Prevention: tackling diabetes before it happens 

Finally, the term tertiary prevention is used to describe limiting physical disability and preventing progression to end-stage complications in those who have already developed some complications of diabetes.  

Although genetic factors undoubtedly play a major role, environmental factors contribute to over 50% of the T2D risk. Our research shows that excess consumption of white rice was strongly linked to a risk of type 2 diabetes due to the high dietary glycemic load. Replacing white rice with brown rice could improve blood glucose and insulin levels. Decreased physical activity is another driver of the diabetes epidemic. In the Chennai Urban Rural Epidemiology Study (CURES), we showed that 50% of new-onset T2D can be prevented just by modifying diet and increasing physical activity. 

Importance of lifestyle modifications 

The importance of promoting a healthy lifestyle for the prevention of diabetes and other non-communicable diseases has recently taken center stage. The term ‘lifestyle’ includes our attitudes, habits, behaviours, physical activity (exercise), diet, and our reaction to stress.  

Several randomised control studies in the U.S., Finland, China, and India have shown that diabetes can be prevented by lifestyle modification.  

The 10 principles of lifestyle modification 

• Having adequate physical exercise 

• Having a healthy diet 

• Getting adequate sleep and sleeping on time 

• Giving up smoking  

• Preventing obesity 

• Avoiding oral tobacco use 

• Moderating the use of alcohol  

• Avoiding substance abuse

• Practising deep breathing or other relaxation techniques 

• Yoga 

We shall discuss some of these in greater detail. 

Increasing physical activity 

One of the strongest drivers of the diabetes epidemic is a marked increase in sedentary lifestyles, especially in urban areas. However, awareness of the importance of physical inactivity in the causation of diabetes remains low. In the ICMR – INDIAB study, we showed that only 24.1% of people exercised regularly and achieved the World Health Organization recommendation of 150 minutes of physical activity per week. Therefore, the promotion of physical activity in the community is a key step towards controlling the twin epidemic of diabetes and obesity.  

Despite the growing evidence of the benefits of exercise, there are still only a few takers for exercise. The reasons are many. Many have ‘starting trouble’ and keep postponing the starting of a regular exercise programme. Even after people have begun, adherence to the exercise regime is even more challenging. While lack of knowledge and awareness about the benefits of exercise are often cited as the reason, lack of motivation appears to be the main issue. This is where doctors can play a crucial role. Specific instructions should be given to patients rather than giving general advice. E.g.: rather than just saying, “You need to exercise”, a doctor should be saying, “You would benefit very much from a brisk walk of at least 45 minutes six days a week”. Such instructions clearly outline the type and amount of time to be spent on the exercise. We need to encourage simple, routine lifestyle changes; tips like using the stairs instead of lifts or parking further from one’s destination and then walking the extra distance or walking to the nearby grocery store instead of using a vehicle.  

In addition to the benefits of physical fitness with respect to reduced cardiovascular risk, regular exercise also lowers cholesterol, increases insulin sensitivity, and leads to a reduction in doses of insulin or tablets. Besides, exercise has an important effect on mental health as it releases ‘happy hormones’ i.e. ‘endorphins’ which have antidepressant effects and reduce anxiety and stress levels. Individuals who exercise regularly also report an improved sense of well-being and better self-esteem as their body shape improves. 

Eating healthy 

Diet is the mainstay of therapy for diabetes mellitus. When a person with diabetes neglects this important aspect of diabetes management, then his/her blood sugars become uncontrolled.

An ideal diabetic diet should: 

• Be balanced and individualised.  

• Be tailored to the patient’s age and weight, physical activity, family diet pattern, and physiological needs, and take into consideration the patient’s preference and food habits. 

• Ensure normal growth and development and attainment of ideal body weight.  

• An obese patient should restrict calories through a reduction in the intake of carbohydrates and fats. 

• Ensure that food must be eaten not only at the appropriate time but also in appropriate amounts. 

• Cut down on refined and starchy food items such as white rice, wheat, maida, rava, white bread, potatoes, other tubers, processed foods, and red meat. 

• Include mainly high-fibre foods like whole grains, pulses, and all green vegetables.

• Include 3-4 helpings of vegetables (preferably raw as salad) and fruits such as guava, apple, oranges, or papaya. 

• Always read labels and select foods that are low in sugar, fat, and salt. 

Stress management 

The inability to manage our time properly leads to undue stress in our lives. Hence, time and stress management have become an integral component of lifestyle modification measures. The combination of diet, exercise, and behavioural modifications is the most effective approach to a healthier life. Behavioural approaches that teach patients to rearrange their daily schedules, support healthy eating habits, do regular physical activity as well as manage their time are important factors in reducing stress. Pranayama and meditation are very powerful tools to reduce stress and anxiety and help you remain calm and collected. 

Prevention of diabetes can be carried out at every stage of our lives. In those who are at high risk, for example, those with a strong family history of diabetes or obese individuals who still have normal glucose tolerance, reducing risk factors can help prevent developing prediabetes. This is primordial prevention and applies to everyone. Not only can you prevent diabetes but also a host of other noncommunicable diseases.  

If you are already at the stage of prediabetes, your risk of developing diabetes in the next few months or years is very high. At this stage, diet and exercise have been shown to prevent 35 – 60% of individuals from developing diabetes. This is the stage of primary prevention. 

If you have already developed diabetes, by achieving the ABC targets, you can prevent complications from setting in. Here, A, B, and C refer to:  

A– HbA1c or three months control test which should be kept below 7%

B – Blood pressure control – At least below 140/90 mmHg if not much lower 

C– Cholesterol, i.e. LDL cholesterol or bad cholesterol which should be at least less than 100mg/dl, preferably much lower. 

This is ample evidence that if the ABC goals of treatment are achieved, one can prevent almost all the complications of diabetes, and this stage is referred to as secondary prevention.  

Finally, if someone has unfortunately developed some complications of diabetes, one can still attempt to slow down the progression to end-stage complications. Although rather late in the disease, tertiary prevention as it is called, is still necessary to limit disability and improve quality of life.  

Diabetes, unlike many other disorders, is one where a lot can be done at every stage of its natural history. The time to act is now. 

(Dr. Mohan is chairman, Dr. Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai.) 

Published – May 22, 2025 10:57 am IST

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