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Small Steps Can Make a Big Difference

Chances are, you know someone who has diabetes. It might even be you. Diabetes is one of the most common disorders in the U.S. It affects about 1 in 9 Americans. Diabetes raises your risk for serious health problems. It can damage the eyes, kidneys, nerves, and heart, and it is linked to some types of cancer.

Now, what if you learned that there’s a low-cost, scientifically proven way to greatly reduce your chances of getting type 2 diabetes, the most common type? Would you give it a try?

More than two decades ago, a landmark NIH-supported study, called the Diabetes Prevention Program (DPP), released its results. It found that people at high risk for diabetes were much less likely to get the disorder if they lost a little weight through healthy eating and physical activity. Their risk of getting diabetes dropped by nearly 60% compared to people who did not aim to make healthy changes.

For those over age 60, the results were even more striking. Their risk of getting diabetes dropped by 71% when they made healthy changes. The benefits were so clear that the study ended a year early, after just three years. Participants in the comparison group were encouraged to also make the healthy changes to reduce their diabetes risk.

DPP has had a lasting influence on medical care in the U.S. and around the world. Since its initial results were reported, lifestyle change programs based on the findings have become widely available across the country.

A 10-year follow-up study showed that people in the original treatment group delayed diabetes by about four years. A later study found benefits even 22 years after the study began, with people in the lifestyle-change group having about a 25% reduced risk of developing diabetes.

“Even though the initial treatments lasted only three years, participants did have longer-term health benefits,” says Dr. William Knowler, an NIH diabetes expert.

NIH-supported researchers continue to study new and proven ways to help people prevent or delay type 2 diabetes. But we already know that taking steps to prevent or manage diabetes can lower your risk of developing diabetes-related health problems.

Are You at Risk?

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Glucose is your body’s main source of energy. Normally, a A substance produced in one part of the body to signal another part to react a certain way.
hormone made by the pancreas called insulin helps glucose get into your cells to be used for energy. If you have diabetes, your body doesn’t make enough insulin or use insulin properly. Glucose then stays in your blood and doesn’t reach your cells.

Anyone can get type 2 diabetes, even children. But certain factors can raise your risk. You’re more likely to develop type 2 diabetes if you are at least 35 years old or have a family history of diabetes. Black Americans, Hispanic/Latino Americans, American Indians, and Asian Americans are also at higher risk.

People who are overweight or have obesity and people who don’t get enough physical activity are also more likely to develop the disease. But these are changeable factors.

About 1 in 3 American adults has a condition called prediabetes. It occurs when your blood sugar is higher than normal, but not yet high enough to be called diabetes. Most people with prediabetes don’t realize they have it. That’s because prediabetes tends to have few symptoms, and many people don’t get screened.

“We can diagnose prediabetes and diabetes with a very simple blood test known as a hemoglobin A1C. You don’t need to fast to do this test,” says Dr. Tannaz Moin, a physician and diabetes researcher at the University of California, Los Angeles. The A1C test reflects your average levels of blood sugar over the past three months.

“Prediabetes is viewed as a very strong risk factor for type 2 diabetes. But not everyone with prediabetes goes on to develop type 2 diabetes,” Moin adds. “That’s why it’s important to be screened and talk with your medical providers about your risk factors and things that you can do to prevent type 2 diabetes if you’re at risk.”

A Role for Medications

Although making healthy lifestyle changes has proven effective for preventing diabetes, it doesn’t work for everyone. For those people, medications may help.

NIH’s DPP study looked at whether the diabetes drug metformin might also prevent or delay diabetes onset. It found that the drug could reduce the risk of developing diabetes by about 30%. For some patients, a combination of metformin and lifestyle changes might be best.

In recent years, a class of drugs called GLP-1 drugs has become widely available for weight management and diabetes treatment. These drugs have proven effective at reducing weight and keeping blood glucose in check. Some studies hint that they might also help to prevent or delay diabetes.

“Body weight is an important factor that determines the risk of getting type 2 diabetes. So the potential here is great,” says Knowler. “But the problem is, as with any new drugs, it takes many years to know how effective and safe they will be. And a huge problem with any kind of weight loss is sustaining it, not achieving it.”

Because GLP-1 drugs are still relatively new, it’s not entirely clear how outcomes will change if people stop taking the drugs. And possible side effects of long-term use are still uncertain.

Healthy Changes That Last

“Making lifestyle changes is hard. So it’s important to get the support you need to make the changes last,” says Dr. Joshua J. Joseph, a physician and diabetes researcher at Ohio State University. “You can get that support through programs like the CDC’s National Diabetes Prevention Program (NDPP).”

NDPP is based on the findings of NIH’s DPP study. It aims to help people make long-term lifestyle changes that prevent or delay diabetes (see the Wise Choices box).

Local hospitals, health departments, libraries, senior centers, and faith-based organizations may also offer programs or seminars to help prevent type 2 diabetes. For physical activity, look for activities that you enjoy. Experts recommend brisk walking for a low-cost activity. Working out with others can be motivating for some people. Consider group classes like Zumba or Pilates.

“It’s important to think of diabetes prevention throughout the lifespan. So, it’s just as critical to work with children on healthy eating and healthy behaviors as it is to work with older people,” Joseph explains. “If we work across the life course, it could lead to large reductions in the development of diabetes in the U.S. and around the world.”

When a parent or other family member has a serious illness, it can be hard to know how to tell children. You might think you’re protecting kids by sparing them from any worries or fears. But they tend to know when something’s going on, and not being told about it could make them feel anxious.

Here are some tips on when to start talking with your child, what to say, and how to support them.

How Should I Have the First Talk?

Pick a time when you’re relaxed enough to talk and won’t be rushed. Maybe a weekend afternoon when no activities are happening and there’s time to answer questions. Just try to avoid telling kids at bedtime because they may have trouble sleeping afterward.

It’s OK to talk with your child even if you don’t have all the information yet.

What Should I Say?

Your goals are to help your child understand what’s happening and what to expect — and comfort them. It’s important to be honest. Kids may have no questions or lots of them. If you don’t know the answers, say you’ll try to find out.

Other things to keep in mind:

Start with the basics about the illness, like what it’s called, what part(s) of the body it affects, and the treatment. It may help to ask them what they’ve heard about the illness.

Support your child’s emotions. Be patient and don’t dismiss what kids are feeling. If they tell you they’re upset or scared, echo what they said: “Yes, I see this makes you very scared. It’s OK to feel that way.” This lets children know you’re hearing and understanding them.

You can also share how you feel and any positive steps you’re taking to cope, like going for walks outside. This may help kids open up more and give them ideas on how to manage their own big feelings.

Explain things based on kids’ age and maturity. Consider how much kids can understand and absorb. Try these age-based tips:

• Early grade school: Keep the information short and simple. For example, “Your mommy is sick. She’ll need to go to the hospital for about 3 days. Doctors will give her medicine.” Tell children that they didn’t do anything to “cause” the illness and they can’t catch it. The doctor may be able to recommend children’s books that can help you explain the illness.
• Older kids: This age group understands more, but don’t give too many details, which could cause worry. You can talk about how a serious illness is different from a headache or cold. Mention the people who will be helping, like doctors and nurses.
• Teens: Teens often want a lot of information. Assure your teen that you or another trusted adult will keep them updated on things like changes in treatment. This helps them know what to expect. Encourage them not to look up the illness online because they may find worse-case examples. Explain that you can ask the health care team for the facts.

Kids and teens of all ages may have a tough time talking about what’s going on. Very young kids can use drawings to help them “say” what they’re feeling. For older kids and teens, suggest that they write in a journal, create artwork, or play music to express themselves. You also can encourage them to find healthy ways to cope with stress, like doing breathing exercises, yoga, or sports.

You don’t have tell your child everything at first. You can share what’s happening little by little. This can be helpful if you’re not sure how long the treatment will take or if it will be a success.

What Else Can Help?

Explain what will be the same and what could change. Tell kids that you and the rest of the family love them and that will always be the case. Talk about how you’ll try to keep things the same, but some stuff may change for a time. For example, someone else may have to pick them up from school and stay with them until dinner. Or maybe the ill person will be in the hospital; need to stay in bed for a while; or have side effects like changes in weight, tiredness, or hair loss.

Talk about what your child can do to help. Finding ways for kids to pitch in can give them a sense of control. Suggest they do things like keep their room clean or wash dishes. Younger kids can pick flowers, draw pictures, or make cards for the person who’s sick. Teens might be able to watch their siblings when needed.

Stick to a routine. This can help kids feel secure. They should be physically active, get enough sleep, and eat well. See that they do all their homework and go to any usual after-school sports or clubs.

Find support. Let your kids know about people they can reach out to. They can lean on another family member or close friend. Or they might talk with a teacher, school counselor, or religious leader.

Consider joining a support group to share experiences and get advice from families who’ve been through it. There are also camps for kids with family members who have a serious illness. These can provide a healthy space for coping.

Watch for stress. If your child shows changes in behavior (like not sleeping or eating, not wanting to be around people, or worrying all the time), call your doctor or a behavioral health care provider. They can help your child manage anxiety and cope.