselves to tertiary prevention. The goal is to prevent further deterioration of physical and mental function, and to have the patient use whatever residual function is available for maximum enjoyment of and participation in life’s activities. Rehabilitation is an essential part of tertiary prevention.

I hope that give you all a peek into how I operationalize “prevent” “prevention” “prevention” in my world.

Thank you.

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Can diabetes be prevented? I believe the answer is yes, no, maybe and sometimes. I give that confusing answer because the question has not yet been satisfactorily answered. If someone claims to know it is their opinion talking and not the facts. Since the cause is not yet fully understood how can we make assumptions about prevention.

Because we do not truly have the answer it is just as damaging to tell someone that it is not preventable. It is wrong to dash someones hopes by telling them that they have no chance. Some people believe that if you can’t beat it why bother, why let that sentiment come onto play over an unimportant technicality.

The blame game is going to continue no matter what someone believes on this subject. You can be blamed for not preventing the actual disease or you can be blamed for not preventing the progression of the disease, it really makes no difference because you have been blamed.

The way to stop the blame game is to teach understanding of the disease, not by trying define it out of existence.

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This discussion has identified one problem: the clinical definition does not match the dictionary definition, which is the definition the rest of the world uses, the world in which the rest of us live.

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I have to take issue with the statement “diabetes cannot be prevented”, though admittedly my point is rather academic and jesuitical.

So much for the disclaimer. Anyway, it can’t be prevented now; that doesn’t mean it never will be. When we understand the underlying mechanisms—and there may well turn out to be more than one—we’ll probably develop a technology that can achieve true prevention. To use a loose analogy, there was a time when polio couldn’t be prevented. Now, it can.

But at the present state of the art . . . no. It can’t be.

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I definitely believe that diabetes can be prevented across a certain percentage of the population. Meaning if everyone was active and ate a better diet, some people who would get diabetes in our current world might not get it at all. Some people would still get diabetes regardless of lifestyle, diet, etc. Some people might delay diabetes by 10 years. Some people would never get diabetes regardless of how they lived and ate.

Unfortunately most of the time people wouldn’t know which of those segments that they fall into. But if many people can improve their BG numbers by losing weight, exercising, and eating little junk food, then it stands to reason that if they had always lived like that, they might have prevented diabetes or at least delayed it by many years.

But if you take one random individual, you may or may not be able to prevent diabetes because you don’t know ahead of time which group he/she falls into.

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That could be true, or not. The “evidence” is purely anecdotal, though admittedly there is a great deal of it. As noted elsewhere, you can’t prove a negative, which cuts two ways: you can’t prove that those people living a “healthy” lifestyle weren’t going to be immune anyway no matter what they did, nor can you prove that the people who did develop D wouldn’t have had they behaved differently.

True, universal prevention based on knowledge of the underlying mechanisms(s) will have to wait for further progress in the science.

But wait . . . there’s another joker lurking. Since we’re reasonably sure the current epidemic is due to some change or combination of changes in circumstances, don’t totally discount the possibllity that as science, culture and society continue to evolve, new triggers may appear. After all, it’s happened once already. To use another sloppy analogy, some bacteria can be effectively treated for a while, but then morph and mutate into more resistant forms.

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Would we agree that on a professional basketball team, the overall prevalence of diabetes is likely lower than it is in a group of similar age and genetics who work in sedentary jobs?

If we would agree on that, would we agree that the more active group has at least to some extent ‘prevented’ diabetes through their activity level?

Apply the same example to your own community— i would suggest that you might find a lower percentage of diabetics, current or future, at your local gym, track, bike trail, etc than one might find at the local restaurant, grocery store, etc. I would suggest that they are also indeed preventing diabetes at least some of the time.

We have to start somewhere. I believe that the idea that we can do nothing as a civilization to prevent diabetes is extremely dangerous.

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No. Not until you prove to me that they would have gotten diabetes had they not had the talent and drive to become professional athletes.

Look, there are radically different points of view on this (obviously!) and I will staunchly defend everyone’s right to their own. But agree? Sorry, no. That’s not the same thing.

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… except that if you think about who is on a professional team, well - it’s a sample bias. They are all also really tall. Anyways, what I’m trying to say is that I don’t think members of a professional basketball team are representative of the general population.

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Certainly Type 2 Diabetes can be prevented. My dad, a T2D, has 10 siblings, and 6 of them have T2D. So there’s a pretty strong genetic component, yes. And yet, 100 years ago, no one in his family had the disease. I also have identical twin cousins discordant for the disease. So clearly there is an environmental trigger and that suggests it is possible to prevent by altering that environment.

On the other hand, I don’t believe we know what to do to reliably prevent it on an individual level. I think we need to change society on a massive scale and then fewer genetically vulnerable people will develop the disease, but I don’t feel comfortable telling people “if you exercise, eat fruits, veggies and fish, lower calories, don’t smoke, and avoid processed carbohydrates you will not develop the disease.” I suspect a lot of the disease is a result of our post-industrial diet, which has destroyed our microbiome over 4 generations. At this point, preventing it may require engineering that, rather than just improving diet.

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Fair point regarding height and basketball-- but I’m sure we can think of other examples where height isn’t a prevalent criteria… My local running and cross country skiing clubs have a broad variety of body types (and abilities) in them and I would be willing to bet lower diabetes prevalence than the general population in this area. No I’ll certainly never be able to prove that any of them would have become diabetic if not for a healthier more active lifestyle… I can’t prove an aweful lot of other things in this world either-- but it’s the best evidence we have. For me it exceeds the burden of proof beyond reasonable doubt.

The problem in my mind of continuing to insist that there’s no proof that we can prevent these trends is that as long as we cling to that philosophy we are just perpetuating the problems as a society that got us in this position to begin with-- and I think that until we are able and willing to take a little bit of responsibility for our own destiny as a culture… It’s just bound to get worse, which quite frankly is alarming to me.

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Interesting conversation, I see it as a bit useless. Every time someone make a point it seems it has no correlation to me as a t2.
Now before I go out a run a 7 mile event tomorrow at the age of 70
I will remember my tall 6-4 grandfather, who worked his garden everyday ( the only other t2 in the family)’ then ponder why my sister at 5-4 200 plus pounds and eats two McDonalds breakfasts with two super sized real Cokes on the weekends, not a t-2. Etc…

I am not disputing diabetes has grown. But grown from what? probably most t-2 died early in the 1960’s from conditions not labeled diabetes, but it was. Is it because we are healthier , living longer and have better diagnostic tools that more cases of diabetes are found.

My mother was diagnosed as a T2 at 91 because her fasting was over 120
I had to have the doctor change her diagnoses, because my mother was afraid she would have to use insulin.

Would there be as many diabetics if doctors and pharma companies could not make gobs of money.

Sorry for the rant, but but there way to many variables in this discussion

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