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Diabetes in Canada: Reducing the risk

Health Matters
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Editorís note: This article is the third in a series about diabetes in Canada. We started by considering the burden diabetes puts on individuals and our communities, followed by a look at diabetes in children and among First Nations populations. This week, we wrap up by considering how to reduce the risk of type 2 diabetes and its complications.

The causes of type 2 diabetes are varied and inextricably linked. They include genetic, behavioural and environmental factors and though no cure exists, type 2 diabetes and its complications can be prevented by reducing the key risk factors.

We categorize risk factors for type 2 diabetes as either modifiable and non-modifiable, reflecting the level of control we have over the risk. The modifiable factors are those can be changed to reduce an individualís risk of developing the disease. The non-modifiable factors are individual characteristics such as age, ethnicity and family history of the disease.

The first of the modifiable risk factors for type 2 diabetes and its complications is being overweight or obese. Excess body weight reduces the effectiveness of insulin in the body leading to increased demand on the pancreas to produce more. This demand cannot be met indefinitely and insulin production eventually declines, leading to type 2 diabetes. At every age, the rate of diabetes is higher among those who are overweight or obese, both men and women.

A second factor, closely linked to overweight is a lack of physical activity. Not only does physical activity work to maintain a healthy weight, it also prevents chronic disease including type 2 diabetes and its complications. Physical activity has also been shown to improve glycemic control, decrease insulin resistance and lower blood pressure.

A third crucial, and modifiable, risk factor for type 2 diabetes is unhealthy eating. Healthy weight depends on a balance between calories consumed and energy expended. Poor food choices can increase the risk of diabetes, especially when overconsumption leads to overweight. And healthy eating will have a role in preventing many chronic diseases. Negative food choices include excessive alcohol consumption and eating too many processed foods.

Tobacco smoking also contributes to the problem of diabetes. It can increase glycemic levels, impair insulin sensitivity and promote abdominal obesity ó all have been associated with an increased risk of type 2 diabetes.

Non-modifiable risk factors are those over which we have no control. They include ethnicity: certain populations have higher rates of type 2 diabetes. These include people of South Asian, Hispanic American and Chinese African ancestry. Not only are they more likely to develop type 2 diabetes, but they do so at an earlier age and with lower levels of overweight values.

Prevention strategies are best when both individual and population level interventions work together. At the individual level, focus is on identifying risk factors and promoting behavioural change. A population approach examines and addresses the entire range of factors that affect health and aims to reduce risk factors in the population as a whole.

The causes of type 2 diabetes are multiple, complex and interconnected. Any approach must address all sides including social, economic, environmental, genetic and lifestyle factors associated with type 2 diabetes.

Editorís note: Dr. Paul Martiquet is the Medical Health Officer for Rural Vancouver Coastal Health including Powell River, the Sunshine Coast, Sea-to-Sky, Bella Bella and Bella Coola.


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