Diabetes Mellitus Type 2: Prevention

To prevent type 2 diabetes mellitus, attention must be paid to reducing individual risk factors. Behavioral risk factors

Diet
- Chronic overeating
  - High calorie intake
  - High-fat diet (saturated fat)
    - High proportion of saturated fatty acids
  - High intake of carbohydrates, especially mono- and disaccharides (monosaccharides and disaccharides) due to excessive consumption of sweets and sweet drinks: per serving of a soft drink (study mean 336 ml) per day, the risk of developing diabetes increased by 21%, per drink with artificial sweetener (eg. It is suspected that artificial sweeteners trigger hyperinsulinemia (a condition in which the concentration of the hormone insulin in the blood is increased above normal levels), which in turn increases the feeling of hunger and blocks lipolysis (fat burning).
- High cholesterol intake
- Excessive consumption of red meat, i.e. muscle meat of pork, beef, lamb, veal, mutton, horse, sheep, goat; 1.48 times the risk.
- Excessive consumption of processed meat
- Intake of grilled meat (red meat, chicken) or fish, i.e., preparation over an open flame and/or at high temperature → heterocyclic aromatic amines (HAAs), polycyclic aromatic hydrocarbons (PAHs), nitrosamines, and advanced glycation endproducts (AGEs).
- Excess of acidifying foods
- Too low a proportion of monounsaturated fatty acids
- Too low a proportion of polyunsaturated fatty acids
- Too low a proportion of complex carbohydrates
- Low-fiber diet – Even small amounts of fiber from whole grains in the diet reduce the risk of developing type 2 diabetes. It is believed that insoluble fiber from grains causes changes in the intestinal wall that lead to increased insulin sensitivity. Soluble fiber, on the other hand, has no preventive effect.
- Breakfast waiver – strongest risk (+55%) when waived for 4-5 days per week.
- Micronutrient deficiency (vital substances) – see prevention with micronutrients.
Consumption of stimulants
- Alcohol (woman: > 40 g/day; man: > 60 g/day).
- Tobacco (smoking); passive smoking.
Physical activity
- Physical inactivity – Even with pre-existing diabetes, regular physical activity can reduce the risk of secondary diseases such as cardiovascular disease and also reduce overall mortality (mortality).
- Sitting for long periods (> 7.5 hours a day) – This increases the relative risk of developing type 2 diabetes mellitus by 112%.
Psycho-social situation
- Traumatic childhood experiences: especially in people in whom four or more stressful factors, ranging from abuse to neglect, come together
- High workload (job stress) and concomitant low control over activities performed; 45% higher risk of type 2 diabetes mellitus than people with low job stress
- Shift work with night duty: diabetes risk correlated significantly with the number of years of night shifts: with one to five years by 11%, five to nine years by 28%, and ten or more years by 46%
Sleep duration
- Children (age 9-10 years): average sleep duration 10.5 hours (8-12 hours); target is 10-11 hours; sleep duration showed an inverse correlation with HOMA index and fasting glucose (fasting blood glucose); each hour of increased sleep improved HOMA index by 2.9 percent (95 percent confidence interval 1.2 to 4.4 percent)
- Adults: sleep deprivation (<4.5 hours of sleep; sleep deprivation produces feelings of hunger, decreases spontaneous exercise behavior, and insulin resistance)
- Too little sleep (< 6 hours) impairs not only the metabolism of insulin, but also that of leptin – a satiety hormone – which also increases the risk of developing diabetes mellitus.
- Prolonged sleep duration: increase of ≥ 2 h sleep per night compared with sleep duration sustained at 7 h was associated with increased risk of developing type 2 diabetes mellitus (“odds ratio” = 1.65 [95% CI (95% confidence interval) 1.15; 2.37]).
Television viewing and the accompanying increased food intake (high energy density snacks and beverages) and physical inactivity.
Overweight (BMI ≥ 25; obesity).
- There is a close association between obesity and type 2 diabetes mellitus, so it can be said that obesity is the most important manifesting factor of type 2 diabetes. Approximately 80-85% of all type 2 diabetics are overweight, and normal weight type 2 diabetics are the exception.
  - Independent risk factors in this context are:
    - Extent and duration of obesity
    - Recent pronounced increase in weight
  - The successful therapy of obesity is therefore also a preventive measure of diabetes mellitus!
- Childhood obesity quadruples the risk of type 2 diabetes
- Obesity is significantly more strongly associated with risk of type 2 diabetes than genetics
Android body fat distribution, that is, abdominal/visceral, truncal, central body fat (apple type) – high waist circumference or waist-to-hip ratio (THQ; waist-to-hip ratio (WHR)) is present When measuring waist circumference according to the International Diabetes Federation (IDF, 2005) guideline, the following standard values apply:
- Men < 94 cm
- Women < 80 cm
The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men and < 88 cm for women.

Environmental pollution – intoxications (poisonings).

Bisphenol A (BPA) as well as bisphenol S (BPS) and bisphenol F (BPF).
Air pollutants
- Particulate matter: long-term exposure to particulate matter in children (for every 10.6 µg/m³ of additional airborne nitrogen dioxide (NO2), the incidence of insulin resistance increased by 17%. For airborne particulate matter (up to 10 µm in diameter), there was a 19% increase in insulin resistance per 6 µg/m³).
Organic phosphates (OP) in insecticides: e.g., chlorpyrifos, dichlorvos (DDVP), fenthion, phoxim, parathion (E 605) and its ethyl and methyl derivatives, and bladane.
Pesticides

Other risk factors

Periodontitis (disease of the periodontium): see below.
Pregnancy

Prevention factors (protective factors)

Genetic factors:
- Genetic risk reduction depending on gene polymorphisms:
  - Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
    - Gene: SGK1
    - SNP: rs9402571 in gene SGK1
      - Allele constellation: GT (slightly decreased risk).
      - Allele constellation: GG (0.85-fold)
Women who breastfed have an approximately 40% reduced risk of developing type 2 diabetes mellitus later in life compared with women who did not breastfeed. This finding is consistent with previous studies that have demonstrated that lactation (breastfeeding) improves insulin sensitivity, which may be related to the increased energy expenditure – circa 500 calories/day – during the lactation period.
Diet
- Frequent high-quality vegetarian foods such as whole grains, vegetables, fruits, legumes or nuts, and tea (34% risk reduction; hazard ratio = 0.66, 95% confidence interval: 0.61-0.72)
- Nuts – A moderate intake of nuts (approximately 70 g/day) results in a reduction in HbA1c. Pistachios may also help reduce postprandial blood glucose (blood glucose after a meal).
- Cinnamon improves prediabetic metabolic status: a randomized controlled trial showed that taking cinnamon capsules for 12 weeks reduced fasting blood glucose and increased glucose tolerance compared with placebo treatment. In addition, a significant decrease in the 2-hour value of plasma glucose was obtained in the oral glucose tolerance test with 75 g glucose. HOOMA-IR, a measure of insulin resistance, was not affected.
- Children who eat breakfast regularly have a more favorable risk profile for type 2 diabetes – especially if the meal is rich in cereals (grains).
- Regular morning meals lower mean fasting insulin levels: a study of 4,000 9- and 10-year-old children who ate breakfast daily had a lower risk of developing type 2 diabetes mellitus compared with children who did not eat breakfast.
Stimulant
- Moderate alcohol consumption: lowest risk had men who reported alcohol consumption of 14 drinks per week/women who reported consumption of 9 alcoholic drinks; limiting alcohol consumption to three to four days per week was most favorable for men and women; men and women who drank seven glasses of wine per week were significantly less likely to develop type 2 diabetes.
- Coffee – Individuals who drank coffee daily (> 11 cups per day) had a 67% lower risk of developing type 2 diabetes mellitus compared with non-coffee drinkers; in carriers of the TCF7L2 risk gene variant, the risk of diabetes decreased by up to approximately 7% per cup of coffee consumed daily
- In younger and normal-weight men, consumption of cocoa or chocolate has a positive effect on insulin resistance and the incidence of diabetes mellitus.
Physical activity
- Physical fitness at a young age – those who had poor fitness at age 18 had a threefold increased risk of type 2 diabetes (regardless of body mass index).
- Cycling to work/cycling for leisure was associated with a reduced risk of type 2 diabetes.
Lifestyle intervention target values whose implementation is critical to prevent or delay diabetes mellitus:
- A maximum of 30% fat in the daily diet and a proportion of saturated fatty acids of no more than 10%.
- 15 g of fiber-containing dietary fiber per 1,000 cal of food intake.
- 150 minutes of physical activity per week
- Weight reduction by 5-7
Diseases
- Active migraine: 30% reduced risk of diabetes; conversely, the prevalence (disease incidence) of migraine in women with diabetes mellitus decreased from 22% to 11% in the 24 years before diagnosis
- In a cross-sectional analysis in the Netherlands, the prevalence of type 2 diabetes was significantly lower in patients with familial hypercholesterolemia.
- Prevention of periodontitis (disease of the periodontium): oral hygiene, ie, brushing teethIn one study, prediabetes was shown to be observed in 18% of patients with mild periodontitis but in 58% with severe periodontitis.

Secondary prevention

Gender Medicine

Men:
- Men lose weight more easily and more than women through caloric restriction and are more likely to maintain the reduced weight.
- Women benefit more from pharmacological support in weight loss, such as with orlistat (lipase inhibitor that blocks fat digestion ).
- Under weight reduction, the metabolic syndrome decreases more in men; the same applies to free mass, waist circumference and pulse pressure.
Women:
- Women were significantly less likely to reach the HbA1c target range below 7 percent on antidiabetic therapy and required more insulin on average than men.
- Women more likely to have severe hypoglycemia (low blood sugar) compared with men; rate of nocturnal hypoglycemia was nearly four times higher.

Prophylaxis of cardiovascular disease

Decisive for the pathogenesis (disease development) of cardiovascular diseases (cardiovascular diseases) is the increase of glucose, blood pressure, and lipid levels as well as insulin resistance. Thus, prevention of cardiovascular disease is based on the following pillars:
- Nutritional measures: Lifestyle and dietary changes (individualized nutritional counseling and sports medicine counseling; see above under “Behavioral risk factors“) and weight reduction (caloric restriction and increased physical activity; bariatric surgery if necessary).
- Improvement of metabolic control: orientation to fasting plasma glucose, the 2-hour value in the oral glucose tolerance test and the HbA1c.
- Lipid lowering: treatment of diabetic dyslipoproteinemias (dyslipidemia) characterized by lowered HDL cholesterol, elevated triglycerides, and LDL cholesterol levels.
- Blood pressure setting
- Prophylaxis with acetylsalicylic acid