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The A1C test ( HbA1C) , also called the glycated hemoglobin test, is a blood test that provides an average of a person’s blood sugar levels over the past two to three months. It measures the percentage of hemoglobin, a protein in red blood cells, that has glucose attached to it.

So how is Type 2 Diabetes Diagnosed?

It results in a percentage that will determine where the individual is Normal, Pre-diabetic, or has evidence of diabetes.

Normal : Below 5.7%

Pre diabetes : 5.7% - 6.4%

Diabetes: 6.5% or higher

Why is the A1C test recommended?

Does not require fasting, making it convenient

It gives a long term image of the blood sugar levels ( past 2-3 months) rather than a snapshot

It helps diagnose and monitor diabetes management over time.

Tip to remember the A1C Test :

The A1C test is like a report card for your blood sugar- AIM FOR THE STRAIGHT A1Cs!

American Diabetes Association – A1C Test

CDC | Diabetes Testing

https://www.cdc.gov/diabetes/diabetes-testing/index.html

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HbA1c Test ( Glycosylation of haemoglobin) | Diabetes

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The Role of the Pancreas and Liver in Type 2 Diabetes 

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The Role of the Pancreas and Liver in Type 2 Diabetes 

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Type 2 diabetes is a condition where the body struggles to regulate blood sugar effectively. Two key organs involved in this process are the pancreas and the liver.

Pancreas(Beta Cells in the Islets of Langerhans) :

The pancreas produces insulin, the hormone responsible for helping cells absorb glucose from the bloodstream. In type 2 Diabetes, the pancreas either does not produce enough insulin or its function is impaired, leading to high blood sugar levels.

Liver :

The liver helps regulate blood sugar by storing excess glucose as glycogen and releasing it when needed. However, in Type 2 Diabetes, the liver may become insulin resistant, causing it to release too much glucose into the bloodstream, even when it’s not needed.

Together, dysfunction in these two organs contributes to high blood sugar levels, a hallmark of Type 2 Diabetes. Managing this condition often involves lifestyle changes, medications, and monitoring to support proper glucose regulation.

Mnemonic to Remember !

Think

“PL = Pancreas & Liver, the Problematic Leaders of Type 2!”

Pancreas = produces insulin( but struggles in type 2)

Liver = Let’s out too much glucose ( even when it shouldn’t)

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Community-Based Lifestyle Programs (e.g., National Diabetes Prevention Program - NDPP)

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Community-Based Lifestyle Programs (e.g., National Diabetes Prevention Program - NDPP)

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These programs provide education and support for individuals at risk of Type 2 diabetes. Participants engage in group sessions focused on nutrition, physical activity, and behavior change over several months. By building healthy habits in a supportive environment, the programs aim to prevent or delay the onset of Type 2 diabetes.

🎯 Target: Individual & Environment

Implementation Challenge:
Barriers include limited program availability in underserved or rural areas, lack of culturally tailored resources, transportation issues, and challenges with maintaining participant engagement over time.

Video: Sarah's Journey

Sarah's journey highlights the importance of resilience and support in overcoming health challenges. Her story serves as an inspiring example of how addressing personal health conditions, such as Type 2 diabetes, requires not only individual effort but also a community of resources and guidance. It emphasizes that long-term success in managing health conditions often involves lifestyle changes, consistent support, and a mindset focused on growth.

Sarah's Journey: National Diabetes Prevention Program
Sarah’s personal narrative highlights her experience with the National Diabetes Prevention Program, emphasizing the importance of lifestyle modifications in managing Type 2 diabetes.
YouTube. (2023). Sarah's Journey - National Diabetes Prevention Program

Choctaw Nation of Oklahoma. (n.d.). Preventing Diabetes: Sarah's Story.
Retrieved from https://www.choctawnation.com

Verywell Health. (2022). How I Changed My Life to Better Manage Type 2 Diabetes.
Retrieved from https://www.verywellhealth.com

I enjoyed this Padlet as it introduced me to the efforts made to support those with Type 2 Diabetes, but also put faces to the condition

*

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Centers for Disease Control and Prevention (CDC)

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Sarah’s Journey: National Diabetes Prevention Program

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Simplistic infographic from Diabetes CDC.GOV on the target disease and some of its factors. 

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Lifestyle choices CAN lead to Type 2 Diabetes

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Lifestyle choices CAN lead to Type 2 Diabetes

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There are many factors and lifestyle choices that can lead to Type 2 Diabetes. If the individual is heading to type 2, their doctor would most likely diagnose their patient as a pre-diabetic. Pre-diabetic is the final warning sign to improve lifestyle choices to prevent type 2 which is non-reversible.

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Affected Population- Ethnicity and Genetics

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Affected Population- Ethnicity and Genetics

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Ethnicity and genetics play a notable role in the risk of developing Type 2 Diabetes. The likelihood is higher if a person has a family history of Type 2 Diabetes. However, it is unclear if this is because of one's biological makeup or because of a person's lifestyle/culture, or both. Certain ethnic groups do face a higher risk, with Native Americans being the most susceptible. Other ethnic groups who are commonly affected are African Americans, Asian Americans, and Hispanic/Latinos.

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How Race and Ethnicity Affect Diabetes Prevalence, Management, and Complications

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diaTribe is a non-profit organization providing free cutting-edge diabetes management tips from diet and exercise, to ways to avoid diabetes complications.

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Differentiating Between Type 1 and Type 2 Diabetes

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Differentiating Between Type 1 and Type 2 Diabetes

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Many symptoms of diabetes are similar between type 1 and type 2, but the causes and treatments differ. Type 2 diabetes is more prevalent than type 1 diabetes, it often begins later in life, and treatment is multifaceted, while treatment for type 1 diabetes is primarily insulin therapy.

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We, Group 9 have selected Type 2 Diabetes as our focus problem. This video explains the differences between Type 1 diabetes and Type 2 diabetes as many tend to confuse the two conditions. Enjoy!

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Understanding Diabetes: Type 1 vs Type 2 Explained | MedAnimations

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Primary Causes - Obesity & Insulin Resistance 

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Primary Causes - Obesity & Insulin Resistance 

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As we learned, Type 2 diabetes is when the body has trouble responding to insulin leading to complications.

The link between obesity and insulin resistances comes in when there is excess fat stored in the body.

Excess body fat tends to get stored in places where it's not supposed to be in. This can be around the abdomen between muscle and in our organs. For example, this can be in the liver causing Fatty liver disease.

There are process in our body and organs that need flexibility and room to function properly. When there is excess fat being stored where its not supposed to be in, those process no longer have the room to function properly. For example, excess fat can stop oxygen from getting where it needs to go.

Some of these processes happen when we eat or when we are fasting. Our body works hard and fast to respond and regulate itself when we eat or skip a meal. When there is excess fat, it can't respond as fast or properly.

In response to the fat the body also creates extra chemicals that in large quantities are bad for us. Or the opposite where it doesn't create enough chemicals. This is what causes things like insulin resistance leading to the diagnosis of Type 2 Diabetes.

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. Author manuscript; available in PMC: 2023 Jan 4.

Abstract

The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a concomitant increase in the prevalence of type 2 diabetes. The cellular and physiological mechanisms responsible for the link between obesity and type 2 diabetes are complex and involve adiposity-induced alterations in β-cell function, adipose tissue biology, and multi-organ insulin resistance, which are often ameliorated and can even be normalized with adequate weight loss.

Introduction

Adipose tissue is the body's major fuel reserve and provides an important transportable energy source that is critical for survival when food is scarce. The high energy density and hydrophobic nature of triglyceride make it a five-fold better fuel per unit mass than glycogen; triglycerides are compactly stored as an oil inside adipocytes and produce ~9.3 kcal per gram when oxidized, whereas glycogen is stored intracellularly as a gel, containing approximately 2 grams of water for every gram of glycogen, and produces only 4.1 kcal per gram when oxidized ( Klein et al., 2002). During starvation, the duration of survival is determined by the size of the adipose tissue mass. Men who are lean die after approximately 60 days of starvation when more than 35% of body weight is lost ( Leiter and Marliss, 1982), whereas people with extreme obesity can tolerate long-term fasting; the longest known duration of fasting was reported in a man with extreme obesity who fasted for 382 days, consuming only acaloric fluids, vitamins and minerals, resulting in a 60% loss in body weight without adverse effects ( Stewart and Fleming, 1973). Adipose tissue also produces and secretes adipokines and exosomes, which are involved in the regulation of important physiological functions, such as appetite, reproductive function and insulin action ( Funcke and Scherer, 2019).

The accumulation of an excessive amount of body fat induces a constellation of metabolic abnormalities and diseases, including insulin resistance, atherogenic dyslipidemia (high plasma triglyceride and low plasma HDL-cholesterol concentrations), nonalcoholic fatty liver disease (NAFLD), β-cell dysfunction, prediabetes, and type 2 diabetes. In general, a progressive increase in body mass index (BMI), which provides an index of adiposity, is associated with a progressive increase in the risk of developing type 2 diabetes ( Colditz et al., 1995). However, fat and triglyceride distribution modify the risk of adiposity-induced metabolic dysfunction ( Klein et al., 2002). People who are obese with a predominant increase in upper body fat (abdominal subcutaneous and intra-abdominal fat), intrahepatic triglyceride content, intramyocelluar lipid content and pancreatic fat) are at higher risk of developing type 2 diabetes than those with a lower body (gluteofemoral) fat phenotype. In fact, increased gluteofemoral body fat mass is associated with decreased plasma triglyceride and increased HDL-cholesterol concentrations, decreased fasting blood glucose and insulin concentrations, increased oral glucose tolerance and insulin sensitivity, and decreased risk of type 2 diabetes in people who are lean, overweight or obese ( Manolopoulos et al., 2010).

Type 2 diabetes is caused by multi-organ insulin resistance, in conjunction with a decline in β-cell insulin secretory function ( Bogardus and Tataranni, 2002). The worldwide increase in the prevalence of obesity is likely responsible for the recent increase in the prevalence of type 2 diabetes because obesity influences both insulin action and β-cell function. In this article, we will review the cellular and physiological mechanisms responsible for the link between excess adiposity and type 2 diabetes and the therapeutic metabolic effects of weight (fat) loss.

β-cell physiology and insulin kinetics

Pancreatic β-cell function is a critical determinant of whether people with obesity develop type 2 diabetes. Plasma insulin concentrations and the rate of insulin secretion during basal conditions and after glucose ingestion is typically greater in people with obesity who do not have type 2 diabetes than people who are lean ( van Vliet et al., 2020). This increase in insulin secretion rate and plasma insulin concentration is often able to overcome the resistance to insulin action, so that fasting blood glucose concentration and oral glucose tolerance are normal. However, a progressive decline in β-cell function causes a progressive decline in glycemic control, resulting in prediabetes and ultimately type 2 diabetes ( Gastaldelli et al., 2004; Weyer et al., 1999).

It is likely that the number of pancreatic β-cells, per se, influences the secretion of insulin during both basal and postprandial conditions. Pancreatic β-cell mass, often expressed as the relative volume (ratio of the β-cell area to exocrine area assessed at autopsy), is about 50% greater in people with obesity than in people who are lean. However the relative β-cell volume in those with impaired fasting glucose or type 2 diabetes is about 50% lower than the relative volume in lean people because of β-cell apoptosis ( Butler et al., 2003). It is unlikely that the increase in β-cell mass associated with obesity is simply caused by insulin resistance, because weight gain in mice fed a high-fat diet is associated with an increased proliferation in β-cell mass before the development of insulin resistance ( Mosser et al., 2015) and both basal and postprandial insulin secretion rates are greater in people with obesity than in lean people when both groups are matched on insulin sensitivity ( van Vliet et al., 2020). The mechanism(s) responsible for β-cell hyperplasia in people with obesity is not known, but could be related to stimulation by specific nutrients, insulin, incretins and growth factors associated with high-calorie diet consumption and obesity ( Linnemann et al., 2014).

Increased plasma free fatty acid (FFA) concentrations associated with obesity and type 2 diabetes can have adverse effects on β-cells. During basal conditions, circulating FFAs are responsible for about 30% of insulin secretion in people with or without diabetes ( Boden et al., 1998). An acute (1.5 to 6 hours) increase in plasma FFAs, induced by infusing a lipid emulsion, increases glucose-stimulated insulin secretion, whereas a more prolonged increase in FFAs for 24 to 48 hours decreases glucose-stimulated insulin secretion in relationship to insulin sensitivity ( Carpentier et al., 1999; Paolisso et al., 1995).. However, it has been argued that the results from studies that infused a lipid emulsion are not clinically relevant, because the plasma FFA concentrations achieved during those studies were much higher than the usual range found in people with obesity or type 2 diabetes and the composition of the plasma FFA profile generated by hydrolysis of lipid emulsion triglycerides is not physiologic ( Weir, 2020). In addition, increases in plasma glucose are probably more harmful to β-cells than FFAs; mild increases in plasma glucose (11 mg/dL) causes phenotypic changes in gene expression that adversely affect β-cells function, growth, and survival ( Ebrahimi et al., 2020). Nonetheless, this does not mean that the concept of β-cell "lipotoxicity" is incorrect, but that other lipid mediators, such as increased β-cell production of long-chain acyl-CoA esters, ceramides, phosphatidic acid and diacylglycerides, rather than plasma FFAs, are involved ( Weir, 2020). It is likely that increases in plasma FFAs, triglycerides and glucose act synergistically, known as "glucolipotoxicity" ( Poitout and Robertson, 2008), or possibly in combination with excess plasma amino acids, known as "nutrient-induced metabolic stress," ( Prentki et al., 2020) cause β-cell dysfunction and death, mediated by oxidative, mitochondrial, and endoplasmic reticulum stress, and β-cell dedifferentiation.

Adipose tissue biology and insulin resistance

Adipose tissue must have considerable metabolic flexibility to be able to cope with the large and rapid changes in energy balance during feeding and fasting throughout the day and to adjust to more long term changes in energy balance that cause adipose tissue expansion or reduction. The increase in adipose tissue mass after chronic positive energy balance is caused by an accumulation of triglycerides in adipocytes, which increases adipocyte size and requires structural remodeling to provide the scaffolding needed to support the expanded adipocyte mass. The specific adaptive responses of adipose tissue to its expansion are an important determinant of adipose tissue health and systemic metabolic homeostasis, and differences in responses likely contribute to the heterogeneity in metabolic health observed in people with obesity ( Crewe et al., 2017; Scherer, 2016; Smith et al., 2019).

Studies conducted in a variety of mouse models of obesity demonstrate a series of complex but interactive biological processes in adipose tissue that contribute to whole-body insulin resistance, including: 1) adipocyte hypoxia, due to inadequate oxygen delivery and increased adipocyte oxygen demand ( Seo et al., 2019; Sun et al., 2012), which stimulates adipose tissue fibrogenesis and macrophage chemotaxis ( Halberg et al., 2009; Khan et al., 2009) and can suppress adipose tissue branched-chain amino acid catabolism thereby increasing plasma branched-chain amino acid concentrations ( Bianchi et al., 2003; Lo et al., 2013); 2) increased number and relative proportion of adipose tissue proinflammatory immune cells (macrophages and T cells) and the expression of genes that encode proinflammatory proteins ( Crewe et al., 2017); 3) decreased adipose tissue production and secretion of adiponectin, an insulin-sensitizing hormone ( Straub and Scherer, 2019); 4) increased adipose tissue lipolytic activity and the release of FFAs into the circulation ( Petersen and Shulman, 2018); and 5) metabolically-deleterious alterations in the cargo content of exosomes derived from adipose tissue macrophages ( Liu et al., 2019; Thomou et al., 2017; Ying et al., 2017). Although each of these factors have been shown to cause insulin resistance in mouse models and reversing their effects improve insulin action, their importance in the pathogenesis of insulin resistance in people is less clear or not yet validated.

Since the discovery in mice that adipose tissue produces proinflammatory cytokines that cause insulin resistance ( Hotamisligil et al., 1993) and the finding that obesity in people is associated with an accumulation of adipose tissue macrophages ( Weisberg et al., 2003), it has been proposed that adipose inflammation is a major driver of insulin resistance in people with obesity. Although inflammatory macrophages and the expression of genes that encode inflammatory proteins are increased in subcutaneous abdominal adipose tissue in people with "metabolically unhealthy obesity" compared with those with "metabolically healthy obesity" ( Fuchs et al., 2021), it is difficult to determine whether these associations are a cause or an effect of insulin resistance. In fact, studies conducted in mouse models have found: i) insulin resistance causes an infiltration of proinflammatory macrophages in adipose tissue ( Shimobayashi et al., 2018); ii) adipose tissue inflammation is part of the normal remodeling that occurs with an increase in body fat ( Wernstedt Asterholm et al., 2014); and iii) suppressing adipose tissue inflammation causes insulin resistance ( Zhu et al., 2020). The importance of adipose tissue immune cells and inflammation as a cause of insulin resistance in people with obesity is not resolved and requires further study.

If adipose tissue regulates metabolic function in other organs, it must somehow communicate with these organs. Several potential signaling mechanisms have been proposed that involve the secretion of adipose tissue products into the circulation that are then delivered to target tissues. These products include proinflammatory proteins, adiponectin, FFAs and exosomes, which are discussed below.

Chronic, low-grade, inflammation, manifested by increased proinflammatory immune cells and expression of genes that encode proinflammatory proteins, is present in people with obesity. However, the increase in adipose tissue gene expression often does not translate to an increase in plasma concentrations of the encoded proteins, and many of these cytokines act locally. A recent study that evaluated plasma cytokines every hour for 24 hours in people with obesity who were insulin-sensitive and those who were insulin-resistant found no difference in 24-hour plasma concentration area-under-the-curves for a battery of cytokines, with the exception of plasminogen activator-1 (PAI-1) ( Fuchs et al., 2021). Plasma PAI-1 concentration was much greater in the obese insulin-resistant group than the obese insulin-sensitive group, and plasma PAI-1 was inversely correlated with measures of both hepatic and skeletal muscle insulin sensitivity. PAI-1 is produced by adipocytes and adipose tissue macrophages (encoded by SERPINE1). In rodent models, adipocyte-specific PAI-1 overexpression causes insulin resistance whereas whole-body and adipocyte-specific knockouts of PAI-1 improve insulin action ( Alessi et al., 2007). These results suggest adipose tissue production of most cytokines, with the exception of PAI-1, have local paracrine effects, but do not have direct effects on systemic metabolic function.

Plasma adiponectin concentrations are often inversely associated with percent body fat, directly associated with insulin sensitivity ( Straub and Scherer, 2019; Tschritter et al., 2003), and can be considered a biomarker of adipose tissue health ( Li et al., 2021; Scherer, 2019). In rodents, adiponectin has anti-inflammatory, anti-fibrotic and insulin-sensitizing effects and increases pancreatic β cell survival and regeneration ( Li et al., 2021; Rutkowski et al., 2013; Ye et al., 2015). The mechanism responsible for the pleiotropic therapeutic effects of adiponectin is likely mediated, at least in part, by increasing ceramidase activity and decreasing intracellular ceramide levels, which occurs when adiponectin binds to adiponectin cell surface receptors 1 and 2 ( Holland et al., 2011).

Obesity is associated with an increased rate of release of FFAs into the bloodstream and delivery of FFAs to body tissues ( Mittendorfer et al., 2009). Although there is a widespread belief that increased plasma FFA concentrations are an important cause of liver and muscle insulin resistance in people with obesity, this notion has been questioned because of conflicting data from different studies and the questionable extrapolation of data from experimental manipulations to real world conditions ( Karpe et al., 2011). During basal conditions, the rate of release of FFAs into the bloodstream in relation to body fat mass is lower in people with obesity than in people who are lean; however, because of the large volume of body fat, the rate of release of FFAs in relation to body fat-free mass is greater in people with obesity than in people who are lean ( Mittendorfer et al., 2009). Lipolysis of adipose tissue triglycerides is very sensitive to insulin ( Conte et al., 2012; van Vliet et al., 2020), so the postprandial suppression of lipolysis and plasma FFA concentrations is often the same in people who are lean or obese because the greater postprandial increase in plasma insulin in people with obesity can compensate for their increase in fat mass ( McQuaid et al., 2011; van Vliet et al., 2020). Experimental increases in plasma FFAs, induced by infusing a lipid emulsion and heparin, impairs, whereas suppression of plasma FFAs by treatment with acipimox, a nicotinic acid derivative that blocks adipose tissue hormone sensitive lipase, increases insulin-stimulated glucose disposal and insulin-mediated suppression of endogenous glucose production ( Boden et al., 1994; Santomauro et al., 1999). However, the changes in plasma FFA concentrations in these studies were much greater than the usual small differences (or no differences) in fasting plasma FFA concentrations observed between lean people and people with obesity and between people with obesity who are insulin-sensitive and those who are insulin-resistant ( Arner and Ryden, 2015; Fabbrini et al., 2009; Gastaldelli et al., 2017; Karpe et al., 2011). Nonetheless, it is possible that the specific intracellular metabolism of fatty acids, which can produce toxic products (e.g. reactive oxygen species, diacylglycerol and ceramides), rather than the amount of fatty acids delivered to a tissue, determines whether plasma FFAs have adverse effects on metabolic function.

The correlation between visceral (intra-peritoneal) adipose tissue mass, insulin resistance and risk of developing type 2 diabetes ( Kissebah et al., 1982) has led to the belief that an increase in visceral fat is a major contributor to insulin resistance because of an increased release of FFAs directly into the portal circulation. However, only about 20% of FFAs delivered to the liver are derived from lipolysis of visceral fat in people with obesity, whereas about 80% are derived from lipolysis of subcutaneous fat ( Nielsen et al., 2004). But there was a large range in values among individuals and the percentage of FFAs delivered to the liver from visceral adipose tissue lipolysis was as high as 50% in some participants, suggesting visceral fat might be an important contributor to hepatic insulin resistance and steatosis in some people. Only about 14% of total FFAs that appeared in the systemic circulation are derived from splanchnic sources (comprised of FFAs released from both subcutaneous and visceral fat). In addition, removal of about one-third of visceral fat by laparoscopic omentectomy does not affect insulin sensitivity in people with type 2 diabetes ( Fabbrini et al., 2010b). Therefore, although FFAs released from visceral fat could influence hepatic insulin sensitivity, they are unlikely to be an important cause of insulin resistance in other tissues.

Recently, it has been shown that adipose tissue derived exosomes, which are small membrane bound extracellular vesicles that contain microRNAs, bioactive lipids and regulatory proteins, regulate metabolic function in other organs. Injecting exosomes isolated from adipose tissue macrophages obtained from lean mice into obese mice improves liver and muscle insulin sensitivity, whereas injecting exosomes isolated from adipose tissue macrophages obtained from obese mice induces liver and muscle insulin resistance in lean mice ( Ying et al., 2017). This study also showed the effect of exosomes on insulin action was mediated by the transfer of specific microRNAs. People with "metabolically-unhealthy obesity" (defined as prediabetes and high intrahepatic triglyceride content) have a much greater number of exosomes in plasma than people who are lean or those with "metabolically-healthy obesity" (defined as normal glucose tolerance and normal intrahepatic triglyceride content) ( Freeman et al., 2018; Fuchs et al., 2021). Moreover, plasma and adipose tissue-derived exosomes obtained from people with metabolically-unhealthy obesity, but not from people who are lean or those with metabolically-healthy obesity, decrease insulin-signaling in muscle myotubes and hepatocytes ( Fuchs et al., 2021).

In summary, the data from studies conducted in animal models and in people demonstrate that obesity-induced alterations in adipose tissue metabolism, extracellular matrix formation, immune cells (primarily macrophages) and inflammation (primarily SERPINE1) are involved in regulating metabolic function in other organs ( Figure 1). Differences in these factors among individuals likely contribute to the heterogeneity in metabolic health associated with obesity in people.

Figure 1.

Alterations in adipose tissue biology associated with metabolic dysfunction in persons with obesity.

Hepatic glucose and lipid metabolism

The liver is the major source of endogenous glucose production. During basal conditions about 80% of endogenous glucose production is derived from hepatic glycogenolysis (glucose produced from the breakdown of liver glycogen) and gluconeogenesis (glucose produced from precursors such as lactate, glycerol and amino acids), and about 20% is derived from gluconeogenesis by the kidneys ( Alsahli and Gerich, 2017). In lean people, glycogenolysis and gluconeogenesis contribute equally to total endogenous glucose production, but the contribution of gluconeogenesis is much higher in people with obesity or type 2 diabetes ( Gastaldelli et al., 2000). An increase in gluconeogenesis is responsible for fasting hyperglycemia, and impaired suppression of endogenous glucose production and gluconeogenesis after meal ingestion contributes to postprandial hyperglycemia in people with prediabetes and type 2 diabetes ( Gastaldelli et al., 2007).

Obesity and type 2 diabetes also have adverse effects on intrahepatic lipid metabolism and are a major cause of nonalcoholic fatty liver disease (NAFLD); about two-thirds of adults with obesity or type 2 diabetes have NAFLD ( Browning et al., 2004; Leite et al., 2009). Hepatic steatosis is primarily caused by an increased production of triglycerides, not a decrease in either the oxidation of fatty acids or the export of triglycerides through very-low-density-lipoprotein (VLDL) secretion ( Fabbrini et al., 2008; Iozzo et al., 2010). Insulin resistance and chronic hyperinsulinemia increase hepatic de novo lipogenesis (fatty acid synthesis from glucose) and the delivery of lipogenic substrates to the liver (i.e. glucose, fatty acids released from hydrolysis of subcutaneous and intra-peritoneal adipose tissue triglycerides, fatty acids released from hepatic hydrolysis of plasma triglycerides, and fatty acids that spill over into the systemic circulation during postprandial lipolysis of triglycerides in chylomicrons) ( Donnelly et al., 2005; Fabbrini et al., 2010a; Smith et al., 2020b; Ter Horst et al., 2021). In fact, hepatic steatosis is unlikely to occur in people who do not have significant insulin resistance ( Fabbrini et al., 2009; Ter Horst et al., 2017). Even people with a genetic variant of the patatin-like phospholipase domain-containing 3 gene (PNPLA3), which markedly increases the risk of NAFLD, are unlikely to develop hepatic steatosis in the absence of obesity and concomitant insulin resistance ( Stender et al., 2017). In addition, both insulin resistance and increased intrahepatic triglyceride content are likely responsible for the increase in hepatic VLDL-triglyceride secretion rate and hypertriglyceridemia observed in people with obesity and NAFLD and those with type 2 diabetes ( Packard et al., 2020).

The molecular mechanisms responsible for hepatic insulin-resistant glucose metabolism in people with obesity are not completely clear. Data from genetically modified rodent models and the limited data from studies conducted in humans demonstrate a decrease in hepatic insulin receptor number and function, in conjunction with proximal insulin signaling defects, cause a decrease in downstream insulin signaling pathways ( Petersen and Shulman, 2018; Ter Horst et al., 2021). Although intrahepatic triglycerides per se are inert and do not directly impair insulin action, their production is associated with the formation of metabolically bioactive lipids, namely ceramides and diacylglycerols (DAGs) that can cause insulin resistance. Studies conducted in genetically modified rodents have shown that both ceramides, specifically those containing saturated C16 and C18 acyl chains (C16:0 and C18:0), and DAGs, specifically the sn-1,2-DAG stereoisomer, can inhibit proximal insulin signaling by affecting phosphorylation of insulin receptor substrate (IRS), phosphoinositide-3-kinase (PI3K), protein kinase C-theta (PKC-Θ), and protein kinase B (PKB also known as AKT) ( Petersen and Shulman, 2018). The potential clinical relevance of these findings is supported by studies showing alterations in both intrahepatic ceramides and DAGs in people with NAFLD ( Apostolopoulou et al., 2018; Luukkonen et al., 2016; Ter Horst et al., 2017).

Skeletal muscle glucose metabolism

During basal conditions, plasma free fatty acids serve as the primarily fuel for skeletal muscle. After glucose or mixed-meal ingestion, the increase in plasma insulin suppresses the lipolysis of adipose tissue triglycerides, decreases plasma free fatty acid concentrations and stimulates muscle glucose uptake, which causes a switch in the predominant muscle fuel from fatty acids to glucose. Insulin-stimulated muscle glucose uptake involves the binding of insulin to myocyte insulin receptors, which initiates a cascade of intracellular signaling events that result in the translocation of glucose transporter 4 (GLUT4) to the plasma membrane, which is necessary for glucose transport into the cell. After entering the myocyte glucose is immediately phosphorylated and can be oxidized for fuel via glycolysis or stored as glycogen (i.e. non-oxidative glucose disposal). Normally, approximately 30% of ingested glucose is taken up by skeletal muscle, of which 50% is oxidized, 35% is stored as glycogen and about 15% undergoes non-oxidative glycolysis, which produces lactate, alanine, and pyruvate ( Kelley et al., 1988; Woerle et al., 2003). People with obesity and people with type 2 diabetes typically have an impairment in both insulin-stimulated muscle glucose oxidation and glycogen synthesis caused by a downregulation in the number and function of insulin receptors and multiple defects in post-receptor insulin signaling ( Mitrakou et al., 1990; Petersen and Shulman, 2018). In addition, increases in intramyocellular lipid and intermyocellular adipose tissue are associated with obesity, type 2 diabetes, and impaired skeletal muscle insulin signaling ( Kiefer et al., 2021; Virkamaki et al., 2001), suggesting alterations in muscle lipid distribution and metabolism contribute to the pathogenesis of insulin resistance ( Kiefer et al., 2021; Virkamaki et al., 2001).

Effect of weight (fat) loss

Weight loss can have profound therapeutic effects on metabolic function, type 2 diabetes and diabetes comorbidities ( Cohen et al., 2020; Gomez-Ambrosi et al., 2017; Klein et al., 2002) ( Figure 2). Moderate 5%-10% weight loss improves glycemic control, plasma triglyceride and HDL-cholesterol concentrations and blood pressure ( Wing et al., 2011). Greater weight loss can achieve diabetes remission, but the rate of remission depends primarily on the duration of diabetes, the ability of weight loss to improve β-cell function, and the criteria used to define remission ( Camastra et al., 2011; Taylor et al., 2018). The ability of weight loss to induce diabetes remission has been demonstrated in randomized controlled trials that compared bariatric surgery with medical therapy: i) 73% of patients who had diabetes for less than 2 years achieved diabetes remission (defined as glycated hemoglobin [HbA1c] <6.2% without diabetes medications) at 24 months after laparoscopic adjustable gastric banding and 20% weight loss ( Dixon et al., 2008); ii) 42% of patients who had diabetes for a mean of 8 years achieved diabetes remission (defined as HbA1c ≤6.0% without diabetes medications) at 12 months after Roux-en-Y gastric bypass surgery and 28% weight loss ( Schauer et al., 2012); and iii) 75% of patients who had diabetes for a mean of 6 years achieved diabetes remission (defined as HbA1c <6.5% without diabetes medications) at 24 months after Roux-en-Y gastric bypass surgery and 33% weight loss ( Mingrone et al., 2012). However, the durability of diabetes remission after bariatric surgery decreases over time and is associated with weight regain; only about 50% of patients maintain remission of diabetes (defined as no diabetes medications and either fasting plasma glucose <100 mg/dL or <126 mg/dL, or HbA1c <6.0%) 5 to 10 years after surgery ( Arterburn et al., 2013; Brethauer et al., 2013; Sjostrom et al., 2004).

Figure 2.

Multi-organ therapeutic effects of weight loss

Recently, the ability to induce diabetes remission with a structured weight management program incorporated into a medical care setting was demonstrated by the DiRECT trial ( Lean et al., 2018; Lean et al., 2019). This cluster-randomized trial was conducted within primary care practices in the United Kingdom in patients with type 2 diabetes diagnosed in the previous 6 years (mean 3 years) and not being treated with insulin. Diabetes remission (defined as HbA1c <6.5% [<48 mmol/mol] without diabetes medications) was achieved in 46% of patients at the end of 12 months and an average weight loss of approximately 10% (10 kg). Remission varied with the amount of weight loss and occurred in 7% of participants who lost 0-5 kg, 34% who lost 5-10 kg, 57% of participants who lost 10-15 kg, and 86% of participants who lost 15 kg or more.

In contrast to weight (fat) loss achieved by negative energy balance induced by bariatric surgery, diet therapy, or pharmacotherapy, surgical removal of adipose tissue does not result in metabolic benefits. For example, the removal of large amounts of subcutaneous abdominal adipose tissue (10 kg of adipose tissue which was equal to a 12% body weight loss and a decrease in 20% of total body fat mass) by using liposuction does not improve adipose tissue, liver or skeletal muscle insulin sensitivity or plasma lipids in women with obesity or obesity with type 2 diabetes ( Klein et al., 2004), and removing approximately 30% of intra-abdominal adipose tissue by laparoscopic omentectomy does not improve whole-body insulin sensitivity in people with obesity and type 2 diabetes ( Fabbrini et al., 2010b). These results demonstrate that fat loss must be induced by negative energy balance to achieve metabolic benefits.

The cellular mechanisms responsible for the therapeutic effects of weight loss on metabolic function are not clear. Adipose tissue is very responsive to negative energy balance and a decrease in body weight. A progressive increase in diet-induced weight loss causes a progressive decrease in whole-body, subcutaneous and intra-abdominal adipose tissue masses due primarily to a decrease in adipocyte size. Progressive weight loss also causes progressive changes in adipose tissue biology, manifested as a stepwise down-regulation of metabolic pathways and genes involved in lipid synthesis, extracellular matrix remodeling and collagen synthesis, plasminogen activator inhibitor-1 (PAI-1) production and oxidative stress ( Magkos et al., 2016). However, the improvement in multi-organ insulin sensitivity after 5% weight loss is usually not associated with a decline in either circulating or subcutaneous adipose tissue markers of inflammation, suggesting the beneficial effect of 5% weight loss on insulin action is not mediated by a reduction in systemic or adipose tissue markers of inflammation. Progressive weight loss also causes a progressive decline in intrahepatic triglyceride content and improvement in liver histological features of NAFLD. In fact, intrahepatic triglyceride is particularly sensitive to negative energy balance; even 48 hours of treatment with a low-calorie diet causes a large decrease in intrahepatic triglyceride content ( Kirk et al., 2009). The sensitivity of adipose tissue and the liver to small decreases in body weight suggest the therapeutic effects of weight loss are mediated, at least in part, by alterations in adipose tissue and liver physiology and the effect of adipose tissue on systemic signaling mechanisms, such as adiponectin, PAI-1 and exosomes released from adipose tissue.

Conclusions

Obesity, particularly when associated with increased abdominal and intra-abdominal fat distribution and increased intrahepatic and intramuscular triglyceride content, is a major risk factor for prediabetes and type 2 diabetes because it causes both insulin resistance and β-cell dysfunction. Accordingly, the worldwide increase in the prevalence of obesity has led to the concomitant increase in the prevalence of type 2 diabetes. A better understanding of the mechanisms responsible for the adverse effects of excess body fat on the factors involved in the pathogenesis of type 2 diabetes can lead to novel therapeutic interventions to prevent and treat this debilitating disease. A series of studies conducted in mouse models and in people have demonstrated alterations in adipose tissue biology that link obesity with insulin resistance and β-cell dysfunction. These alterations include adipose tissue fibrosis (increased rates of fibrogenesis and expression of genes involved in extracellular matrix formation), inflammation (increased proinflammatory macrophage and T cell content and the production of PAI-1), and the production of exosomes that can induce insulin resistance. However, none of these factors can influence systemic metabolic function without a mechanism for adipose tissue communication with other organs. It is possible that several adipose tissue secretory products that are released into the bloodstream, including PAI-1, adiponectin, FFAs and exosomes, are involved in this signaling process, but additional research is needed to fully assess their clinical importance. In addition, it is also likely that cross-talk among adipose tissue, the liver, muscle and pancreatic islets contribute to insulin resistance and hepatic steatosis ( Figure 3). Decreasing body fat mass by inducing a negative energy balance, not by surgical removal, can ameliorate or normalize obesity-induced metabolic dysfunction and can even achieve diabetes remission if there is adequate restoration of β-cell function.

Figure 3.

Inter-organ cross-talk in the pathogenesis of metabolic dysfunction in people with obesity. CO2 = carbon dioxide, HSC = hepatic stellate cell, FFA = free fatty acid, PAI-1 = plasminogen activator inhibitor-1, TG = triglyceride, TGRL = triglyceride-rich lipoprotein, VLDL = very-low-density lipoprotein.

Klein et al. examine the cellular and physiological mechanisms that explain why people with obesity develop metabolic dysfunction and type 2 diabetes. They also review the effects of weight loss, induced by negative energy balance, on adipose tissue biology and multi-organ system function that can cause remission of diabetes.

Funding:

Supported by National Institutes of Health grants DK56341 (Nutrition Obesity Research Center), DK20579 (Diabetes Research Center), UL1TR002345 (Clinical and Translational Science Award), RC2-DK118620, R01-DK55758 and R01-DK099110, the Academy of Finland, and support from Merck, Novo Nordisk and the Sigrid Jusélius Foundation.

Declaration of interests:

SK serves as a scientific consultant for Janssen and Altimmune and has a sponsored research agreement with Janssen. AG serves as a scientific consultant for Eli Lilly, Gilead, Inventiva, and Boehringer. HY-J serves as a scientific consultant for Merck, Novo Nordisk, Eli Lilly and Hamni Pharmaceuticals. PES has sponsored research agreements with Merck and Novo Nordisk.

Footnotes

References

Leiter LA, and Marliss EB (1982). Survival during fasting may depend on fat as well as protein stores. JAMA 248, 2306-2307. [PubMed] [Google Scholar]

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The accumulation of an excessive amount of body fat can cause type 2 diabetes, and the risk of type 2 diabetes increases linearly with an increase in body mass index. Accordingly, the worldwide increase in the prevalence of obesity has led to a ...

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The article Sedentary behavior as a mediator of type 2 diabetes best explains how the lack of physical exercise can become a higher risk of type 2 for any individual.

Minor mobility throughout the day can store glucose from the food we consume throughout the day and will eventually be stored as excess fat stored in our body. As the blood glucose rises, type 2 diabetes is presented.

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Dr.Pickle PhD : Educational Content of the Pancreas 

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Dr.Pickle PhD : Educational Content of the Pancreas 

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This is a short video done by Dr. Pickle, PhD (@drpicklephd) who is an educational creator who breaks down medical topics in a simple, easy-to-understand way for people without a scientific background. I believed this was a very interesting explanation of the function of the Pancreas.

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Diabetes: Insulin Resistance and the visual consequences. 

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Diabetes: Insulin Resistance and the visual consequences. 

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Insulin is a hormone produced by the pancreas that helps the body use sugar (glucose) for energy. Insulin resistance is a condition where the body's cells don't respond properly to insulin. As a result, the body needs more insulin to help glucose enter cells. The pancreas tries to keep up by making more insulin.

Insulin resistance leads to Type 2 Diabetes.

Before developing Diabetes, the individual would first develop visual concerns on their skin like skin-tags, acanthosis for example.

The importance of the visual insulin resistance is showing that the organs are already affected as the body is showing its sign on the skin.

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Insulin Resistance - Wired Skin Signs | Reverse insulin resistance | Diabetes mellitus

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Diabetes and Hearing … What Happens to the Ears ? 

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Type 2 Diabetes and The Surprising Connection to Hearing Loss 🧏🏻‍♀️

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Type 2 Diabetes and The Surprising Connection to Hearing Loss 🧏🏻‍♀️

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(This may be long because I was intrigued and the topic of hearing loss is personal)

As someone who has hearing loss and is in the speech and hearing sciences program with goals to become an audiologist, I thought I understood the many factors that contribute to hearing loss. But after conducting my research on the connection to hearing health and diabetes, I was surprised to discover that high blood sugar can also lead to hearing loss. I never realized that people with diabetes are at higher risk for hearing problems. This new insight really emphasized the wide spectrum of aural rehabilitation especially on those with Type 2 Diabetes.

What is the connection between Diabetes and Hearing Loss?

Hearing Loss - High Blood Sugar can damage the nerves and blood vessels in the ear, leading to gradual hearing loss.

Social Isolation - Already dealing with a stigmatized condition like type 2 diabetes, hearing loss can make communication harder, leading to emotional and social challenges.

Aural Rehabilitation: Diabetics may eventually benefit from hearing aids, auditory training, or speech therapy to improve communication quality of life.

Why does hearing loss occur to diabetics?

Chronic high blood sugar weakens blood vessels including those in the ears.

Nerve damage from diabetes can affect the auditory system, leading to hearing decline.

Many diabetics are unaware of how hearing loss can develop slowly, which is why early intervention is important.

Treatment Options

Hearing Aids - hearing aids amplify sounds to improve communication

Auditory Training - this training helps individuals retrain their brain to better process sounds and speech especially in loud environments.

Speech Therapy - SLPs can help diabetics develop strategies for clear communication and help them understand speech related issues caused by their type 2 diabetes condition.

Regular Auditory Monitoring - Routine hearing assessments are important in providing early intervention to catch signs of hearing loss to best provide treatment.

Diabetes and Hearing Loss | American Diabetes Association

https://diabetes.org/about-diabetes/complications/hearing-loss/diabetes-and-hearing-loss

Diabetes and Hearing Loss | American Academy of Audiology

https://www.audiology.org/consumers-and-patients/hearing-and-balance/diabetes-and-hearing-loss/

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Diabetes and Hearing...What Happens to the Ears?

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Your Brain is significantly impacted by Type two Diabetes, especially if the condition is not being managed properly. The effects of one's blood sugar being too high leads to damage in the blood vessels, which leads to the death of brain cells. Blood sugar being too low deprives the brain of oxygen.

Both of these conditions, hyperglycemia and hypoglycemia, can lead to long term damage such as memory loss, irritability, confusion, and dementia.

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Learn about the connection between diabetes and the brain and how to keep your brain healthy.

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Diagnosing Type 2 Diabetes: Fasting Blood Sugar ( FBS ) Test

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Diagnosing Type 2 Diabetes: Fasting Blood Sugar ( FBS ) Test

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The Fasting Blood Sugar Test (FBS) measures your blood glucose levels after at least 8 hours of fasting (usually occurs overnight). It is one of the most common ways doctors screen for Type 2 diabetes.

How is Type 2 Diabetes diagnosed with a FBS test?

Your fasting blood sugar level is measured in milligrams per deciliter ( mg/dL ) of blood.

Normal : 100 mg/dL

Prediabetes : 100 - 125 mg/dL

Diabetes: 126 mg/dL or higher

Why is the FBS test an essential form of diagnosis?

It helps detect diabetes early, even before the symptoms tend to be observable or before it occurs.

A fasting test provides more of an accurate reading of how the body regulates blood sugar.

It also goes hand in hand with A1C test in diagnostic testing to provide confirmation of condition

Tip to remembering the FBS test :

(remembering FBS results)

Under 100, you’re a champ.

100-125, take are one glance.

126 or more, diabetes is at the door.

Mayo Clinic – Glucose Tests

https://www.mayoclinic.org/tests-procedures/glucose-tolerance-test/about/pac-20394296

NIDDK – Diabetes Testing & Diagnosis

https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis

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We have a group assignment due Monday, March 24! We have to schedule a meeting via Zoom before then. Please comment what times you would be available in Arizona time.

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Fun fact: You can be prediabetic without displaying presenting with any of the symptoms above. 

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Other Conditions that Cause Type 2 Diabetes

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Other Conditions that Cause Type 2 Diabetes

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When it comes to Type 2 Diabetes, there are conditions with processes that if left uncorrected can lead to the development of Type 2 Diabetes and all its affects. Two of these conditions are prediabetes and gestational diabetes.

Prediabetes

Prediabetes is often a precursor for Type 2 diabetes. Like Type 2 Diabetes, it involves high glucose levels caused by insulin resistance, but not high enough to meet the requirements for Type 2.

Unlike Type 2 Diabetes, prediabetes is reversible and treatable with lifestyle and diet changes. In some cases, medication is needed.

While prediabetes is a common precursor to prediabetes, it's possible to develop Type 2 without having prediabetes.

Gestational Diabetes

During a woman's pregnancy, the placenta releases hormones that lead to insulin resistance. When the woman's pancreas is unable to produce enough insulin to combat the insulin resistance created by the hormones it results in gestational diabetes.

Like prediabetes, if left untreated it causes the development of Type 2 Diabetes.

Key takeaway - both conditions share the same pathophysiological processes involved in Type 2 Diabetes such as insulin resistance, but in a lesser severity. The difference being that these conditions are treatable. However if left untreated, the body grows more resistant to insulin causing the development of Type 2 Diabetes.

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Learn about all the different kinds of diabetes and the basics of this condition.

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The image from Mayo Clinic shows the comparison between a healthy and damaged kidney. In this image you can see how healthy glomeruli are clear, but when damaged become cloudy. 

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90% of people with diabetes are people with type 2 specifically. Some contributing factors are family history of kidney disease, high blood pressure, smoking, diet, high cholesterol, hypo/hyperglycemia, age, obesity, and inactivity. Overtime, Type 2 Diabetes that is not managed well can lead to Diabetic Kidney Disease (DKD). DKD can cause damage to glomeruli, the blood vessel clusters that filter waste in the kidneys. Type 2 diabetes can contribute to nerve damage of nephrons in glomeruli, this is called Diabetic nephropathy. Without nephrons, the kidneys are unable to filter wastes from the body which can lead to many complications. One of which is high blood pressure, which can exacerbate damage to the kidneys by increasing pressure within the kidneys that already are unable to filter at a successful rate. However, if type 2 diabetes patients manage diet, weight, and exercise rates of Diabetic Kidney Disease and Diabetic Nephropathy have been shown to be lower than patients that do not properly manage their condition. Early stages may have no symptoms, but later symptoms can include high blood pressure, swelling, foamy urine, confusion, shortness of breath, loss of appetite, nausea and vomiting, itching, fatigue, and weakness. By monitoring symptoms, consulting physicians early, and following permanent changes to lifestyles, patients with type two diabetes are able to manage symptoms and damage to their kidneys.

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Type 2 diabetes can affect the whole body if not treated properly. One of the many body parts that this disease can affect is the eyes. Having high blood sugar for long periods of time can often lead to things such as blurry vision, cataracts, retinopathy, and glaucoma as well. Diabetes is also the leading cause of blindness in adults between the ages of 20-74. Another reason it is very important for diabetics to keep their blood sugar in range is because they are more likely to be affected by things like glaucoma. It is very important for diabetics to get their eyes checked every year so that if there is anything wrong, the doctors can catch it early.

https://th.bing.com/th/id/OIP.6DEqsnwyeoxyrIp3uo-HnQHaEK?rs=1&pid=ImgDetMain

https://www.webmd.com/diabetes/diabetes-eye-problems

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Type 2 diabetes can lead to nerve neuropathy, as excess glucose can damage nerves. About half of people with diabetes have diabetic neuropathy.

The most common type, peripheral neuropathy, affects the feet and legs, then the hands and arms later. The most common symptoms of peripheral neuropathy are numbness, sharp pains, tingling. I have heard of the affects of diabetes on feet, which can lead to amputation, but have never known why that happens until now.

Other types of neuropathy include autonomic neuropathy, which affects the autonomic nervous system, and a common symptom is weakness or fainting when standing; proximal neuropathy, which focuses on the thighs, hips, or buttocks; and mononeuropathy, which affects only a single nerve.

Nerve damage can often go undetected until it is too late, which could explain why it affects so many people with type 2 diabetes. Neuropathy can be prevented or delayed by managing blood sugar and taking care of your feet.

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Type 2 Diabetes & The Silent Threat to Your Heart 🫀

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Type 2 Diabetes & The Silent Threat to Your Heart 🫀

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Before this assignment, I thought Type 2 Diabetes was just about blood sugar. But after learning more, I realized it’s a major risk to heart health which tends to lead to heart attacks, strokes, and even amputations. This hits close to home when I thought about my maternal grandfather’s side of the family, where diabetes runs genetically. Sadly, his sister passed away from a heart attack which was a direct consequence of her Type 2 Diabetes. That recollection really opened my eyes to how dangerous diabetes can be.

Some of the major consequences are:

Heart attack: it’s known that high blood sugar weakens arteries, increasing plaque buildup and blockages.

Stroke : reduced blood flow to the brain can result in permanent damage or disability.

Heart Failure: the heart struggles to pump efficiently, which leads to fatigue, shortness breath or swelling.

Peripheral Artery Disease(PAD) : poor circulation in the legs and feet can cause pain, slow healing hands and eventually amputation. (my great aunt actually had a few of her toes amputated because of this condition).

Now, why does it happen ?

The excess of sugar actually damages blood vessels which makes them become fragile over time.

High Blood Pressure and Cholesterol tends to be common in diabetes which puts an extra strain on the heart. (this is actually genetic in my family as well)

Inflammation and poor circulation creates the perfect environment for cardiovascular diseases.

I learned that diabetes isn’t just about cutting sugar; it’s also about taking care your heart’s health.

Saying regarding cardiovascular diseases and diabetes:

Managing your blood sugar is key because a sweet tooth today could lead to a heartache tomorrow!

American Heart Association | Target : Type 2 Diabetes

https://www.heart.org/en/professional/quality-improvement/target-type-2-diabetes

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Medications are a common treatment option given to patients with a Type 2 Diabetes diagnosis. A few are listed above. One of the most common is Metformin. This drug assists by lowering blood sugar levels through minimizing the amount of glucose being produced in the liver.

Secretagogues are medications that send signals to the pancreas to release more insulin.

Glitazone helps treat Type 2 diabetes by increasing insulin sensitivity.

https://emedicine.medscape.com/article/117853-treatment?form=fpf

https://www.ncbi.nlm.nih.gov/books/NBK518983/

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Individual applying Ozempic medication. 

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Ozempic - APPROVED for Diabetic medication 

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Ozempic - APPROVED for Diabetic medication 

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I think one way or another we have heard of the treatment, Ozempic. Many of us have heard and seen its affects from celebrities and their rapid weight-loss. But did you know that Ozempic was initially created for type 2 diabetics to help lower their blood sugar? Upon trial and error, the founders learned that not only does Ozempic help individuals lower their blood sugar levels, but also helps aid weight loss by reducing food cravings. Ozempic is not approved by the FDA as a weight loss medication but it is certified to help type 2 Diabetics lower their blood sugar and keep it stable.

Here is more information on the Ozempic medication and how it can potentially help Type 2 Diabetics reduce their blood sugar and stabilize their sugar and reduce harm to other organs.

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Diabetes CAN lead to LLA (Lower-Limb Amputations)

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Diabetes CAN lead to LLA (Lower-Limb Amputations)

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Unstable high blood sugar overtime can cause complications that can lead to Lower-Limb Amputations.

Symptoms suggesting that the diabetic patient may need LLA is when a fungal infection is present, swelling of the feet that does not go away and more.

Peripheral arterial disease can narrow the blood vessels that carry blood to your legs and feet. Poor blood supply can make even a tiny cut heal slowly or not at all.

Peripheral nerve damage can cause loss of sensation so you may not notice cuts, sores, or ulcers on your feet.

With these complications, even a small cut can become a serious infection.

CDC link best explains how to prevent Diabetes-related amputations, when to see a doctor and more.

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Lifestyle Change: Prioritizing Stress Management to Support Type 2 Diabetes

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Lifestyle Change: Prioritizing Stress Management to Support Type 2 Diabetes

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Managing stress is not just helpful, it’s essential for individuals with type 2 diabetes. Chronic stress triggers the release of hormones like cortisol and adrenaline, which can increase insulin resistance and spike blood sugar levels (American Diabetes Association). By learning how to manage stress through practices like mindfulness meditation, physical activity, talk therapy, and deep breathing, individuals can gain better control over both their emotional well-being and their blood glucose levels. Stress management isn’t a luxury,it’s a key part of diabetes care that can transform someone’s health journey.

Difficulty Level: 6/10 – Building new habits around stress relief can be challenging at first, especially for individuals with busy lifestyles or those unfamiliar with self-care techniques. However, with the right support and consistency, these practices can become second nature and incredibly empowering.

Supporting Professional: A mental health counselor, psychologist, or certified diabetes care and education specialist (CDCES) can work closely with patients to identify stress triggers, teach coping strategies, and help establish a sustainable self-care routine. According to the CDC (2023), integrating mental health care into diabetes management has been shown to significantly improve outcomes.

References:

• American Diabetes Association. (2022). Ease Diabetes Stress. https://diabetes.org/health-wellness/mental-health/ease-diabetes-care-stress.

• Centers for Disease Control and Prevention. (2023). Diabetes and Mental Health. https://www.cdc.gov/diabetes/managing/mental-health.html

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How I Manage Stress While Living With Type 2 Diabetes

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Managing stress can be a challenge for those living with type 2 diabetes. Try these five things to help keep stress levels from getting out of control.

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Cognitive decline is a serious and common consequence of Type 2 Diabetes. 1 in 4 patients with Type 2 Diabetes suffer from this complication of the disease. The reason for this is how T2DM can cause damage to the brain cells. The following are 3 ways the disease contributes to cell death:

Poor management of one's blood sugar can deprive our brain of oxygen by damaging the blood vessels.

Chronic inflammation.

Insulin resistance- This can cause something called "plaques and tangles" which damaged our neuron communication. This is what happens in the brain when someone has Alzheimer's Disease.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8925983/#:~:text=Cognitive%20impairment%20is%20common%20in,less%20than%2010%20years%20ago

https://www.health.harvard.edu/blog/whats-the-relationship-between-diabetes-and-dementia-202107122546#:~:text=There%20are%20multiple%20reasons%20why,features%20among%20diabetes%20and%20Alzheimer's

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Cognitive Impairment in Type 2 Diabetes Mellitus

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Objective To determine the incidence of cognitive impairment established on the mini-mental state assessment in type 2 diabetic patients presenting at Holy Family Hospital, Rawalpindi. Materials and methods This cross-sectional descriptive study was…

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Symptoms of Diabetes: Frequent Urination & Excessive Thirst

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Symptoms of Diabetes: Frequent Urination & Excessive Thirst

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Frequent urination and excessive thirst are two of the most common symptoms of diabetes and they go hand in hand.

Here's the breakdown:

Freaquent Urination (Medical term: Polyuria)

What to look out for 🔎 - An individual will find themselves having to constantly go urinate, especially at night. Often waking up from sleep to go urinate.

What is happening 🧐 - Because the body of the individual isn't producing enough insulin, there is excess sugar in the blood that is not being used by the body. 👉 The kidneys then work extra hard to expell the excess sugar in the blood from the body. 👉 The kidneys often have to pull in extra water from the body to achieve this. 👉 This leads to the production of extra urine. 👉 Which leads to the following symptom 👇

Excessive Thirst ( Medical Term: Polydipsia)

What to look out for 🔎 - An individual will have an inextinguishable thirst and will find themselves having to drink a lot of fluid.

What is happening? 🧐 - The kidneys are pulling extra water from the body to expell the excess sugar in the body. 👉 This causes the individual to be dehydrated. 👉 The body signals the individual to replenish the lost fluid.

The cycle repeates 🔁 - The intake of fluid leads to more urination.

Adjacent Symptom: Dry Mouth (Medical Term: Xerostamia)

What to look out for 🔎 - The individual experiences a persistent feeling dryness, thirst and discomfort in the mouth. This leads to increased thirst.

What is happening? 🧐 - Due to the frequent urination, an individual will become dehydrated leading to dry mouth. In addition, the high blood sugar levels caused by diabetes can damage the salivary glands and reduce saliva production.

⁽https://my.clevelandclinic.org/health/symptoms/22495-diabetes-and-dry-mouth)

Key Takeaway 🔑

Lack of insulin production and increased blood sugar levels caused by diabetes affect the kidneys. Which leads to these symptoms.

Frequent urination and excessive thirst are said to be hallmark symptoms of diabetes.

Each of these symptoms alone should not be a cause for concern and can be caused by other factors.

🚩 When these symptoms present together, and are disruptive to an individuals life - it's a sign to get tested for diabetes.

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Diabetes symptoms: When diabetes symptoms are a concern

Diabetes symptoms can be hard to spot. Here's what to look for and when to get care.
By Mayo Clinic Staff
Many people have diabetes but don't know it. That's why the American Diabetes Association (ADA) recommends that most adults begin diabetes screening at age 35. The ADA advises diabetes screening before age 35 for those who are overweight and have additional risk factors for prediabetes or type 2 diabetes.

Testing for diabetes also should take place for anyone who has early symptoms of diabetes. But those symptoms aren't always easy to notice. In fact, symptoms can develop so slowly that people may have type 2 diabetes for years before they're diagnosed with the disease.

If you notice the following symptoms, make an appointment to get care:

Being very thirsty.

Urinating often.

Being much more tired than usual.

Having blurry vision.

Losing weight without trying.

Recognizing possible diabetes symptoms can lead to early diagnosis and treatment. That can help prevent complications of diabetes and lead to a lifetime of better health.

Here are more details about possible symptoms of diabetes:

Greater thirst and more urination

Being very thirsty and urinating often are common diabetes symptoms. In people who have diabetes, extra sugar - which also is called glucose - builds up in the blood. This forces the kidneys to work overtime to filter and absorb the extra sugar.

When the kidneys can't keep up, extra sugar goes into the urine. And it takes along fluids from the body's tissues. That causes dehydration, which usually leads to a feeling of thirst. Drinking more fluids to quench the thirst then leads to more urination.

Fatigue

Diabetes can make you feel very tired. This is called fatigue. It happens because high blood sugar disrupts the body's ability to use sugar for energy. Dehydration from increased urination also can leave you feeling tired.

Weight loss

When you lose sugar through frequent urination, you also lose calories. Along with dehydration, this can cause rapid weight loss. That's especially true in people who have type 1 diabetes. But it also can happen in some people with type 2 diabetes. People newly diagnosed with diabetes may gain some weight right away as a result of better hydration. Then over time, because less sugar is being lost in urine, weight gain may continue unless steps are taken to prevent it.

Blurry vision

Diabetes symptoms sometimes involve eyesight. High levels of blood sugar pull fluid from the body's tissues, including the lenses of the eyes. This affects the eyes' ability to focus. With diabetes treatment and better control of blood sugar, the eyes' ability to focus usually returns and blurry vision goes away.

If it's not treated, diabetes can cause new blood vessels to form in the retina - the back part of the eye. That can damage other blood vessels. For most people, these early changes don't cause vision problems. However, if the changes aren't found and they get worse, they may lead to vision problems and, eventually, blindness.

Slow-healing sores or frequent infections

High levels of blood sugar can cause poor blood flow and damage the body's natural healing process. Because of this, people with diabetes may notice slow-healing sores, especially on the feet. In women with diabetes, bladder and vaginal yeast infections may happen more often.

Tingling and numbness in the hands and feet

Although it's a less common symptom, tingling and a loss of sensation, called numbness, can happen in the hands and feet of people with diabetes. That's because too much blood sugar can affect the way nerves work. Burning pain in the arms, hands, legs and feet also may happen.

Red, swollen, tender gums

Diabetes may weaken the body's ability to fight germs. That raises the risk of infection in the gums and in the bones that hold the teeth in place. This can lead to another less common diabetes symptom when the gums pull away from the teeth. The teeth then may become loose, and sores or pockets of pus may develop in the gums.

Take your body's hints seriously

If you notice any possible symptoms of diabetes, contact a member of your health care team. Diabetes is a serious condition. The earlier it's diagnosed, the sooner treatment can begin. With active participation and support from a health care team, people with diabetes often can successfully manage the disease and enjoy active, healthy lives.

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Show references

1. Symptoms and causes of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/symptoms-causes. Accessed March 9, 2023.

2. Diabetes symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/symptoms.html. Accessed March 9, 2023.

3. American Diabetes Association. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes - 2023. Diabetes Care. 2023; doi:10.2337/dc23-S002.

4. Diabetes, gum disease and other dental problems. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/gum-disease-dental-problems. Accessed March 9, 2023.

5. Wexler DJ. Overview of general medical care in nonpregnant adults with diabetes mellitus. https://www.uptodate.com/contents/search. Accessed March 9, 2023.

6. Papadakis MA, et al., eds. Diabetes mellitus and hypoglycemia. In: Current Medical Diagnosis & Treatment 2023. 62nd ed. McGraw Hill; 2023. https://accessmedicine.mhmedical.com. Accessed March 10, 2023.

7. Diabetes mellitus (DM). Merck Manual Professional Version. https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm. Accessed March 10, 2023.

8. Eye complications. American Diabetes Association. https://diabetes.org/diabetes/complications/eye-complications. Accessed March 10, 2023.

See more In-depth

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Diabetes symptoms: When diabetes symptoms are a concern

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Diabetes symptoms can be subtle. Pay attention to the clues your body gives you.

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While there are many symptoms of type 2 diabetes, one out of the many that can arise is unexpected weight loss. When people have type 2 diabetes, the body does not use insulin effectively and cannot deliver the glucose to the cells, and it builds up in the blood. If the glucose isn't arriving in the cells, then the body thinks it is starving and finds a way to make up for it. It produces energy by burning fat and muscle very quickly, which is what causes the unexpected weight loss. This also causes the kidneys to work extra hard because they are trying to eliminate the excess sugar in the blood. This can cause damage to the kidneys as well, since they are working overtime. Type 1 diabetes is similar, but instead of the body being unable to use insulin, it stops producing it all at once.

https://health.clevelandclinic.org/what-you-should-know-about-unexplained-weight-loss-and-diabetes

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193

https://cdn.images.express.co.uk/img/dynamic/11/750x445/1041659.jpg

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Long-term Consequence of Diabetes: Vision Loss 👁

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Long-term Consequence of Diabetes: Vision Loss 👁

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As we learned, the high blood sugar levels associated with Diabetes, long term, cause damage to blood vessels all over the body. This leads to loss of function or malfunction of many body parts. One of these affected body parts is the eyes. This is refered to as Diabetic Rhetinopathy. Which just means "disease or condition of the retina".

This condition is caused when the excess sugar either weakens or causes blockages in the tiny blood vessels in the eye.

Weakened blood vessels leak into the center of the eye.

Blocked blood vessels die off.

The eye attempts to grow new vessels.

These new blood vessels are abnormal. They are fragile and prone to leakage.

This condition and consequences range in severity. Its severity depends on the management of blood sugar levels. The longer blood sugar levels remain unmanaged, the more damage is done.

This can lead to the following long term consequences :

Vitreous hemorrhage - This is when weakened or abnormally grown blood vessels in the eye leak into the vitreois. This part of the eye contains a clear jelly like substance. The bleeding causes a spotty vision. If the bleeding is severe, it can completely obstruct the vision, but will NOT cause permanent vision loss. It can take weeks or months for the blood to clear from the eye.

Retinal detachment - The new abnormally grown blood vessels (in the eye) stimulate the growth of scar tissue. This can pull the retina away from the back of the eye. This can cause spots floating in the vision, flashes of light or severe vision loss.

Glaucoma - When new blood vessels grow in the iris (colored part of the eye, in the front) disrupting the regular flow of fluid out of the eye. This causes pressure to build in the eye, which can damage the optic nerve (the nerve that carries images from the eye to the brain).

Macular Edema - When the damaged blood vessels leak into the macula, a critical component of the eye responsible for sharp, detailed, color vision. The leakage causes it to swell which affects the vision.

Cataracts - The damage to the blood vessels in the eye can cause the accumulation of proteins and glucose in the lens of the eye. This causes cloudy vision.

Blindness - Diseases in the eye, Macular Edema, and Glaucoma or a combination of these conditions can lead to complete vision loss. Especially when these conditions are poorly managed.

Key Takeaway 🔑

In conclusion, diabetes leads to long term vision problems. From limited vision to complete blindness. An individual with Diabetes is at risk to completely losing their vision if they don't manage the condition or their blood sugar levels. The onset of these conditions aren't always preventable, however they can be slowed down.

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Overview

Diabetic retinopathy (die-uh-BET-ik ret-ih-NOP-uh-thee) is a diabetes complication that affects eyes. It's caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).

At first, diabetic retinopathy might cause no symptoms or only mild vision problems. But it can lead to blindness.

The condition can develop in anyone who has type 1 or type 2 diabetes. The longer you have diabetes and the less controlled your blood sugar is, the more likely you are to develop this eye complication.

Products & Services

Symptoms

You might not have symptoms in the early stages of diabetic retinopathy. As the condition progresses, you might develop:

Spots or dark strings floating in your vision (floaters)

Blurred vision

Fluctuating vision

Dark or empty areas in your vision

Vision loss

When to see an eye doctor

Careful management of your diabetes is the best way to prevent vision loss. If you have diabetes, see your eye doctor for a yearly eye exam with dilation - even if your vision seems fine.

Developing diabetes when pregnant (gestational diabetes) or having diabetes before becoming pregnant can increase your risk of diabetic retinopathy. If you're pregnant, your eye doctor might recommend additional eye exams throughout your pregnancy.

Contact your eye doctor right away if your vision changes suddenly or becomes blurry, spotty or hazy.

Causes

Over time, too much sugar in your blood can lead to the blockage of the tiny blood vessels that nourish the retina, cutting off its blood supply. As a result, the eye attempts to grow new blood vessels. But these new blood vessels don't develop properly and can leak easily.

There are two types of diabetic retinopathy:

Early diabetic retinopathy. In this more common form - called nonproliferative diabetic retinopathy (NPDR) - new blood vessels aren't growing (proliferating).

When you have NPDR, the walls of the blood vessels in your retina weaken. Tiny bulges protrude from the walls of the smaller vessels, sometimes leaking fluid and blood into the retina. Larger retinal vessels can begin to dilate and become irregular in diameter as well. NPDR can progress from mild to severe as more blood vessels become blocked.

Sometimes retinal blood vessel damage leads to a buildup of fluid (edema) in the center portion (macula) of the retina. If macular edema decreases vision, treatment is required to prevent permanent vision loss.

Advanced diabetic retinopathy. Diabetic retinopathy can progress to this more severe type, known as proliferative diabetic retinopathy. In this type, damaged blood vessels close off, causing the growth of new, abnormal blood vessels in the retina. These new blood vessels are fragile and can leak into the clear, jellylike substance that fills the center of your eye (vitreous).

Eventually, scar tissue from the growth of new blood vessels can cause the retina to detach from the back of your eye. If the new blood vessels interfere with the normal flow of fluid out of the eye, pressure can build in the eyeball. This buildup can damage the nerve that carries images from your eye to your brain (optic nerve), resulting in glaucoma.

Risk factors

Anyone who has diabetes can develop diabetic retinopathy. The risk of developing the eye condition can increase as a result of:

Having diabetes for a long time

Poor control of your blood sugar level

High blood pressure

High cholesterol

Pregnancy

Tobacco use

Being Black, Hispanic or Native American

Complications

Diabetic retinopathy involves the growth of abnormal blood vessels in the retina. Complications can lead to serious vision problems:

Vitreous hemorrhage. The new blood vessels may bleed into the clear, jellylike substance that fills the center of your eye. If the amount of bleeding is small, you might see only a few dark spots (floaters). In more-severe cases, blood can fill the vitreous cavity and completely block your vision.

Vitreous hemorrhage by itself usually doesn't cause permanent vision loss. The blood often clears from the eye within a few weeks or months. Unless your retina is damaged, your vision will likely return to its previous clarity.

Retinal detachment. The abnormal blood vessels associated with diabetic retinopathy stimulate the growth of scar tissue, which can pull the retina away from the back of the eye. This can cause spots floating in your vision, flashes of light or severe vision loss.

Glaucoma. New blood vessels can grow in the front part of your eye (iris) and interfere with the normal flow of fluid out of the eye, causing pressure in the eye to build. This pressure can damage the nerve that carries images from your eye to your brain (optic nerve).

Blindness. Diabetic retinopathy, macular edema, glaucoma or a combination of these conditions can lead to complete vision loss, especially if the conditions are poorly managed.

Prevention

You can't always prevent diabetic retinopathy. However, regular eye exams, good control of your blood sugar and blood pressure, and early intervention for vision problems can help prevent severe vision loss.

If you have diabetes, reduce your risk of getting diabetic retinopathy by doing the following:

Manage your diabetes. Make healthy eating and physical activity part of your daily routine. Try to get at least 150 minutes of moderate aerobic activity, such as walking, each week. Take oral diabetes medications or insulin as directed.

Monitor your blood sugar level. You might need to check and record your blood sugar level several times a day - or more frequently if you're ill or under stress. Ask your doctor how often you need to test your blood sugar.

Ask your doctor about a glycosylated hemoglobin test. The glycosylated hemoglobin test, or hemoglobin A1C test, reflects your average blood sugar level for the two- to three-month period before the test. For most people with diabetes, the A1C goal is to be under 7%.

Keep your blood pressure and cholesterol under control. Eating healthy foods, exercising regularly and losing excess weight can help. Sometimes medication is needed, too.

If you smoke or use other types of tobacco, ask your doctor to help you quit. Smoking increases your risk of various diabetes complications, including diabetic retinopathy.

Pay attention to vision changes. Contact your eye doctor right away if your vision suddenly changes or becomes blurry, spotty or hazy.

Remember, diabetes doesn't necessarily lead to vision loss. Taking an active role in diabetes management can go a long way toward preventing complications.

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Diabetic retinopathy - Symptoms and causes

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Good diabetes control and regular exams can help prevent this diabetes complication that affects the eyes. Find out how.

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This image from American Optometric Association shows the difference between a healthy and diabetic eye.  

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Patients monitoring for vision loss symptoms have a wide range of changes to be mindful of. Blurred vision, double vision, vision loss, Floaters, pain, and changes to lighting/shadows. Unfortunately, these symptoms normally present themselves later in diagnosis rather than early onset. However, maintaining a healthy lifestyle has been proven to prevent and lessen damage to the eyes as a healthy lifestyle allows for improved cardiovascular health. This aids in maintaining the strength of blood vessels in the eye. In addition laser treatments, surgery, and injections can be used to treat damage that can occur from diabetes.

National Eye Institute. “Diabetic Retinopathy .” Nih.gov, 10 Dec. 2024, www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy.

NIDDK. “Diabetic Eye Disease | NIDDK.” National Institute of Diabetes and Digestive and Kidney Diseases, 25 Mar. 2019, www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease.

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Fatigue is very common in patients with diabetes because a lot more factors play a role. Regular tiredness, weakness, sweating, and shakiness, especially after meals, is due to the impact on glucose levels. Hypoglycemia can be accompanied by headaches and fatigue after a full night's rest. Hyperglycemia is on the other side of blood glucose levels, however it can be managed more so with insulin adjustments. It is recommended to work with a diabetic nutritionist to find a balanced diet that allows a patient to maintain glucose levels to lessen effects of fatigue.

Diabetes.co.uk. “Many People with Diabetes Will Describe Themselves as Feeling Tired, Lethargic or Fatigued at Times.” Diabetes, 15 Jan. 2019, www.diabetes.co.uk/tiredness-and-diabetes.html.

Kalra, Sanjay, and Rakesh Sahay. “Diabetes Fatigue Syndrome.” Diabetes Therapy, vol. 9, no. 4, 4 June 2018, pp. 1421–1429, pmc.ncbi.nlm.nih.gov/articles/PMC6064586/, https://doi.org/10.1007/s13300-018-0453-x.

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One long-term consequence of type 2 diabetes can be digestive system issues. Having high blood sugar levels over time can harm the small blood vessels and nerves in your body, including the digestive system. 60-70% of people with diabetes suffer from some type of nerve damage or diabetic neuropathy. Once diabetes damages the nerves going to your stomach and intestines, it may not be able to move food normally. This can cause constipation as well as alternating bouts of diarrhea which tend to happen mostly at night.

https://www.webmd.com/diabetes/diabetes-constipation-diarrhea

https://static.toiimg.com/thumb/92284163.cms?width=680&height=512&imgsize=93248

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Diabetic nephropathy is kidney disease caused by diabetes. With diabetes, nephrons (units in the kidney that filter waste and blood and control fluids) become thick and scarred. This can lead to albumin, a protein, leaking from the nephrons into urine.

Symptoms rarely show up until 5-10 years after kidney damage begins, but testing for higher rates of albumin in urine can help detect kidney problems. People with severe or chronic kidney disease might have fatigue, headaches, nausea, swelling in legs, and shortness of breath.

High blood pressure can damage kidneys more, and many people with type 2 diabetes have high blood pressure. Kidney disease can also make it harder to lower blood pressure, making managing blood pressure an important way to prevent or slow kidney damage.

https://medlineplus.gov/ency/article/000494.htm

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Insulin therapy is a critical long term treatment for individuals with Type 2 diabetes who can no longer maintain healthy blood glucose levels through oral medications, diet, or exercise alone. It involves administering insulin via injections, pens, or pumps to regulate blood sugar and prevent complications. Often associated with Type 1 diabetes, insulin becomes necessary in advanced stages of Type 2 diabetes to prevent hyperglycemia and it’s dangerous effects.

Approximate Cost:

With insurance : $35 - $300/ month (depends on insulin type and plan)

Without insurance: $300 - $1,000+ /month

Supplies ( syringes, test strips, glucose monitors) : $100 - $300/ month

Insulin pump(usually optional) : $4,000- $6,000 initially, with $3,000 - $6,000/ year for supplies

Costs can vary widely based on the brand of insulin, delivery methods, and insurance coverage.

* learning about these costs was mind blowing as I did not realize how expensive it is to manage and live with diabetes ( type 1 &2 )

Insurance Coverage

Most private insurance plans, as well as Medicare and Medicaid, cover insulin therapy for people with Type 2 diabetes. However, patients may face copays, deductibles, or restrictions based on insulin type. Some insurance plans, may require individuals to partake in step therapy in which they try cheaper medications must be tried before adjusting to and approving insulin.

Long Term Consequences of Not Seeking Treatment due to Cost :

Avoiding insulin therapy because of cost can lead to serious and fatal consequences.

Cardiovascular disease: increased risks of heart attacks and strokes

Kidney Failure: leading to dialysis or transplant

Vision Loss : diabetic retinopathy

Peripheral neuropathy: results in pain, numbness, or amputations

Increased hospitalizations: uncontrolled blood sugar levels.

* Instead of adding more financial strain, these complications can be prevented if treated with the proper treatment immediately. Although it is easier said than done for many individuals experiencing this condition when in need of a crucial medical treatment like insulin.

American Diabetes Association. (2023). Insulin Basics. https://diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-basics

Mayo Clinic. (2023). Type 2 Diabetes Treatment. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-treatment/art-20044084

Tseng, C. W., Masuda, C., Chen, R., & Hartung, D. M. (2020). Impact of higher insulin prices on out-of-pocket costs in Medicare Part D. Diabetes Care, 43(4), e50–e51. https://doi.org/10.2337/dc19-1294

Crawford, S. (2023, April 27). The Price of Insulin: A Q&A with Kasia Lipska. Yale School of Medicine. https://medicine.yale.edu/news-article/the-price-of-insulin-a-qanda-with-kasia-lipska/

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Starting Insulin Early For Type 2 Diabetes

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Metformin is a popular medication prescribed to individuals with T2DM. Metformin works against the disease by improving how your body handles insulin.

The cost for people who are insured ranges between $10-$50. Without insurance, the cost can get up to $100 per month. On a scale 1-5, the likelihood of insurance covering the medication is about a 4. Most insurances are likely to cover the medication with or without copay.

If the medication is not taken as prescribed, the individual can experience loss of blood sugar control, which can lead to the long term consequences discussed previously.

https://www.nhs.uk/medicines/metformin/about-metformin/

https://health.costhelper.com/cost-diabetes-care.html

https://www.goodrx.com/metformin/side-effects-when-you-stop-taking-metformin

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Cognitive Behavioral Therapy is a fairly common treatment that works on addressing the patients mental health problems and finding ways to resolve/manage them on their own.

This can be used to treat depression, which is common among persons diagnosed with Type 2 diabetes. The rate for depression among T2DM patients is 3x higher than those without the disease.

This type of rehabilitation is provided by a mental health professional such as a psychologist, psychiatrist, therapist, or licensed clinical social worker.

https://diabetesjournals.org/care/article/39/12/2126/31378/Psychosocial-Care-for-People-With-Diabetes-A

https://www.ncbi.nlm.nih.gov/books/NBK279297/

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Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association

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Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, an

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Rehabilitation for Co-Occurring Eating Disorders and Type 2 Diabetes 

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Rehabilitation for Co-Occurring Eating Disorders and Type 2 Diabetes 

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Eating disorders and Type 2 diabetes can co-occur in complex and harmful ways. Individuals with diabetes may develop disordered eating patterns such as restricting insulin (known as diabulimia), or engaging in binge eating due to strict dietary rules. This cycle can lead to poor blood sugar control, physical fatigue, emotional distress, and difficulty managing daily routines. Because both conditions affect daily function ( physically, emotionally, and behaviorally) which requires rehabilitative support.

1. Nutritional and Behavioral Therapy (Occupational Therapy)

Helps individuals develop consistent, healthy eating routines and coping strategies for stress and body image. Therapists may work on meal planning, insulin timing, and building positive habits.

Treats long-term effects of disordered eating behaviors and poor self-management habits; improves daily functioning and emotional regulation.

2. Exercise Therapy with Blood Sugar Awareness (Physical Therapy)

Creates safe and structured movement plans tailored to manage blood glucose levels, build strength, and promote a healthy relationship with exercise.

Treats physical inactivity, insulin resistance, and energy imbalance; improves strength, endurance, and overall health.

" Disordered eating in T2D patients often goes unrecognized due to overlapping symptoms and the focus on weight management in diabetes care."

Resources:

National Eating Disorders Association: nationaleatingdisorders.org

American Diabetes Association: diabetes.org

Diabulimia Helpline: diabulimiahelpline.org

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Navigating Eating Disorders in Patients with Type 2 Diabetes

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Occupational Therapy can treat difficulties resulting from cognitive impairment such as assistance with managing ADLs, and developing strategies for other tasks such as administering medication and monitoring blood sugar levels.

This type of treatment would need to be preformed by a licensed occupational therapist.

https://diabetesjournals.org/spectrum/article/29/4/224/32739/Management-of-Adults-With-Diabetes-and-Cognitive

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Management of Adults With Diabetes and Cognitive Problems

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Management of diabetes involves a high degree of patient involvement and daily performance of many self-care tasks. These include monitoring of blood gluco

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Psychosocial Rehabilitation for Type 2 Diabetes and Diabulimia 

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Psychosocial Rehabilitation for Type 2 Diabetes and Diabulimia 

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Diabulimia is a dangerous and often under-recognized eating disorder that occurs when a person with diabetes (often seen in Type 1 but also present in Type 2 with insulin use) deliberately restricts or omits insulin to control or lose weight. When paired with Type 2 Diabetes, it becomes especially complicated; individuals may already experience shame around their body, food guilt, and anxiety about blood sugar levels, which can fuel disordered eating behaviors.

This co-occurring condition significantly affects daily functioning and long-term physical and emotional health. Individuals may struggle with fatigue, mood swings, self-blame, depression, and difficulty adhering to treatment plans, making psychosocial rehabilitation critical.

Cognitive Behavioral Therapy (CBT)

CBT helps individuals identify distorted thoughts related to food, body image, and insulin use and replaces them with healthier beliefs and coping strategies.

CBT helps target long-term emotional distress, body image dysmorphia, and disordered eating behaviors; it promotes emotional regulation and more consistent diabetes self-care.

This treatment is provided by a licensed mental health therapist or psychologist trained in both eating disorders and chronic illness.

Motivational Interviewing (MI) & Diabetes Self Management Education and Support (DSMES)

MI is a collaborative counseling style that helps individuals explore their ambivalence about change. DSMES gives them the practical tools and emotional support needed to manage diabetes.

MI enhances motivation to stop insulin manipulation and encourages health-promoting behavior; DSMES supports long-term treatment adherence and confidence in self-management.

This treatment is provided by therapists, counselors, or social workers; DSMES is delivered by Certified Diabetes Care and Education Specialists (CDCES), nurses, or dietitians

Why It Matters:

Without psychosocial support, individuals with Diabulimia and T2D face serious health risks like diabetic ketoacidosis, vision loss, nerve damage, and severe emotional burnout. These therapies not only address the physical side of diabetes but also the psychological pain and shame that drive disordered behaviors.

Resources

National Eating Disorders Association nationaleatingdisorders.org

Diabulimia Helpline: diabulimiahelpline.com

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Diabulimia, Causes, Signs and Symptoms, Diagnosis and Treatment.

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Walking AFTER eating can help blood sugar

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Walking AFTER eating can help blood sugar

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A possible solution for both physical and occupational rehabilitation at no cost is to begin to have daily walks after our meals. It is simple and can be done for simply 2 minutes after finishing a meal.

Study suggests that muscles need glucose to function, so movement helps clear sugars from the bloodstream.

With the help of medication, physical activity after meals and choosing better meal options can help the patient stay on track to a healthier lifestyle and better glucose readings.

CNN posted a great article describing and persuading its readers to walk after our meals to lower our blood sugar levels.

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First step, choosing better food options

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First step, choosing better food options

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There is no particular order in which a type 2 Diabetic will pursue their new lifestyle. It is strongly suggested to first change their mindset on food. To begin to learn the good and the bad options, such as learn about the many protein options given to them but overall to follow the lower glycemic index of food items: this is where one can learn what foods have a higher response of conversion to our blood sugar levels and which are safe to consume.

It's no secret that home cooked meals taste better but does require time to prepare and cook unlike fast foods. But home cooked meals is a step further to a healthier lifestyle and to stabilize blood sugar.

More recommendations are provided here by the CDC.

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Speech Therapy is a type of rehabilitation that can identify and work on issues people face with swallowing.

A person with T2DM can develop difficulty swallowing overtime, due to damage to the nerves, diabetic neuropathy. Difficulty swallowing is referred to as dysphagia.

This type of rehabilitation must be done with a Speech-Language pathologist who can assess the individual's situation and provide a person centered treatment.

chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://griffinshare.fontbonne.edu/cgi/viewcontent.cgi?article=1044&context=slp-posters-2023

https://www.woosterhospital.org/responsibilities-of-a-speech-pathologist/#:~:text=A%20speech%20pathologist%20or%20a%20speech%20therapist,disorders%20and%20swallowing%20disorders%20from%20health%20conditions

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Ozempic is an injectable medication used to treat type 2 diabetes. The active ingredient in Ozempic is semaglutide, a GLP-1 agonist. Ozempic helps to lower blood sugar by increasing insulin production, reducing the amount of sugar the liver releases, and slowing the movement of food in the body. It is also used with people with type 2 diabetes and heart disease to lower the risk of cardiovascular events, including strokes and heart attacks. People with type 2 diabetes and chronic kidney disease can also benefit from using Ozempic, as it can also lower the risk of further kidney damage or failure.

The price of Ozempic can vary based on several factors, including insurance coverage, pharmacy choice, and medication supply and dosage. In this video, one woman still pays over $200 a month for Ozempic, despite being on Medicare. On a website from the manufacturer, the list price for Ozempic is just under $1000/pen.

Some ways to save on Ozempic include using coupons or ordering medicine through mail-order pharmacies, telemedicine providers, or as video above suggests, from another country. The manufacturer of Ozempic also offers a savings program and a savings card, but they cannot be combined with Medicaid or Medicare.

https://www.healthline.com/health/drugs/ozempic-cost

https://www.ozempic.com/why-ozempic/how-ozempic-works.html

https://www.novocare.com/diabetes/products/ozempic/explaining-list-price.html

https://www.webmd.com/drugs/2/drug-174491/ozempic-subcutaneous/details

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PRICE SURGE: Diabetes drug Ozempic prices increasing this year

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While there are many ways to treat type 2 diabetes, one way to treat it is something called GLP-1 receptor agonists. These are medicines that are taken through an injection. They help keep people's blood sugars low and slow digestion. These medicines that are taken by injection can also help with weight loss. There are even some that decrease the chances of having a stroke and heart attack. Some of these medicines include things like dulaglutide (Trulicity), exenatide (Byetta, Bydureon, Bcise), liraglutide (Saxenda, Victoza), and semaglutide (Rybelsus, Ozempic, Wegovy). Some side effects can be things such as nausea, diarrhea, and vomiting. If we just focus on one of these treatments such as Wegovy, the approximate cost for that would be 1,349.02 for a 28-day supply. However, if you have insurance, it can cover it, but it depends on what insurance you have. According to the Wegovy website, it looks like there are options for people whose insurance doesn't cover Wegovy. Novo Nordisk offers a co-pay program to reduce costs for those who may be uninsured or whose insurance doesn't cover them. If someone does not receive this treatment, there can be negative consequences such as gaining weight back and most people end up gaining it back within a year of stopping the medication.

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199

https://www.wegovy.com/coverage-and-savings/wegovy-coverage-options.html?showisi=true&&utm_source=bing&utm_medium=cpc&utm_term=wegovy%20shot&utm_campaign

https://www.houstonpublicmedia.org/npr/2023/01/30/1152039799/wegovy-works-but-heres-what-happens-if-you-cant-afford-to-keep-taking-the-drug/

https://th.bing.com/th/id/OIP.i-dSTo7g8-OrYlWwsV3diwAAAA?rs=1&pid=ImgDetMain

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Cognitive Rehabilitation for Type 2 Diabetes

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Cognitive Rehabilitation for Type 2 Diabetes

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Type 2 diabetes can increase the risk of cognitive impairments, and these impairments can make self-management difficult. The MAPSS-DM study is looking at the effects of cognitive rehabilitation using games on BrainHQ and the Memory, Attention, and Problem-Solving Skills for Persons with Diabetes (MAPSS-DM) intervention. This program involves classes on cognitive impairments, and lifestyle changes and strategies to reduce impairment. If these methods can be shown to reduce cognitive impairment in people with type 2 diabetes, they are more likely to become widespread and common resources.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10184896/#sec022

https://cuevaslab.com/2021/11/22/the-mapss-dm-study-what-should-participants-expect/

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Many people who have type 2 diabetes can participate in many different types of physical or occupational rehabilitation programs, but two physical treatments that people can do to treat/manage type 2 diabetes are to have a healthy diet and go to physical therapy or exercise regularly to regulate their blood sugars. According to the American Diabetes Association, of all the individuals that reported having type 2 diabetes, 31% of them said they do not participate in any type of physical activity, while another 38% of them reported very little physical activity. Having a good diet and exercising regularly is an important factor in treating and managing type 2 diabetes. Maintaining a healthy diet and exercising regularly can improve insulin sensitivity as well as glycemic control and reduce the need for oral medications or insulin.

https://diabetesjournals.org/care/article/25/10/1722/25464/Diet-and-Exercise-Among-Adults-With-Type-2

https://th.bing.com/th/id/OIP.pYNm3db8mjGPigFSz9k02QHaFL?rs=1&pid=ImgDetMain

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Two psychosocial rehabilitation treatments for type 2 diabetics can be tele rehabilitation and psychosocial group interventions. Telerehabilitation has to do with doing things from home or remotely. Tele rehabilitation can help by improving psychosocial status and exercise capacity. Many people cannot go in person to see their providers or receive helpful services such as this in person, so telebehavioral rehabilitation is the next best thing for them. Psychosocial group interventions are a way to help people through the emotional turmoil they go through when diagnosed with diabetes. There are so many ways these group interventions can help people, such as receiving emotional support from people who have gone through similar experiences and just feeling understood by others and vice versa for other people. Rehabilitation providers and healthcare workers who use resources from professional organizations, state practice acts as well as government regulatory bodies are the people who can provide telerehabilitation. A healthcare provider or a mental health professional who works in inpatient or outpatient facilities can provide psychosocial group interventions.

https://diabetesjournals.org/spectrum/article/16/2/88/696/Psychosocial-Group-Interventions-in-Diabetes-Care

https://www.ncbi.nlm.nih.gov/

https://ezcareclinic.io/wp-content/uploads/2022/03/Ezcare-Support-1-2022-03-07T223020.129.jpg

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This image shows an example of a balanced diet for a patient with T2D 

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In addition to medications, a registered dietitian can work with patients who have type 2 diabetes (T2D) to find a dietary and exercise plan that supports the balance of individuals needs. Registered dietitians are able to create personalized meal plans that support glucose and insulin levels through the day to keep T2D patients feeling more consistent. This could range anywhere from adding more snacks between meals, change in food, and even leveraging physical activity can help patients with T2D. Dietitians initial consultations can range anywhere between $70-$200 with follow up appointments ranging between $50-$150. It's likely dietitians would be covered under most T2D patients’ insurance due to the great impact that change in diet and exercise can have on a patient. This would drastically change the out of pocket price for T2D patients making it extremely more affordable as pricing would fall under their insurance deductible and copay rates. If a patient can not manage their diet and exercise and does not consult with a registered dietitian they are at a much higher rate of their condition leading to complications with renal, cardiovascular, and neurological systems that can lead to fatality.

Type 2 diabetes. (2025, March 19). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/21501-type-2-diabetes#management-and-treatment

Cdces, M. a. M. R. (2025, January 17). How a registered dietitian can help people with diabetes. culinahealth.com. https://culinahealth.com/how-a-dietitian-can-help-with-diabetes/

Ld, K. Z. R. (2024, May 21). Cost of nutritionists & dietitians (Insurance & Out-of-Pocket). Zaya Care. https://zayacare.com/blog/how-much-do-nutritionists-and-dietitians-cost/

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This image shows early symptoms to keep in mind while living with T2D

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Dysarthria is a common side effect of Type 2 Diabetes. Dysarthria occurs when the nervous system prevents individuals from fully controlling their speech ability. This includes major parts attributed to speech such as tongue, larynx, and jaw. The inability of being able to control these areas can lead to inability of speech clear enough to be interpreted into communication. However, Patients who work with a speech pathologist can practice exercises such as stretches, repetition, and vocal stimulation to combat the effects of Dysarthria.

Dysarthria. (2025, March 19). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17653-dysarthria

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This image gives a glimpse into how neurofeedback helps to retrain healthy brain waves  

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Neurofeedback is the practice of training brain waves to achieve intended goals. For patients with T2D this can help reduce feelings of anxiety or impulse that commonly arise with such diagnosis. Anxiety can be overwhelming to the point individuals prefer to isolate themselves rather than navigating these feelings. This can lead to all types of poor life habits that take a toll long term on the mental health of these individuals. Uncontrollable impulses are also attributed to patients with T2D due to the requirement of a strict diet. These patients can feel overwhelmed with impulse urges that can lead to binge eating which greatly exacerbates their condition. Neurofeedback works to stabilize brain waves and provide health tools to aid in one's ability to fight these feelings that can exacerbate their condition. While many licensed mental health professionals can practice neurofeedback,  psychologists and psychiatrists primarily are seen for these treatments.

Marzbani, H., Marateb, H., & Mansourian, M. (2016). Methodological note: Neurofeedback: a comprehensive review on system design, methodology and clinical applications. Basic and Clinical Neuroscience Journal, 7(2). https://doi.org/10.15412/j.bcn.03070208

Which professionals use neurofeedback? | About Neurofeedback. (n.d.). https://www.aboutneurofeedback.com/neurofeedback-info-center/faq/which-professionals-use-neurofeedback/

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This image shows a few benefits of aquatic therapy in T2D patients.  

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Swimming has been very successful as a method of physical therapy in patients with T2D. Oftentimes patients with T2D can suffer from a lot of chronic pain that can contribute to lack of exercise. Swimming has been so successful due to the ability to work out the cardiovascular system while limiting discomfort on parts of the body such as joints that would not normally be able to move with such ease for a prolonged amount of time. Initially Physical therapists can set a training plan that most patients are able to find success with if continuously followed. Continued activity allows T2D patients to prevent long term neurological and cardiovascular decline due to their diagnosis

Kris Swartzendruber, Michigan State University Extension. (2017, July 31). Swimming benefits for people with diabetes. MSU Extension. https://www.canr.msu.edu/news/swimming_benefits_for_people_with_diabetes

Åsa, C., Maria, S., Katharina, S. S., & Bert, A. (2012). Aquatic Exercise Is Effective in Improving Exercise Performance in Patients with Heart Failure and Type 2 Diabetes Mellitus. Evidence-based Complementary and Alternative Medicine, 2012, 1–8. https://doi.org/10.1155/2012/349209

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Environmental intervention might be recommended to help manage type 2 diabetes by introducing changes to physical activity and food intake. Both walkability and amount of green space in a neighborhood can reduce the likelihood for developing T2D, as well as promoting physical activity, a significant benefit to those already living with T2D. There is also a decreased risk of obesity and cardiovascular disease in these environments, which also benefit people with type 2 diabetes.

Living close to less healthy food options such as fast food, convenience stores, and bars can also increase the risk of developing type 2 diabetes and may exacerbate T2D. These areas, although not exclusive to food deserts but encompassing them, are not ideal for those living with T2D. Rather, an environment with available sources for healthier foods, such as supermarkets and grocery stores would be a better option.

Environmental intervention, including moving to an area that has increased walkability, more green space, and grocery stores would help with many symptoms of type 2 diabetes, and can help mitigate further issues from arising.

Amuda, A. T., & Berkowitz, S. A. (2019). Diabetes and the Built Environment: Evidence and Policies. Current diabetes reports, 19(7), 35. https://doi.org/10.1007/s11892-019-1162-1

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Neuromuscular Massage and Electrical Stimulation

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Neuromuscular Massage and Electrical Stimulation

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Neuromuscular massage helps treat areas that are causing ongoing muscle pain that could lead to referred pain. These massages can lead to a reduction in muscle pain, improved posture, and increased blood flow, flexibility, and strength. Neuromuscular massages are performed by massage therapists.

Neuromuscular electrical stimulation is where electrical currents are passed through muscles, having them contract similarly to physical exercise therapy. This allows for muscle strengthening and retraining. Physical therapists and other healthcare professionals may administer neuromuscular electrical stimulation.

https://www.aiam.edu/massage-therapy/neuromuscular-massage-therapy/

Nussbaum, E. L., Houghton, P., Anthony, J., Rennie, S., Shay, B. L., & Hoens, A. M. (2017). Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiotherapy Canada. Physiotherapie Canada, 69(5), 1–76. https://doi.org/10.3138/ptc.2015-88

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Type 2 diabetes is most definitely linked to cognitive decline, especially if your blood sugars are not in range, and they are always running high. The brain is the body's command center, and it uses sugar in the blood for energy. The brain is the most energy-demanding organ according to the CDC, and it requires half of all the sugar energy in the body to work correctly. If people's blood sugar gets out of range it can mess up the command center. Diabetes can harm nerves all throughout the body, including the brain. This can end up leading to problems with learning, memory, weight gain, mood shifts, as well as hormonal changes. The longer it goes on it can also lead to bigger issues such as Alzheimer's.

https://www.cdc.gov/diabetes/diabetes-complications/effects-of-diabetes-brain.html

https://www.belmarrahealth.com/wp-content/uploads/2016/11/type-2-diabetes-cognitive-impairment-linked-tobrain-atrophy-resembling-early-stage-alzheimers-500x400.jpg

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When an individual is diagnosed with Type 2 Diabetes, depending on their blood sugar levels, they will be prescribed many medications such as insulin, or metformin as a start. Other options to maintain or decrease blood sugar levels could be Ozempic, Wegovy for example as prescribed by their doctor.

What all medications have in common is that they all work to improve the lives of type 2 diabetic patients but there is a high cost that comes with it. Not all insurances cover the costs that are essential for diabetics.

According to the American Diabetes Association, "the average cost of healthcare for a person with Diabetes is $16,752 a year--more than twice the cost of health care for a person without diabetes."

Good news is, Medicare has been a fundamental health insurance company whom helps cover medicines and supplies for diabetics. Although Medicare is usually covers individuals whom are 65 years or older; they have special rules for specific groups of people, like those whom are diabetic and need financial assistance with their medication for example.

Medicare can also cover diabetes screening tests, self- management training, etc.

The National Institute of Diabetes and Digestive and Kidney Diseases explain more on how Medicare plan A and/or B can help diabetics financially with their medications and therapies.

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Symptoms of a diabetic experiencing hypoglycemia and hyperglycemia.

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Upon learning of one's diagnosis of type 2 diabetes can be very scary and heartbreaking to learn. Once diagnosed, where shall the patient start? Immediately one can become overwhelmed with the diagnosis and the new lifestyle they will encounter.

One of the new habits a newly diabetic will face is to monitor their blood glucose levels. Is it too high of a range? Is it too low? Constantly checking for the status of their blood glucose level can create an unhealthy habit of checking constantly and developing anxiety because of it.

The purpose of checking your blood glucose level is to determine whether the patient needs a higher dose of medication or is on the right track of stabilizing their blood sugar. The fear one may develop is constantly thinking of hyperglycemia and hypoglycemia - both of which could occur depending on whether blood glucose is too high or if the medication they take will drop their levels too low. Both conditions are very scary and can lead to a serious health effects/emergencies.

The National Library of Medicine states more about the anxiety built up of hyperglycemia and hypoglycemia.

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Intersection of Speech, hearing and cognitive issue with Diabetics 

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Intersection of Speech, hearing and cognitive issue with Diabetics 

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Type 2 diabetes can affect many parts of the body especially the organs; high blood sugar levels can create more issues that solutions for those with diabetes. These affects can lead to mild cognitive impairment or dementia in the future.

Fortunately, there are various rehabilitation approaches to help speech, hearing and cognitive functions. It is important to begin rehabilitation so that symptoms can disperse or remain stable.

The patient can also visit an endocrinologist for diabetes management. An audiologist for hearing assessments and more.

It is important to educate one another as much as possible in regards to type 2 diabetes and the risks factors one may face if left untreated.

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Physical Activity is one of the most effective lifestyle changes a person can make to help manage and improve their diagnosis of T2DM. This lifestyle change can help with prevention of Type 2 diabetes as well as improving blood sugar levels, insulin sensitivity, and overall health.

This can be a free lifestyle change that can begin on a very small level, depending on a person's physical capabilities, and work up to a larger scale.

On a scale of 1-10, I'd put the level at a 3. This is based on motivation and determining what physical activities one can do and what may be beneficial based on a person's specific circumstances.

A Primary Care Physician or Physical Therapist can help guide a patient through this lifestyle change.

https://diabetesjournals.org/care/article/39/11/2065/37249/Physical-Activity-Exercise-and-Diabetes-A-Position

https://www.cdc.gov/diabetes/living-with/physical-activity.html

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This image is an example of how to use insulin around meal times to help stabilize blood sugar levels

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Monitoring blood sugar with T2D takes many lifestyle changes. Scheduling regular follow ups with their doctor to ensure the patient is still finding success with the care plan they have aligned on. Within that care plan, finding an appropriate medication to support a more consistent blood sugar has been shown to improve side effects patients feel due to T2D. The appropriate medication would be one the patients body reacts well to, in addition the medication application and frequency would be sustainable for the patient. It has been shown if a treatment is not sustainable for a patient the success rate for the treatment being successful lowers dramatically. All of this would be in addition to the patient regularly checking their blood sugar levels to ensure they are in an appropriate range.

Diabetes management: How lifestyle, daily routine affect blood sugar. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-management/art-20047963

Living with Diabetes. (2024, May 15). Diabetes. https://www.cdc.gov/diabetes/living-with/index.html

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Smoking can increase your risk of developing type 2 diabetes by 30-40%, and for people with T2D already, it can worsen conditions and increase complications. Nicotine raises blood sugar and smoking increases inflammation, so blood sugar management becomes more difficult. Smoking can also raise your blood pressure, decrease HDL ("good") cholesterol, and increase your risk of blood clots, kidney disease, and heart disease.

When a person quits smoking, their lungs and circulation begin to improve within a few months, and past a year, their risk of heart disease is cut in half. Quitting smoking can also lower blood sugar levels, so checking blood sugar should happen more frequently until the body adjusts to a smoke-free lifestyle; as a result, blood sugar management becomes easier for those with T2D.

Quitting smoking can be extremely difficult, and many people don't succeed on their first try. On a scale of 1-10, quitting smoking would be at least an 8. With nicotine replacement products, this number might drop to 4 or 5.

A person may stop smoking cold turkey (immediately), over time, or with alternatives such as nicotine patches or gum. These products can double your chance of quitting smoking, but can also raise blood sugar. A primary care physician (PCP) can help with quitting smoking, and people with T2D should talk to their PCP before starting nicotine replacement products.

https://www.heart.org/en/health-topics/diabetes/prevention--treatment-of-diabetes/living-healthy-with-diabetes#

https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/5-steps-to-quit-smoking

https://www.cdc.gov/diabetes/risk-factors/diabetes-and-smoking.html

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So you’ve decided to quit smoking, vaping or using any form of tobacco. Great.

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Maintaining Weight/Reducing Alcohol Consumption 

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Maintaining Weight/Reducing Alcohol Consumption 

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There are many different lifestyle changes that can help someone with type 2 diabetes and maintaining weight and limiting alcohol consumption are a few examples of that. Being obese makes life for someone who has type 2 that much harder to manage. Not only does being overweight make it harder to manage it, but it also increases the risk of high blood pressure as well as high cholesterol, which are risk factors for cardiovascular disease. However, the key to maintaining weight is eating well and being physically active. Eating well and watching the portion sizes of our food as well as reading food labels is helpful in maintaining weight too. On a scale from 1-10, I would say that this lifestyle change can be pretty hard for someone to make, so I would label it as a 6 or 7 in terms of how hard it is. The type of medical professional that can help with this could be a nutritionist or dietician. Alcohol consumption is another lifestyle change that can be necessary for type 2 diabetics because drinking alcohol can affect diabetics in several ways. The liver is where excess sugar is stored in the form of glycogen and when someone's blood sugar dips down, the liver converts glycogen into glucose. However, the body can't do this while metabolizing alcohol, so as a result, people's blood sugars will stay low. On a scale of 1-10, I would say that this lifestyle change is about a 4 or 5 just because it doesn't seem too hard to drink moderately, especially if it is for health reasons. A dietician or nutritionist or even a primary care provider could assist someone with this lifestyle change.

https://www.heart.org/en/health-topics/diabetes/prevention--treatment-of-diabetes/living-healthy-with-diabetes

https://www.verywellhealth.com/can-i-drink-alcohol-if-i-have-type-2-diabetes-1087730

https://tse1.mm.bing.net/th/id/OIP.rgR_mRdR5oNHSfDySgtYvgHaEK?rs=1&pid=ImgDetMain

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Hispanic/Latinx Individuals & Type 2 Diabetes

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Hispanic/Latinx Individuals & Type 2 Diabetes

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Hispanic/Latinx individuals are at a significantly higher risk for type 2 diabetes due to a combination of genetic predisposition, cultural dietary patterns, and social determinants of health such as limited access to healthcare and preventive education.

Why They're at Greater Risk:

Higher rates of insulin resistance and family history of diabetes.

Traditional diets may be high in refined carbs, sugars, and saturated fats.

Unique Challenges:

Language barriers and immigration status can limit access to healthcare.

Cultural stigma around illness may delay diagnosis or treatment.

Lack of health insurance and lower health literacy can hinder disease management.

Reference

Dabelea, D., & Bell, R. A. (2019). Racial and Ethnic Disparities in Type 2 Diabetes and Its Complications in the United States: An Overview. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC6953173/

Addie L. Fortmann, Kimberly L. Savin, Taylor L. Clark, Athena Philis-Tsimikas, Linda C. Gallo; Innovative Diabetes Interventions in the U.S. Hispanic Population. Diabetes Spectr 1 November 2019; 32 (4): 295–301. https://doi.org/10.2337/ds19-0006

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Diabetes in the Hispanic and Latino Population

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Engaging in regular physical activity is one of the most effective ways to prevent type 2 diabetes. Exercise helps the body use insulin more efficiently, lowers blood sugar levels, and supports healthy weight management.

Why It Works:
At least 150 minutes of moderate-intensity exercise per week can significantly reduce the risk of developing type 2 diabetes by improving insulin sensitivity and glucose uptake in the muscles.

Challenges:

Many individuals face barriers like lack of safe spaces to exercise, time constraints due to work/family responsibilities, and limited access to fitness resources.

In underserved communities, there may also be a lack of culturally appropriate or accessible exercise programs.

Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., Chasan-Taber, L., Albright, A. L., Braun, B., American College of Sports Medicine, & American Diabetes Association (2010). Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147–e167. https://doi.org/10.2337/dc10-9990

Benoit J. Arsenault, Jean-Pierre Després; Physical Activity for Type 2 Diabetes Prevention: Some Is Better Than None, More Is Better, and Earliest Is Best. Diabetes Care 1 June 2023; 46 (6): 1132–1134. https://doi.org/10.2337/dci22-0065

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Ask Dr. Bob: Physical Activity and Diabetes

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Tune in for Ask Dr. Bob LIVE on Monday, August 14 at 2:30 p.m. ET. During this episode, Dr. Bob will be answering your questions about physical activity and…

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Continuous Glucose Monitors (CGMs) in Type 2 Diabetes

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Continuous Glucose Monitors (CGMs) in Type 2 Diabetes

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Continuous Glucose Monitors (CGMs) are small wearable devices that track blood glucose levels in real time, 24/7. They measure interstitial glucose through a tiny sensor inserted under the skin and transmit data to a reader or smartphone. For individuals with type 2 diabetes, CGMs allow for better glucose control, fewer finger pricks, and improved insight into how lifestyle factors affect blood sugar. This technology is especially valuable in tailoring treatment and avoiding long-term complications. (Used primarily for treatment and glucose monitoring.)

Potential Downsides:
Despite their benefits, CGMs can be expensive and not always covered by insurance, limiting access for low-income individuals. Some users may experience skin irritation, feel overwhelmed by constant data, or lack the tech skills to use the device effectively. These challenges can create disparities in care and reduce the potential impact of this innovative tool.

American Diabetes Association. (n.d.). CGM (Continuous Glucose Monitors). https://diabetes.org/advocacy/cgm-continuous-glucose-monitors

Mamkin, I., Ten, S., Bhandari, S., & Ramchandani, N. (2008). Real-time continuous glucose monitoring in the clinical setting: The good, the bad, and the practical. Journal of Diabetes Science and Technology, 2(5), 882–889. https://doi.org/10.1177/193229680800200520

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Lady and gentleman, welcome to the future! How amazing is technology these days? Where now type 2 diabetics can track their blood glucose levels by using a special pen design to keep track of your levels? How cool!

How the Smart Insulin Pen works is it is a reusable injector pen with a connection to a smartphone app to not only keep track of glucose readings but it can remind the patient to check their levels. It can send alert to your phone when inactive.

The Smart Insulin pen has been rapidly growing in popularity because it is considered more affordable that what's on the market as well as easy to use and great option on checking your blood glucose.

To learn more, please consider visiting the Devices and Technology article for the pros and cons of the smart insulin pen.

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Child checking their blood glucose level. 

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Type 2 diabetes cases continue to increase on a linear path where researchers believe that the cases in young people will increase by 2060.

This prediction is based on data from 2002-2017 where they examined the number of young people under 20 with type 2 diabetes and how cases have increased.

The rise of cases could be contributed by the artificial foods and dyes found in our foods especially those that are specifically advertised for children (candy, cereal boxes etc). The level of inactivity in children and teens - growing up in the 90s, 2000s children were out playing and being active as much as possible without giving it a thought. Nowadays most children and teens are focused on the latest devices and putting their sole focus on that instead of any active play.

Could this be a reason why the rise of diabetes is increasing? Researchers and I believe so. The CDC explains and shows the graphical data that supports their findings.

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Food is delicious, nutritious and always on our mind. But is imperative to learn which food choices can amplify our well being and which can lead us down to a path of illness.

Educating ourselves, families and friends on the different food groups will be a lot easier to form our plates and can even encourage us to cook our own meals instead of takeout where we aren't sure exactly how our food was prepared.

Food should be treated as medicine with the occasional sweet treat.

Another great example is to educate ourselves with the many foods that are considered low-glycemic which means that the food group will not create a spike in our glucose levels.

For more healthy eating tips, I strongly recommend to read the How to Eat Healthy article by the American Diabetes Association.

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Hearing the words, "you are diagnosed with Diabetes" can send anyone in a whirlwind. What does this mean? What did I do wrong? Can I reverse this diagnosis? Is it the end for me? What now?

It can be very stressful, emotional time for anyone diagnosed with any illness especially one that could have been prevented. But here are, fully diagnosed, what can we do now to better our quality of life? Luckily, you are not alone.

The American Diabetes Association has provided a link where one can learn everything there is about diabetes from what foods to consume, which foods to avoid, how to check blood glucose levels, what exercises are best to incorporate based on your schedule etc. It is an amazing tool and I highly recommend it for those who are not only diagnosed with diabetes but friends and family members to learn about the disease as well and how to best support their loved one.

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Another Population affected are communities with a lower socioeconomic status.

This is likely due to the fact that people with a lower socioeconomic status tend to have a lower income, lack in education, and limited access to healthcare and healthy food options due to the neighborhood this populations lives in. When seeking care it can be expensive if there is no health insurance and some could lack the transportation needed to make it to the doctor for routine visits.

https://diabetesjournals.org/care/article/44/1/258/33180/Social-Determinants-of-Health-and-Diabetes-A

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How Social Determinants of Health Contribute to Type 2 Diabetes

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A healthy diet is important. Along with this, it is essential to eliminate any substance use such as smoking.

Smoking can damage our blood vessels, which can lead to insulin resistance. Additionally, It has been found that nicotine raises your blood sugar. According to the CDC, you face a higher rate of 40% of being diagnosed with T2DM than people who do not smoke.

Quitting smoking is beneficial for your overall health. However, this can be a very difficult habit to kick as many people are addicted to smoking. It would be important not to turn to sugar, unhealthy foods, or other substances to replace the habit.

https://www.cdc.gov/diabetes/risk-factors/diabetes-and-smoking.html#:~:text=Increased%20risk%20of%20type%202,products%2C%20raises%20your%20blood%20sugar

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Smoking can increase your risk of type 2 diabetes, and make it harder to manage if you have it.

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Insullin Pumps are an important treatment option of T2DM. This technology releases an appropriate amount of insulin for your body during the day to maintain proper blood sugar levels. Unfortunately, they can cause weight gain and can be quite expensive, costing around $8,000.

https://diabetes.org/living-with-diabetes/treatment-care/diabetes-technology-guide

https://www.medicalnewstoday.com/articles/323387#:~:text=initial%20weight%20gain%20as%20the,cough%20when%20taking%20inhaled%20insulin

https://hcp.medtronic-diabetes.com.au/insulin-pump-costs

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RECALL OF METFORMIN EXTENDED RELEASE
In May 2020, the Food and Drug Administration (FDA) recommended that some makers of metformin extended release remove some of their tablets from the U.S. market. This is because an unacceptable level of a probable carcinogen (cancer-causing agent) was found in some extended-release metformin tablets. If you currently take this drug, call your healthcare provider. They will advise whether you should continue to take your medication or if you need a new prescription.

Many people with diabetes take insulin to help manage their blood sugar levels. However, insulin therapy can cause a range of side effects, such as hypoglycemia.

Insulin is a hormone that helps regulate the amount of sugar, or glucose, in the blood. Insulin has a counterpart called glucagon, a hormone that works in the opposite way.

The body uses insulin and glucagon to ensure that blood sugar levels do not get too high or low and that cells receive enough glucose to use for energy.

When blood sugar is too low, the pancreas secretes glucagon, which causes the liver to release glucose into the bloodstream. However, people with diabetes might need to take supplementary insulin to help keep their blood sugar levels within a normal range.

In this article, we look at the side effects, risks, and myths of insulin therapy and provide tips for taking insulin safely.

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People with type 1 diabetes need to take insulin. However, it can lead to side effects.

Many different types and brands of insulin are available in the United States.

The side effects that a person might experience depend on the type of insulin they are taking.

Common side effects include:

Insulin shots cause the cells in the body to absorb more glucose from the bloodstream. As a result, taking too much or administering an injection at the wrong time may cause an excessive drop in blood sugar.

If a person's blood sugar level drops too low, they may experience symptoms, such as:

dizziness

trouble speaking

fatigue

confusion

pale skin

sweating

twitching muscles

seizure

loss of consciousness

Having a strict insulin schedule is essential for keeping blood sugar levels within a healthy range. A doctor may prescribe insulins that act at different speeds to keep a person's blood glucose levels more consistent.

People at risk of hypoglycemia should wear a medical bracelet stating their type of diabetes, plus other necessary information, such as whether they control their condition with insulin.

These bracelets provide information to first aiders and medical professionals in case a person becomes conscious.

Other possible complications

There is also the possibility that taking insulin will cause more severe side effects, although these are less common.

Fat necrosis may develop in people who regularly inject insulin. This condition causes a painful lump to grow in the subcutaneous tissue, which is just below the skin's surface.

These researchers found that the insulin therapy group in the study had an increased risk of several complications, including:

Another review concluded that the risks of insulin therapy might outweigh the benefits for people with type 2 diabetes. The authors highlighted the following downsides of insulin therapy:

the need to increase the dose and complexity of the treatment plan over time

the increased risk of severe hypoglycemia

a higher possible risk of death

a potential increase in the risk of specific cancers, including pancreatic cancer

Diabetes impairs insulin production by the pancreas and use of this essential hormone by the body. The condition causes high blood sugar levels.

However, not every person with type 2 diabetes will need to take insulin. People with type 1, on the other hand, will have to supplement their insulin supply for the rest of their lives.

There are three main types of diabetes:

Type 1 diabetes: Typically starts in childhood when a person does not produce enough insulin. Usually results from the body's immune system attacking an otherwise healthy pancreas.

Type 2 diabetes: Can develop at any age but 45 years is the average age of onset. Either the pancreas does not produce enough insulin, or the body's cells become resistant to its actions.

Gestational diabetes: Occurs during pregnancy and makes it harder for a woman's body to respond to insulin. Typically stops after childbirth but increases a woman's risk of developing type 2 diabetes.

Type 1 and type 2 diabetes are usually lifelong conditions. According to the Centers for Disease Control and Prevention (CDC), more than 30 million people in the United States have diabetes. Type 2 diabetes is the most common, accounting for 90-95 percent of those with diabetes.

People with type 1 diabetes require daily insulin therapy to maintain regular blood sugar levels. However, the exact treatment regimen will vary from person to person.

An individual can deliver their insulin to their body through a pump. This is a machine that provides the hormone through a port, removing the need for injections. Some pumps are automatic, while others require more user input.

Some individuals may need to supply two to four doses every day. Extra shots of rapid- or short-acting insulin may be necessary at mealtimes.

People also use injections, pens, and inhalers to take insulin.

Types of insulin

A doctor can help customize a safe and effective insulin therapy regimen for a person with type 1 diabetes. According to the American Academy of Family Physicians, there are several different types of insulin that people can use separately or in combination.

Rapid-acting insulins that start to work within 15 minutes and can last around 3-5 hours.

Short-acting insulins that take 30-60 minutes to start working and have a duration of 5-8 hours.

Intermediate-acting insulins that take 1-3 hours to start working but last 12-16 hours.

Long-acting insulins that start to work in about 1 hour and can last 20-26 hours.

Premixed insulins that combine a rapid- or short-acting insulin with a longer-lasting one.

A doctor will prescribe one of these insulins or a mixture alongside a carefully controlled schedule. Following this closely will reduce the risk of side effects and complications.

Non-insulin treatments

People with type 2 diabetes can often manage their condition without insulin therapy.

Alternative treatment options include lifestyle and dietary changes and non-insulin medications, such as metformin. However, if a person is unable to control their blood sugar levels using these treatments, a doctor may recommend insulin therapy.

Women with gestational diabetes typically receive insulin, but they can also manage their diabetes with metformin. A doctor will explain the safest way to take these medications during pregnancy.

According to the American Diabetes Association (ADA), several common myths surround the use of insulin therapy for people with type 2 diabetes.

People who take insulin may sometimes hear others make the following statements, but they have no basis in research or fact:

"Insulin can cure diabetes." There is, at present, no cure for diabetes. However, insulin can help a person control its effects.

"It will cause disruption in your life." While a course of insulin takes some getting used to, a person can enjoy a full and active life, as long as they stick to their insulin schedule.

"Insulin injections cause pain." Many people have a phobia of needles. However, modern insulin pens cause almost no pain. People using pumps can avoid injections altogether.

"Insulin will increase the frequency of severe hypoglycemia." While insulin can increase the risk of hypoglycemia, certain insulins can limit a sudden drop in blood sugar.

"Insulin causes weight gain for as long as a person uses it." Insulin might increase weight at first, but this is not an ongoing effect. The body first needs to adapt to insulin supplementation.

"The injection site is not important." Where on the body a person inserts a needle or pen determines the speed at which insulin has an effect. This can be vital after meals when quick drops in blood glucose levels reduce the impact of the food.

"Insulin is addictive." Insulin is not an addictive drug and is vital for any person whose pancreas does not produce insulin.

Talking to a doctor should put someone's mind at ease about any concerns or anxieties they have about insulin therapy.

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Monitoring blood sugar is essential for people to avoid the side effects of insulin.

Insulin is a prescription medication. A person should speak to their doctor about:

choosing the right type of insulin for them

possible side effects or interactions with other drugs

self-administering insulin safely and effectively

People with type 2 or gestational diabetes should discuss with their doctor whether insulin therapy is the best choice for them.

They may be able to use other treatment options to control their blood sugar levels, such as non-insulin medications and lifestyle and dietary changes.

It is essential that people who need to take insulin monitor their blood sugar levels regularly. Taking too much or too little insulin can lead to side effects or complications.

Following the prescribed treatment schedule is also vital. It is essential not to miss a dose and take every dose at the right time.

Anyone who experiences side effects while taking insulin therapy should speak to a doctor. It is possible that another treatment plan or a different type of insulin may be more suitable for their needs and lifestyle.

A doctor can also advise on how to prevent or reduce specific side effects.

People with type 1 diabetes need to take insulin daily to control their blood sugar levels and remain healthy. However, this treatment can cause weight gain at the start of the course, and taking too much insulin can lead to hypoglycemia.

Many individuals with type 2 diabetes and gestational diabetes can use non-insulin medications and lifestyle changes to manage their condition without needing insulin.

When taking insulin, it is vital that people follow their treatment plan. Anyone experiencing side effects or complications while taking insulin should speak to their doctor, who can recommend other treatment plans or different types of insulin.

A doctor can also provide advice on how to prevent or reduce certain side effects.

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Insulin therapy: Side effects, myths, and tips

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People with type 1 diabetes need to take insulin to stay healthy. Doctors sometimes also prescribe insulin for people with type 2 diabetes or gestational diabetes. However, insulin therapy can sometimes cause side effects. Learn more here.

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The Diabetes Prevention Program- A study on individual counseling

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The Diabetes Prevention Program- A study on individual counseling

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The Diabetes Prevention Program has intervened through individual counseling for affected populations. This is done on an individual level. A study done utilizing this program showed a 34% less of the population developing Type 2 Diabetes.

A challenge that this educational measure faces is a lack of referrals from providers, simply because they may not be aware of the program.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7445538/#:~:text=Increasing%20Provider%20Referrals%20to%20the%20NDPP&text=These%20results%20are%20fully%20consistent,NDPP%20uptake%20with%20provider%20referrals.&text=Despite%20the%20comparably%20low%20rate,individuals%20to%20intensive%20lifestyle%20interventions.&text=Relatively%20few%20point%2Dof%2Dcare,the%20NDPP%20are%20made%20currently.&text=First%2C%20many%20providers%20are%20unaware,referred%20patients%20to%20the%20program.&text=To%20address%20this%20issue%2C%20NDPP,Research%20and%20Quality;%20R18HS026172).

https://pmc.ncbi.nlm.nih.gov/articles/PMC6682852/

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Abstract

To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive lifestyle intervention from a large efficacy trial, the NDPP aims to reduce incidence through lifestyle change and weight loss. This narrative review summarizes evidence on reach, effectiveness, and sustainability of the NDPP, while highlighting opportunities to overcome challenges in these areas. Major successes include reaching hundreds of thousands of at-risk individuals across the nation, with notable effectiveness upon full participation and widespread insurance coverage. Yet, more work is needed to ensure greater public health impact, particularly among priority populations at heightened risk who also experience disparities in program outcomes. Preliminary evidence suggests a number of strategies may improve reach and effectiveness of the NDPP, often with more rigorous study needed prior to widespread uptake. Updating the NDPP to better match the current evidence-base may also be important, such as directly targeting glycemia with a patient-centered approach and promoting metformin as an adjunct or second-line treatment. Finally, revisiting pay-for-performance reimbursement models may be critical to sustainability by ensuring adequate availability of suppliers and ultimately reducing diabetes prevalence.

Keywords: obesity, type 2 diabetes mellitus, prediabetes, lifestyle modification, prevention

Introduction

Diabetes affects 13% of adults in the US, imposing major public health and economic burdens. Another 34.5% of US adults are estimated to have prediabetes, or elevated blood glucose that may progress to type 2 diabetes without intervention. The National Diabetes Prevention Program (NDPP) is an evidence-based intervention to prevent diabetes in at-risk populations in the US that has been disseminated nationwide since 2010 under Centers for Disease Control and Prevention (CDC) leadership, with the first participants served in 2012. The NDPP is a translation of the intensive lifestyle intervention from the Diabetes Prevention Program (DPP) trial, which demonstrated a 58% reduction in incidence over 3 years, with benefits persisting up to 15 years., Using a lower-cost scalable model, the NDPP promotes ≥5% weight loss over one year via in-person classes, distance learning, online programming, or a combination of modalities. Participants may include overweight/obese adults with prediabetes or other risk factors such as past gestational diabetes. This narrative review examines the current impact of NDPP dissemination in the US based on recent literature and reports, including successes as well as opportunities to overcome challenges regarding reach, effectiveness, and sustainability.

Reach

Successes with Reach

The NDPP has achieved impressive scaling with over 1,500 sites as of 2020, per the CDC's registry of organizations participating in their Diabetes Prevention and Recognition Program (DPRP) that monitors fidelity and quality., This reflects an exceptional degree of adoption for a prevention program that transitioned from a clinical trial to translation into communities. There are currently NDPP sites in all 50 US states, the District of Columbia, and most US territories. Sites include community-based organizations, healthcare clinics and systems, pharmacies, health plans, public health and other governmental institutions, universities, and private wellness companies, uniquely providing a variety of settings in which to access the program. In turn, population reach has been fast increasing from about 35,000 eligible participants served as of 2016 to over 324,000 by early 2019. Whereas the inherently limited capacity of in-person sites might cap potential growth, online and distance learning models have also been approved by the CDC since 2015 and 2018, respectively, with more limitless potential to expand reach. Indeed, despite fewer online than in-person NDPP suppliers and later approval for dissemination, online delivery exceeds the reach of in-person programs. Such virtual delivery can also ensure wide geographic reach to fill the many gaps where in-person sites are unavailable.,

Overcoming Challenges with Reach

Increasing Awareness of Diabetes Risks

As 88 million US adults are estimated to have prediabetes, reach to hundreds of thousands of at-risk persons with the NDPP is highly commendable, but not yet scaled for population health impact. An upstream issue is that few adults with prediabetes are aware of their condition (15.3%), although it is encouraging that risk awareness has been increasing over time. Self-reports of perceived risk for diabetes due to a variety of factors increased from 30% in 2011 to 45% in 2016. Moreover, when individuals become aware of having prediabetes, they are likely to take preventative action as 71% report efforts to reduce the likelihood of diabetes onset. Media campaigns are a common approach to increase widespread risk awareness and promote the NDPP (i.e., 90.2% of NDPP sites reported use of mass media as a recruitment strategy), yet resulting uptake appears limited, and cost-effectiveness is unclear. Increasing awareness and reach of the NDPP through systematic screening and referrals has arisen as a more promising scalable strategy.

Increasing Provider Referrals to the NDPP

A large study led by the American Medical Association found 56% enrollment upon point-of-care referrals to the NDPP and 11% enrollment using a retrospective, algorithm-based approach to referrals. These results are fully consistent with the first known study of NDPP uptake with provider referrals. Despite the comparably low rate of engagement upon algorithmic referrals, the potential to automate this approach is important for scalability, as well as reducing provider burden to meet US Preventive Services Task Force recommendations to refer at-risk individuals to intensive lifestyle interventions., Relatively few point-of-care referrals to the NDPP are made currently. First, many providers are unaware of the NDPP as a resource for their patients. A 2016 survey of over 1,200 primary care providers found that only 38% were aware of the NDPP, and fewer (23%) had referred patients to the program. To address this issue, NDPP sites can proactively seek to establish referral networks with providers. Indeed, the majority of NDPP sites participating in a recent CDC-led evaluation (70.1%) were found to use provider referrals for recruitment, and there are ongoing on efforts to support systematic linkages between clinical providers and community-based NDPPs (e.g., a study funded by the Agency for Healthcare Research and Quality; R18HS026172).

Addressing Disparities in Reach

A challenge is that men and younger individuals are under-represented in the NDPP, and additional participation gaps exist for priority populations. In a 2019 CDC report, only 24.7% of NDPP participants were men, despite their higher prevalence of prediabetes compared to women (37.4% vs. 29.2%). There may also be a missed opportunity for lifelong diabetes prevention among the 28.7 million US adults under age 45 with prediabetes, as the average age of participants is 55.1. Another challenge is high initial "no shows" among enrollees overall (25-60%), ⁻ which appear higher yet for racial/ethnic minority, low-income, and younger participants. Specifically, Latino enrollees were half as likely to initially attend as compared to non-Hispanic white enrollees, and women <40 years were about a quarter as likely to attend as their older counterparts (men were not included in this study). Other data suggest lower show rates for Medicaid beneficiaries (69.6%) versus enrollees with other types of insurance (77.7%; no p-value reported). Low intervention uptake in these groups is likely related to previously identified factors including social support, transportation/costs, beliefs about illness and lifestyle change, as well as social and economic disadvantages. To increase reach, encouraging enrollment alongside a partner or family member may be beneficial, as likelihood of initial attendance was three-fold greater than with individual enrollment, which especially benefited men and Latinos (indicating potential to address their reach gaps). Qualitative studies have further suggested strategies including more education and motivational interventions at referral and/or enrollment, providing childcare and transportation, offering classes solely for similar target populations, and using a more flexible and interactive class format., In turn, more empirical work is needed to fully demonstrate the potential benefits of these and other strategies.

Effectiveness

Successes with Effective Implementation

The NDPP was closely based on successes demonstrated with the lifestyle arm of the DPP clinical trial, in which participants achieved 4.9% mean weight loss by the end of intervention through low-fat diet and increased physical activity. The NDPP similarly promotes ≥5% weight loss through lifestyle change to reduce risk. Reports show a promising 4.2% mean weight loss for in-person NDPP classes and 4.3% weight loss for virtual programs. These are impressive outcomes given delivery to the general population of adults with diabetes risks, in contrast to extensive eligibility criteria in the original DPP trial, including completion of a 3-week run-in to ensure compliance. Although incident type 2 diabetes has not yet been systematically examined as a program outcome, it is nonetheless encouraging that each kilogram of weight loss was associated with 16% decreased incidence among lifestyle intervention participants in the DPP trial, suggesting considerable benefit is likely.

Additional successes with NDPP implementation include evidence that adults age 65 and older have remarkable weight loss (e.g., 6.4% median weight loss after ≥6 months in the program), consistent with the exceptional benefit observed for seniors in the DPP's lifestyle arm, and important given high age-related risks. Further, while the DPP trial required elevated blood glucose at enrollment, individuals who qualify for the NDPP based on broader definitions of risk appear to have positive outcomes. Specifically, no significant differences in weight loss were observed for participating women with and without a history of gestational diabetes, or for participants who qualified based on a risk survey versus confirmed prediabetes and/or prior gestational diabetes. Moreover, the original DPP trial largely excluded women in their childbearing years, yet early evidence suggests that participating women who become pregnant appear to have favorable obstetric and neonatal outcomes. Together, these findings suggest that the NDPP's broad eligibility criteria enable many individuals to benefit from intervention, and might even be leveraged to break the transgenerational disease cycle.

Overcoming Challenges with Effective Implementation

Improving Outcomes for All

Nearly three-quarters of participants (71.7%) do not achieve the ≥5% weight loss goal according to a CDC report. Of further concern, disparately low weight loss is observed for women, younger adults, and racial/ethnic minority and low-income participants, who lose about half as much weight as their counterparts.,, Improving retention appears key overall to ensuring beneficial weight loss outcomes (e.g., each session attended is associated with 0.3% more weight loss). Yet median attendance is only 134 days, such that most participants complete less than half of the yearlong program. In many cases, greater attendance mitigates, or at least attenuates, weight loss disparities.,, Improved retention has been observed with a variety of implementation strategies, including delivering a motivational session before the NDPP begins (+100 days for "pre-session" attendees), attending with a partner (+35 days), provider referrals (+34 days), special population tailoring (e.g., culture- and gender-specific adaptions; +30 days), and non-monetary incentives (e.g., gym memberships; +28 days)., Evidence for monetary incentives is mixed with no greater retention observed in a report comparing site-level strategies, while increased attendance was found specifically among Medicaid beneficiaries in another study, but without greater weight loss. Overall, it remains important to consider feasibility, cost, and utility of these strategies for specific settings and populations.

In addition to increasing reach, virtually-delivered programming also has potential to address barriers to retention given findings that 61% of enrollees anticipated challenges attending in-person classes due to other responsibilities (e.g., work, school, dependent care) and 30% anticipated challenges with transportation. Yet, despite high rates of early engagement in online NDPPs, only 19% of participants attended for ≥9 months, and patterns of disparate weight loss outcomes among subgroups remained a concern. Thus, online delivery alone does not appear to resolve effectiveness challenges. Low retention rates in both in-person and online NDPPs likely affect reported outcomes, as data are typically examined for only those who attend a minimum number of sessions or have a minimum number of recorded weights, which often varies from one report to another (particularly as CDC standards for evaluating NDPP outcomes have been revised over time)., Supplementing online interventions with in-person coaching was shown to improve weight loss (mean = 4.6%). A less resource-intensive approach of supplemental text message support did not improve retention or weight loss in the in-person NDPP. Reducing the intervention to delivery via short text messages demonstrated high retention but also was insufficiently effective. Overall, further research appears needed, including to examine what specific virtual components are beneficial, and to what extent additional in-person or other "real" interaction with a lifestyle coach may yield optimal results. As of 2019, less than 1% of participants receive combined in-person and virtual delivery approaches, which may be an important area for future growth.

Opportunities to Modernize the NDPP

While achieving all lifestyle goals was associated with the greatest risk reduction in the DPP, few (17%) were able to do so. Evidence continues to confirm the majority of participants are unable to achieve the recommended lifestyle goals of the NDPP. Thus, an opportunity for improvement is updating the NDPP to ensure generalizability, while incorporating more current evidence. Otherwise, there is tremendous risk of many participants being "set up to fail," which may contribute to learned helplessness and dissuade future behavior change attempts. Dietary guidance merits reconsideration as achieving ≤25% of calories from fat appeared to be the least protective DPP goal. For example, achieving the low-fat dietary goal, on top of physical activity and weight loss goals, appeared to add minimal or even reduced benefit in terms of resulting diabetes incidence. Although the newest CDC-published curriculum (Prevent T2) relaxes the dietary goal to ≤30% of calories from fat without required dietary monitoring, the NDPP continues to promote a low-fat diet that nutrition science has generally evolved away from. Newer evidence suggests that various eating plans reduce risk and individualization is needed. An inflexible physical activity goal may also inadvertently deter retention, as NDPP participants were 25% less likely to return after not meeting the current goal of ≥150 weekly minutes in a prior session. Weight loss was the most protective goal in the DPP lifestyle intervention, but regain begins even during intervention, and much is regained over time,, which is likely problematic. Moreover, despite aiming to prevent diabetes, glycemia is minimally addressed in CDC-published NDPP curricula.

Incorporating a Health at Every Size (HAES) approach may allow a more flexible focus on long-term risk reduction (i.e., lowered glycemia) over temporary weight loss, with guidance on intuitive eating (i.e., eating in response to internal cues without a prescribed diet) and reframing physical activity as a tool for well-being. HAES-aligned interventions have shown better retention than traditional weight loss interventions, which may have important implications for the NDPP. This approach would also likely benefit participants with binge eating behavior, reported by nearly 10% of the DPP sample. Adding quarterly monitoring of glycated hemoglobin (A1C) using point-of-care instruments could enable sites to meaningfully incorporate glycemia testing into their NDPP delivery, or participants could seek laboratory testing. At least annual testing is recommended to detect diabetes onset among individuals with prediabetes, which would help evaluate the NDPP, although more frequent testing could be used for biofeedback during the yearlong program. Continuous glucose monitoring could also be considered as a newer technology to inform risk reduction behavior, but is relatively costly, and not likely covered by insurance for this purpose. Additionally, there is substantial evidence for metformin to reduce risk, including as an adjunct treatment to lifestyle intervention, yet it is infrequently adopted in real-world practice to prevent diabetes and unaddressed in the current NDPP curricula. Participants could be advised to discuss metformin with their providers upon joining the NDPP, which may be especially important to ensure continued treatment for the many individuals unable to complete the program. Overall, encouraging participants to adopt a range of preferred behaviors and treatment strategies that lower glycemia on an individual basis may be more beneficial, patient-centered, and better align with precision medicine initiatives than a one-size-fits-all approach.

Sustainability

Successes with Payer Coverage

Long-term sustainability of the NDPP is likely dependent on payer coverage as initial dissemination appears largely supported by time-limited grant funding. Payer coverage was established as an early priority and has required a remarkable collaboration of government, academic, community, healthcare, and payer sectors. For example, United Health Group was collaborating by 2009 to demonstrate payer involvement with an early translation of the NDPP in community settings of the Young Men's Christian Association. Subsequently, nearly 50 insurers began to cover NDPP services by 2016. Notably, Medicare coverage began in April 2018, offering unprecedented opportunity to prevent diabetes among the estimated 46.6% of seniors with prediabetes. The adapted Medicare-covered model, the Medicare Diabetes Prevention Program (MDPP), is near-identical to the in-person NDPP. Additionally, the MDPP provides a second year of services beyond the one-year NDPP model disseminated by the CDC, offering an enhanced opportunity to support weight loss maintenance., In turn, Medicare coverage has tremendous potential to further bolster private payer coverage by setting industry standards, and ensure expanded Medicaid coverage that has become available for 11 states as of January 2020). A common feature of these coverage models is requiring adherence to CDC-established standards for NDPP delivery.,

Ensuring payer coverage is facilitated by strong return on investment (ROI) findings. Early projections suggested that providing the NDPP could yield 5.7 billion USD in savings over 25 years. More current estimates of future healthcare cost savings have continued to demonstrate that the NDPP is a high-value service. ⁻ For a commercially-insured population, 3-year ROI was up to 42% based on maximum net savings of 35,037 USD. For Medicare beneficiaries, a 2017 report calculated an average reduction in Medicare Part A and B expenditures of 278 USD per quarter, or 1112 USD per member per year, over the 3 years following NDPP enrollment relative to a comparison group of beneficiaries. Cost-effectiveness has also been demonstrated in a Medicaid beneficiary population, particularly if considering a time horizon greater than 10 years.

Overcoming Challenges with Payer Coverage

Addressing Low Payment Rates

Pay-for-performance reimbursement rates appear insufficient relative to reported costs, limiting sustainability. For a private payer example, cost of delivering an early version of the in-person NDPP appeared to range from 275-425 USD per participant with average reimbursement of 212 USD, leaving a gap of 63-213 USD. With Medicare, reported delivery costs (for first-year, in-person services) were 553-800 USD with average reimbursement of only 108-190 per participant,, resulting in a gap of 363-792 USD. Medicaid reimbursement rates tend to be comparably low, producing an especially wide gap. For example, costs for in-person NDPP delivery to Minnesota Medicaid beneficiaries was 767-915 USD per participant, with estimated average reimbursement of 163 USD (based on 13.62 USD reimbursed per session and 12 sessions attended on average), producing a large gap of 604-752 USD to suppliers for each beneficiary they serve. How or why low payment rates came to be established is unclear, especially given compelling evidence for ROI, yet they are likely detrimental to achieving a sufficient number of suppliers relative to the need. Although low reimbursement rates benefit third-party payers in the short-term, they are likely to miss opportunity for substantial long-term savings from reduced diabetes prevalence. More evidence also appears needed to assess the sustainability of virtual NDPP delivery. Costs for online programming are generally not reported (possibly for proprietary protections in for-profit business models), but were found to be about one-third of in-person delivery costs in one evaluation yet still produced an unsustainable gap after reimbursement of 206 USD per participant.

Addressing Limited Suppliers

Insufficient reimbursement relative to costs may be a deterrent to maintaining and growing NDPP access. Half of suppliers who previously offered the NDPP appear to have since extinguished their services. Over 3000 organizations provided the NDPP between 2012-2019, whereas only half remain in 2020. Regarding Medicare suppliers, a report found relatively few locations where beneficiaries could receive services over a year after coverage began, with only 1 site per 100,000 beneficiaries on average. Specifically, 75% of US states/territories had no MDPP sites, <1 site per 100,000 beneficiaries, and/or availability limited to a single municipality. Another concern is that suppliers may be dissuaded from entering markets with especially high-risk populations who are less likely to achieve performance payment milestones., In fact, severe shortages of MDPP sites were observed in states/territories with largest populations of racial/ethnic minority beneficiaries, continuing patterns observed with NDPP availability. While it is encouraging that MDPP suppliers since appear to be increasing, the overall downward trend in NDPP sites may be further problematic. Although value-based care is important, increased rates and risk-adjusted payment models appear needed to attract more suppliers. Expanded coverage of virtually-delivered programs may also help.

Conclusion

Over the past decade, the CDC has successfully led the translation of an efficacious lifestyle intervention into a nationwide program reaching hundreds of thousands of individuals at risk for type 2 diabetes, with notable effectiveness upon full participation and widespread insurance coverage. Nonetheless, working to overcome challenges in reach, effectiveness, and sustainability of the NDPP appears needed to achieve substantial public health impact, as summarized in Table 1. These challenges will likely demand continued collaboration of cross-sector stakeholders that enabled successes to date, which can be difficult given differing priorities at times. There is particular urgency to capitalize on the incredible growth of NDPP dissemination before critical momentum is lost. For example, Medicare coverage of the NDPP remains under the umbrella of the Centers for Medicare and Medicaid Services Innovation Center, and coverage may be discontinued if the model is unsuccessful. Resolving low reimbursement rates may be an especially critical factor, such that market forces can in turn drive improved reach and effectiveness. The NDPP must be withstanding in the years to come, as having enormous resources again dedicated to scaling the next promising intervention in the US is otherwise unlikely, such that NDPP is a must-succeed effort both to prevent diabetes and forge a path for future public health initiatives.

Table 1.

Current Challenges

Potential Solutions

Reach

Not yet at reach level needed for population health impact

Men and younger adults are under-represented, plus more initial no-shows for low-income, racial/ethnic minority and younger participants

Adopt automated, algorithmic referral approach linking clinical providers and NDPP services

Make program more appealing, personally relevant, and convenient

Effectiveness

Three-quarters of participants do not achieve ≥5% weight loss goal

Disparately low weight loss for women, younger adults, and racial/ethnic minority and low-income participants

One-size-fits-all approach to intervention is ineffective for majority of participants

Weight regain begins during intervention and much is all is regained over time

Risk of participants being "set up to fail" may dissuade future behavior change

Effectiveness in terms of glycemia and incident diabetes is largely unknown

Further research to examine what specific virtual delivery and hybrid models are optimal

Individualization to align with newer evidence and precision medicine initiatives

Incorporate Health at Every Size approach to focus on long-term risk reduction (i.e., lowered glycemia) over temporary weight loss

Consider recommending metformin as an adjunct or second-line treatment

Add testing to evaluate glycemia and incident diabetes outcomes, and provide biofeedback to inform participant behavior

Sustainability

Pay-for-performance rates are below costs, especially for in-person delivery

A concerning trend that half of previous NDPP sites have extinguished services, likely after grant-funding has ended

Insufficient reimbursement may be a deterrent to sustaining and growing access, especially in high-need areas

Low payments afford short-term benefits to payers, but missed opportunity for substantial long-term savings from reduced diabetes prevalence

Funding Statement

Manuscript preparation was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health (K23DK115820; R01DK119478). The contents of this publication are solely the responsibility of the authors and do not represent official views of funding organizations.

Disclosure

NDR has received past and present grant support from the Centers for Disease Control and Prevention for work related to the National Diabetes Prevention Program, and grants from National Institutes of Health, during the conduct of the study. The authors report no other conflicts of interest in this work.

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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.

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Articles from Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy are provided here courtesy of Dove Press

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Current Perspectives on the Impact of the National Diabetes Prevention Program: Building on Successes and Overcoming Challenges

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To address the public health and economic burden of type 2 diabetes, the Centers for Disease Control and Prevention (CDC) began dissemination of the National Diabetes Prevention Program (NDPP) in the United States in 2010. Based on the intensive ...

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Two special populations that are affected by type 2 diabetes are people who are overweight and Hispanic people as well. People who are overweight are affected by type 2 because that puts them at a higher risk of getting the disease if they aren't weighing what they should. Obesity can also cause type 2 diabetes to get worse quicker when compared to someone who isn't overweight. Some challenges that this population faces are struggling to lose weight and incorporate a healthier lifestyle if they aren't used to doing so. The Hispanic population is affected by type 2 diabetes because the chances of Hispanic people developing this disease are much higher compared to other ethnicities. Part of this is due to sociocultural factors such as lower income and decreased access to education and healthcare. Some challenges this population may face when receiving care for this could be the quality of care they receive if they come from a low-income family. It could be harder to see a good doctor and even more difficult to afford insulin or the medicine they may need since diabetes is an expensive disease to have.

https://health.clevelandclinic.org/diabesity-the-connection-between-obesity-and-diabetes

https://pmc.ncbi.nlm.nih.gov/articles/PMC6953173/

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This image shows how exercise can aid in side effects of PCOS

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Over half of women who have Polycystic ovary syndrome (PCOS) develop type two diabetes (T2D) by the age of 40. This is due to the resistance of insulin which is a common side effect for patients with PCOS. PCOS is a condition where small sacs of fluid, called cysts, for on the ovaries. Although there is no cure for PCOS, it is strongly suggested that the patient also get tested for T2D immediately after PCOS diagnosis. This allows treatment to begin if the patient has developed T2D or allows for a lifestyle change to support the prevention of T2D. Since PCOS develops within the first few menstrual cycles and during this stage of puberty managing weight can be very difficult for some people. This is why it is important to maintain a healthy weight and exercise frequently.

Diabetes and polycystic ovary syndrome (PCOS). (2024, May 15). Diabetes. https://www.cdc.gov/diabetes/risk-factors/pcos-polycystic-ovary-syndrome.html

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Example of cycle caused by lack of sleep 

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There has been a strong link between getting enough sleep and developing T2D. Studies have shown that people who get less than 6 hours of quality sleep consistently were at a higher risk of developing T2D. However, people who consistently had quality sleep more 7-8 hours were less likely to develop T2D. Although sleep is the first thing people tend to cut back on when spread too thin, it is actually the most important thing to ensure you get. It indeed can be a challenge for people to get both an adequate amount of sleep and a quality rest, but if one can not peacefully sleep after making time to sleep they should consult their doctor for sleep aids that could be best for them.

Darraj, A. (2023). The Link between sleeping and Type 2 Diabetes: A Systematic review. Cureus. https://doi.org/10.7759/cureus.48228

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One public health measure that has been taken to help control type 2 diabetes is the ACA, extending healthcare to millions of Americans. Many chronic diseases such as type 2 diabetes disproportionally affect certain population subgroups, such as racial and ethnic minorities as well as those facing socioeconomic disadvantage. Many ACA provisions were made to make sure that these groups of people have equitable access to health insurance coverage as well as a patient-centered medical home where people can receive evidence-based preventative services at a cheaper price. I think this targets the policy level of things because it helps millions of people, not just a small community of people. Another measure that has been taken to prevent and or control type 2 diabetes are different foundations and organizations raising money for it and making people who are prediabetic and or at a high risk of developing this disease aware of what can happen if it isn't managed properly. The measure that is being taken is at the community and individual level.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5210175/

https://www.cdc.gov/pcd/issues/2017/16_0437.htm

https://www.gaucherdisease.org/wp-content/uploads/2020/08/ACA.jpg

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Living with type 2 diabetes (T2D) the best treatment is a treatment that fits a patients’ lifestyle. Blood glucose meters are a great resource for patients who are diligent about checking their glucose levels. The patient simply pricks their finger with a provided needle that allows for just enough blood to be squeezed out and dropped onto the special disposable strip. That strip allowed the meter to test and display glucose levels. Although basic meters do the job very well, some patients opt to get meters with even more data available to them for additional aid in T2D management. However this can be a challenging way to monitor glucose levels for people who are more likely to forget to consistently check their levels.

Diabetes Technology Guide | ADA. (n.d.). https://diabetes.org/living-with-diabetes/treatment-care/diabetes-technology-guide

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EndoBarrier is a "duodenal-jejunal bypass liner" that is implanted in the small intestine. It acts similarly to a typical gastric bypass surgery (Roux-en-Y gastric bypass), but is minimally invasive and reversible. Type 2 diabetes patients often turn to bariatric surgery once they are already taking medication and insulin and have made lifestyle changes, but have yet to achieve control over their T2D. EndoBarrier is endoscopically placed and removed one year after being implanted. In this study, up to 80% of T2D patients saw improvements in their conditions from before the EndoBarrier placement even a year after removal. These benefits include weight loss, blood glucose management improvement, and lowered risk for future cardiovascular events.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10090889/

https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/pdi.2393

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» Type 2 Diabetes: Importance of Screening and Life Style changes

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Early screening and lifestyle change greatly aids in preventing type two diabetes (T2D). Since medical professionals have seen the great benefits of early screenings in the growing cases of T2D there have been countless efforts to raise awareness of these benefits. In this, insurance companies were able to see the decreases incases of T2D for those who did early detection screenings and took action to change their lifestyle. They've included early screening in most coverage plans as well as makes an effort to screen school aged children while they are at school for those who may not have access to medical attention at home. You can see similar screenings being held in areas where consistent access to medical professionals may not be an option.

Peer, N., Balakrishna, Y., & Durao, S. (2020). Screening for type 2 diabetes mellitus. Cochrane Library, 2020(6). https://doi.org/10.1002/14651858.cd005266.pub2

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There are many devices out there to make type 2 diabetes easier and more convenient for people and one of those devices is a FreeStyle Libre 2 glucose monitor. There are many different versions of continuous glucose monitors, such as the dexcom continuous glucose monitor, but the freestyle libre is different because with the freestyle libre you scan the sensor and then the number pops up on your phone or the freestyle libre 2 handheld readers. The sensor must be replaced every two weeks and requires a prescription. This is different from the dexcom CGM because the dexcom one connects to an app on your phone and shows you the numbers on your app instead of having to scan something. It is also different because the dexcom CGM has to be changed every 10 days instead of 2 weeks. Both are very beneficial and can make a diabetic's life much more convenient in every sense.

https://www.goodrx.com/freestyle-libre-2/what-is

https://myehcs.com/wp-content/uploads/FreestyleLibre2.png

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One preventive measure for type 2 diabetes is losing any excess weight if needed. Losing any extra weight lowers the chances of developing type 2 diabetes. The American Diabetes Association recommends that people who have prediabetes lose at least 5-7% of their body weight to lower their chances of getting diabetes. People in one huge study were able to lower their chances by 60% over the course of three years. In this study, they lost 7% of their body weight with changes in diet as well as physical activity. It can also reduce the risk of high blood pressure, bad cholesterol and keep blood sugar numbers in range.

https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-prevention/art-20047639

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