Category Archives: Diabetes

At Palo Alto Medical Foundation, our teams will work with you to personalize your diabetes care and prevent complications. We strive to understand your life goals and health history to develop a treatment plan based on your unique needs. We serve people with Type 1 diabetes, Type 2 diabetes, gestational diabetes and prediabetes.

Type 1 diabetes and Type 2 diabetes share a similar name, but they are very different conditions. Prediabetes is a term used to indicate a higher than normal level of blood sugar, but not high enough to meet the diagnosis of diabetes. Without treatment (diet, exercise, weight management and medications for some), prediabetes can lead to Type 2 diabetes, heart disease and stroke.

You dont have to face diabetes alone. PAMFs network of primary care doctors, specialist nurses and dietitians, and diabetes educators provide support, information and tools to help you feel confident in managing your diabetes and taking steps for better health.

We offer a wide range of diabetes-specific programs and services, including:

We also provide special services for pregnant women who develop gestational diabetes, ensuring mom and baby stay healthy throughout pregnancy and after birth.

Original post:
Diabetes | Sutter Health

Int J Health Sci (Qassim). 2017 Apr-Jun; 11(2): 6571.

1Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

2Department of Public Health & Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

3Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

4Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

1Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

1Faculty of Industrial Management, Universiti Malaysia Pahang, Lebuhraya Tun Razak, 26300 Gambang, Kuantan, Pahang, Malaysia

2Department of Public Health & Community Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

3Department of Family Medicine, College of Medicine, Majmaah University, Kingdom of Saudi Arabia

4Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Globally, type 2 diabetes mellitus (T2DM) is considered as one of the most common diseases. The etiology of T2DM is complex and is associated with irreversible risk factors such as age, genetic, race, and ethnicity and reversible factors such as diet, physical activity and smoking. The objectives of this review are to examine various studies to explore relationship of T2DM with different dietary habits/patterns and practices and its complications. Dietary habits and sedentary lifestyle are the major factors for rapidly rising incidence of DM among developing countries. In type 2 diabetics, recently, elevated HbA1c level has also been considered as one of the leading risk factors for developing microvascular and macrovascular complications. Improvement in the elevated HbA1c level can be achieved through diet management; thus, the patients could be prevented from developing the diabetes complications. Awareness about diabetes complications and consequent improvement in dietary knowledge, attitude, and practices lead to better control of the disease. The stakeholders (health-care providers, health facilities, agencies involved in diabetes care, etc.) should encourage patients to understand the importance of diet which may help in disease management, appropriate self-care and better quality of life.

Keywords: Type 2 diabetes mellitus, diet, knowledge, attitude, practices, complications

Diabetes mellitus (DM) was first recognized as a disease around 3000 years ago by the ancient Egyptians and Indians, illustrating some clinical features very similar to what we now know as diabetes.1 DM is a combination of two words, diabetes Greek word derivative, means siphon - to pass through and the Latin word mellitus means honeyed or sweet. In 1776, excess sugar in blood and urine was first confirmed in Great Britain.2,3 With the passage of time, a widespread knowledge of diabetes along with detailed etiology and pathogenesis has been achieved. DM is defined as a metabolic disorder characterized by hyperglycemia resulting from either the deficiency in insulin secretion or the action of insulin. The poorly controlled DM can lead to damage various organs, especially the eyes, kidney, nerves, and cardiovascular system.4 DM can be of three major types, based on etiology and clinical features. These are DM type 1 (T1DM), DM type 2 (T2DM), and gestational DM (GDM). In T1DM, there is absolute insulin deficiency due to the destruction of cells in the pancreas by a cellular mediated autoimmune process. In T2DM, there is insulin resistance and relative insulin deficiency. GDM is any degree of glucose intolerance that is recognized during pregnancy. DM can arise from other diseases or due to drugs such as genetic syndromes, surgery, malnutrition, infections, and corticosteroids intake.5-7

T2DM factors which can be irreversible such as age, genetic, race, and ethnicity or revisable such as diet, physical activity and smoking.8, 9

Globally, T2DM is at present one of the most common diseases and its levels are progressively on the rise. It has been evaluated that around 366 million people worldwide or 8.3% in the age group of 20-79 years had T2DM in 2011. This figure is expected to rise to 552 million (9.9%) by 2030.10 This disease is associated with severe complications which affect patients health, productivity, and quality of life. More than 50% of people with diabetes die of cardiovascular disease (CVD) (primarily heart disease and stroke) and is a sole cause of end stage renal disease which requires either dialysis or kidney transplantation. It is also a major cause of blindness due to retinal damage in adult age group referred to as diabetic retinopathy (DR). People with T2DM have an increased risk of lower limb amputation that may be 25 times greater than those without the disease. This disease caused around 4.6 million deaths in the age-group of 20-79 years in 2011.11

A large number of cross-sectional as well as prospective and retrospective studies have found significant association between physical inactivity and T2DM.12 A prospective study was carried out among more than thousand nondiabetic individuals from the high-risk population of Pima Indians. During an average follow-up period of 6-year, it was found that the diabetes incidence rate remained higher in less active men and women from all BMI groups.13 The existing evidence suggests a number of possible biological pathways for the protective effect of physical activity on the development of T2DM. First, it has been suggested that physical activity increases sensitivity to insulin. In a comprehensive report published by Health and Human Services, USA, 2015 reported that physical activity enormously improved abnormal glucose tolerance when caused by insulin resistance primarily than when it was caused by deficient amounts of circulating insulin.14 Second, physical activity is likely to be most beneficial in preventing the progression of T2DM during the initial stages, before insulin therapy is required. The protective mechanism of physical activity appears to have a synergistic effect with insulin. During a single prolonged session of physical activity, contracting skeletal muscle enhances glucose uptake into the cells. This effect increases blood flow in the muscle and enhances glucose transport into the muscle cell.15 Third, physical activity has also been found to reduce intra-abdominal fat, which is a known risk factor for insulin resistance. In certain other studies, physical activity has been inversely associated with intra-abdominal fat distribution and can reduce body fat stores.16 Lifestyle and environmental factors are reported to be the main causes of extreme increase in the incidence of T2DM.17

Among the patients, diabetes awareness and management are still the major challenges faced by stakeholders worldwide. Poor knowledge related to diabetes is reported in many studies from the developing countries.18 Some studies have suggested that the occurrence of diabetes is different in various ethnic groups.19 Knowledge is a requirement to achieve better compliance with medical therapy.20 According to a study conducted by Mohammadi21 patients knowledge and self-care management regarding DM was not sufficient. Low awareness of DM affects the outcome of diabetes. Another study conducted in Slovakia by Magurov22 compared two groups of patients (those who received diabetes education and those who did not). The results indicated that receiving diabetes education significantly increased awareness about the disease in patients (p < 0.001). The study further concluded that having diabetes knowledge can notably improve patients quality of life and lessen the burden on their family. Dussa23 conducted a cross-sectional study on assessment of diabetes awareness in India. The study concluded that level of diabetes awareness among patients and general population was low. Another study conducted in India by Shah24 reported that 63% of T2DM patients did not know what DM is and the majority were also unaware about its complications.

According to the study conducted by Bani25 in Saudi Arabia, majority of the patients 97.3% males and 93.1% females were unaware about the importance of monitoring diabetes, with no significant gender difference. Diabetes knowledge, attitude, and practice were also studied in Qatari type 2 diabetics. The patients knowledge regarding diabetes was very poor, and their knowledge regarding the effect of diabetes on feet was also not appreciable.26 Results from a study conducted in Najran, Saudi Arabia27 reported that almost half of the patients did not have adequate knowledge regarding diabetes disease. Males in this study had more knowledge regarding diabetes than female patients. Diabetes knowledge among self-reported diabetic female teachers was studied in Al-Khobar, Saudi Arabia.28 The study concluded that diabetes knowledge among diabetic female teachers was very poor. It was further suggested that awareness and education about diabetes should be urgently given to sample patients. The knowledge of diabetes provides the information about eating attitude, workout, weight monitoring, blood glucose levels, and use of medication, eye care, foot care, and control of diabetes complications.29

The role of diet in the etiology of T2DM was proposed by Indians as mentioned earlier, who observed that the disease was almost confined to rich people who consumed oil, flour, and sugar in excessive amounts.30 During the First and Second World Wars, declines in the diabetes mortality rates were documented due to food shortage and famines in the involved countries such as Germany and other European countries. In Berlin, diabetes mortality rate declined from 23.1/100,000 in 1914 to 10.9 in 1919. In contrast, there was no change in diabetes mortality rate in other countries with no shortage of food at the same time period such as Japan and North American countries.31 Whereas few studies have found strong association of T2DM with high intake of carbohydrates and fats. Many studies have reported a positive association between high intake of sugars and development of T2DM.32 In a study, Ludwig33 investigated more than 500 ethnically diverse schoolchildren for 19 months. It was found that for each additional serving of carbonated drinks consumed, frequency of obesity increased, after adjusting for different parameters such as dietary, demographic, anthropometric, and lifestyle.

A study was conducted which included the diabetic patients with differing degrees of glycemic control. There were no differences in the mean daily plasma glucose levels or diurnal glucose profiles. As with carbohydrates, the association between dietary fats and T2DM was also inconsistent.34 Many of prospective studies have found relations between fat intake and subsequent risk of developing T2DM. In a diabetes study, conducted at San Louis Valley, a more than thousand subjects without a prior diagnosis of diabetes were prospectively investigated for 4 years. In that study, the researchers found an association between fat intake, T2DM and impaired glucose tolerance.35,36 Another study observed the relationship of the various diet components among two groups of women, including fat, fiber plus sucrose, and the risk of T2DM. After adjustment, no associations were found between intakes of fat, sucrose, carbohydrate or fiber and risk of diabetes in both groups.37

Recently, evidence suggested a link between the intake of soft drinks with obesity and diabetes, resulting from large amounts of high fructose corn syrup used in the manufacturing of soft drinks, which raises blood glucose levels and BMI to the dangerous levels.38 It was also stated by Assy39 that diet soft drinks contain glycated chemicals that markedly augment insulin resistance. Food intake has been strongly linked with obesity, not only related to the volume of food but also in terms of the composition and quality of diet.40 High intake of red meat, sweets and fried foods, contribute to the increased the risk of insulin resistance and T2DM.41 In contrast, an inverse correlation was observed between intake of vegetables and T2DM. Consumption of fruits and vegetables may protect the development of T2DM, as they are rich in nutrients, fiber and antioxidants which are considered as protective barrier against the diseases.42 Recently, in Japanese women, a report revealed that elevated intake of white rice was associated with an increased risk of T2DM.43 This demands an urgent need for changing lifestyle among general population and further increase the awareness of healthy diet patterns in all groups.

American Diabetes Association has defined self-dietary management as the key step in providing the diabetics, the knowledge and skill in relation with treatment, nutritional aspects, medications and complications. A study showed that the dietary knowledge of the targeted group who were at high risk of developing T2DM was poor. Red meat and fried food were consumed more by males as compared to females. The percent of males to females in daily rice consumption was significantly high.44

In recent times in Saudi Arabia, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity. Unfortunately, many Saudis are becoming more obese because of the convenience of fast foods, and this adds to the scary diabetes statistics.45 On the other hand, Saudis drink too many high-sugar drinks. In addition, Backman46 reported dietary knowledge to be a significant factor that influences dietary behaviors. In another study conducted by Savoca and Miller47 stated that patients food selection and dietary behaviors may be influenced by the strong knowledge about diabetic diet recommendations. Significant positive relationship was observed between knowledge regarding diabetic diet and the amount of calorie needs (r = 0.27, p < 0.05).48 The study concluded that knowledge regarding diabetic diet is essential and is needed to achieve better dietary behaviors. Results of study conducted in Saudi Arabia25 reported that more than half of the diabetic patients denied modifying their dietary pattern, reduction in weight and perform exercise.

National Center for Health Statistics reported that socioeconomic status plays an important role in the development of T2DM; where it was known as a disease of the rich.49 On the contrary, the same reference reported that T2DM was more prevalent in lower income level and in those with less education. The differences may be due to the type of food consumed. Nutritionists advised that nutrition is very important in managing diabetes, not only type but also quantity of food which influences blood sugar. Meals should be consumed at regular times with low fat and high fiber contents including a limited amount of carbohydrates. It was observed that daily consumption of protein, fat and energy intake by Saudi residents were higher than what is recommended by the International Nutritional Organization.50

DM can be controlled through improvement in patients dietary knowledge, attitudes, and practices. These factors are considered as an integral part of comprehensive diabetes care.51 Although the prevalence of DM is high in gulf countries, patients are still deficient in understanding the importance of diet in diabetes management.52 Studies have shown that assessing patients dietary attitude may have a considerable benefit toward treatment compliance and decrease the occurrence rate of complications as well.52 A study conducted in Egypt reported that the attitude of the patients toward food, compliance to treatment, food control with and without drug use and foot care was inadequate.53 Another study presented that one-third of the diabetic patients were aware about the importance of diet planning, and limiting cholesterol intake to prevent CVD. Various studies have documented increased prevalence of eating disorders and eating disorder symptoms in T2DM patients. Most of these studies have discussed about the binge eating disorder, due to its strong correlation with obesity, a condition that leads to T2DM.53 Furthermore, a study revealed that the weight gain among diabetic patients was associated with the eating disorder due to psychological distress.54 In another study that examined eating disorder-related symptoms in T2DM patients, suggested that the dieting-bingeing sequence can be applied to diabetics, especially obese diabetic patients.55 Unhealthy eating habits and physical inactivity are the leading causes of diabetes. Failure to follow a strict diet plan and workout, along with prescribed medication are leading causes of complications among patients of T2DM.56 Previous studies57 conducted in Saudi Arabia have reported that diabetic patients do not regard the advice given by their physicians regularly regarding diet planning, diet modification and exercise.

Diabetics dietary practices are mainly influenced by cultural backgrounds. Concerning each of the dimensions of dietary practices, there were significant positive relationships between knowledge regarding diabetic diet and dietary practices. Knowledge was a salient factor related to dietary behaviors control.46 Moreover, patients knowledge on a recommended diet indicates their understanding of dietary guidelines which influenced their food selection and eating patterns.47 The association between dietary knowledge and dietary practices among T2DM patients in the previous studies were inconsistent. Another study revealed that there was no relationship between dietary knowledge and compliance of dietary practices.58 On the other hand, the same study found that a high dietary knowledge score was associated with following dietary recommendations and knowledgeable patients performed self-management activities in a better way. Dietary knowledge significantly influences dietary practices. In Indonesia, a study was conducted to measure dietary practices among diabetic patients, which elaborated that the Indonesian people, preferred to consume high-fat foods which lead to an increased risk of CVD.59 The trend of skipping breakfast has dramatically increased over the past 10 years in children, adolescents, and adults.60,61 There is increasing evidence that skipping breakfast is related with overweight and other health issues.62 In addition, frequent eating or snacking may also increase the body weight and risk of metabolic diseases.63,64 Rimm65 demarcated western and prudent dietary patterns. The prudent dietary pattern was characterized by increased consumption of fish, poultry, various vegetables and fruits whereas; the western dietary pattern was characterized by an increased consumption of processed and red meat, chips, dairy products, refined grains, and sweets and desserts. These patterns were previously associated with T2DM risk. The glycemic index is an indicator of the postprandial blood glucose response to food per gram of carbohydrate compared with a reference food such as white bread or glucose. Hence, the glycemic load represents both the quality and quantity of the carbohydrates consumed.66-69 Another study conducted in Lebanon demonstrated direct correlation of the refined grains and desserts and fast food patterns with T2DM, however, in the same study an inverse correlation was observed between the traditional food pattern and T2DM among Lebanese adults.70

DM is the fourth among the leading causes of global deaths due to complications. Annually, more than three million people die because of diabetes or its complications. Worldwide, this disease weighs down on health systems and also on patients and their families who have to face too much financial, social and emotional strains. Diabetic patients have an increased risk of developing complications such as stroke, myocardial infarction, and coronary artery disease. However, complications such as retinopathy, nephropathy, and neuropathy can have a distressing impact on patients quality of life and a significant increase in financial burden. The prevalence reported from studies conducted worldwide on the complications of T2DM showed varying rates. The prevalence of cataracts was 26-62%, retinopathy 17-50%, blindness 3%, nephropathy 17-28%, cardiovascular complications 10-22.5%, stroke 6-12%, neuropathy 19-42%, and foot problems 5-23%. Mortality from all causes was reported between 14% and 40%.71 In a study, researchers found that 15.8% incidence of DR is in the developing countries. The prevalence of DR reported from Saudi Arabia, Sri Lanka, and Brazil was 30%, 31.3%, and 35.4%, respectively; while in Kashmir it was 27% and in South Africa it was 40%. The prevalence of DR 26.1% was observed among 3000 diabetic patients from Pakistan; it was significantly higher than that what was reported in India (18%) and in Malaysia (14.9%).72-76 Studies conducted on diabetes complications in Saudi Arabia are very few and restricted. A 1992 study from Saudi Arabia showed that in T2DM patients; occurrence rate of cataract was 42.7%, neuropathy in 35.9% patients, retinopathy in 31.5% patients, hypertension in 25% patients, nephropathy in 17.8% patients, ischemic heart disease in 41.3% patients, stroke in 9.4% patients, and foot infections in 10.4% of the patients. However, this study reported complications for both types of diabetes.77

Interventional studies showed that high carbohydrate and high monounsaturated fat diets improve insulin sensitivity, whereas glucose disposal dietary measures comprise the first line intervention for control of dyslipidemia in diabetic patients.78 Several dietary interventional studies recommended nutrition therapy and lifestyle changes as the initial treatment for dyslipidemia.79,80 Metabolic control can be considered as the cornerstone in diabetes management and its complications. Acquiring HbA1c target minimizes the risk for developing microvascular complications and may also protect CVD, particularly in newly diagnosed patients.81 Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the principal macronutrient of worry in glycemic management.82 In addition, an individuals food choices and energy balance have an effect on body weight, blood pressure, and lipid levels directly. Through the mutual efforts, health-care professionals can help their patients in achieving health goals by individualizing their nutrition interventions and continuing the support for changes.83-85 A study suggested that intake of virgin olive oil diet in the Mediterranean area has a beneficial effect on the reduction of progression of T2DM retinopathy.86 Dietary habits are essential elements of individual cardiovascular and metabolic risk.87 Numerous health benefits have been observed to the Mediterranean diet over the last decades, which contains abundant intake of fruit and vegetables. The beneficial effects of using fish and olive oil have been reported to be associated with improved glucose metabolism and decreased risk of T2DM, obesity and CVD.88

The review of various studies suggests that T2DM patients require reinforcement of DM education including dietary management through stakeholders (health-care providers, health facilities, etc.) to encourage them to understand the disease management better, for more appropriate self-care and better quality of life. The overall purpose of treating T2DM is to help the patients from developing early end-organ complications which can be achieved through proper dietary management. The success of dietary management requires that the health professionals should have an orientation about the cultural beliefs, thoughts, family, and communal networks of the patients. As diabetes is a disease which continues for the lifetime, proper therapy methods with special emphasis on diet should be given by the healthcare providers in a way to control the disease, reduce the symptoms, and prevent the appearance of the complications. The patients should also have good knowledge about the disease and diet, for this purpose, the health-care providers must inform the patients to make changes in their nutritional habits and food preparations. Active and effective dietary education may prevent the onset of diabetes and its complications.

Read more:
Effect of diet on type 2 diabetes mellitus: A review - PMC

Metabolism. Author manuscript; available in PMC 2009 May 1.

Published in final edited form as:

PMCID: PMC2410097

NIHMSID: NIHMS49995

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

bPennington Biomedical Research Center, Baton Rouge, Louisiana 70808, U.S.A.

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

aDepartment of Endocrinology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China

bPennington Biomedical Research Center, Baton Rouge, Louisiana 70808, U.S.A.

Berberine has been shown to regulate glucose and lipid metabolism in vitro and in vivo. This pilot study was to determine the efficacy and safety of berberine in the treatment of type 2 diabetic patients. In study A, 36 adults with newly diagnosed type 2 diabetes were randomly assigned to treatment with berberine or metformin (0.5 g t.i.d.) in a 3-month trial. The hypoglycemic effect of berberine was similar to that of metformin. Significant decreases in hemoglobin A1c (HbA1c; from 9.5% 0.5% to 7.5% 0.4%, P<0.01), fasting blood glucose (FBG; from 10.6 0.9 mmol/L to 6.9 0.5 mmol/L, P<0.01), postprandial blood glucose (PBG; from 19.8 1.7 to 11.1 0.9 mmol/L, P<0.01) and plasma triglycerides (from 1.13 0.13 mmol/L to 0.89 0.03 mmol/L, P<0.05) were observed in the berberine group. In study B, 48 adults with poorly controlled type 2 diabetes were treated supplemented with berberine in a 3-month trial. Berberine acted by lowering FBG and PBG from one week to the end of the trial. HbA1c decreased from 8.1% 0.2% to 7.3% 0.3% (P<0.001). Fasting plasma insulin and HOMA-IR were reduced by 28.1% and 44.7% (P<0.001), respectively. Total cholesterol and low-density lipoprotein cholesterol (LDL-C) were decreased significantly as well. During the trial, 20 (34.5%) patients suffered from transient gastrointestinal adverse effects. Functional liver or kidney damages were not observed for all patients. In conclusion, this pilot study indicates that berberine is a potent oral hypoglycemic agent with beneficial effects on lipid metabolism.

Type 2 diabetes is a worldwide health threat and treatment of this disease is limited by availability of effective medications. All of the existing oral hypoglycemic agents have subsequent failure after long term administration. Thus, new oral medications are needed for long-term control of blood glucose in patients with type 2 diabetes. Certain botanical products from generally regarded as safe (GRAS) plants have been widely used in diabetes care because of their anti-oxidation, anti-inflammation, anti-obesity and anti-hyperglycemia properties.[1, 2]. However, the drawback of using GRAS plants is the difficulty in control their quality as most of these botanical products are mixtures of multiple compounds. Compared to other products from GRAS plants, berberine is a single purified compound, and has glucose-lowering effect in vitro and in vivo [3-6].

Berberine (molecular formula C20H19NO5 and molecular weight of 353.36) is the main active component of an ancient Chinese herb Coptis chinensis French, which has been used to treat diabetes for thousands of years. Berberine is an Over-the-Counter (OTC) drug, which is used to treat gastrointestinal infections in China. Berberine hydrochloride (BHClnH2O) - the most popular form of berberine, is used in this pilot study. The chemical structure of Berberine and related isoquinoline alkaloids are quite different from the commonly used other hypoglycemic agents, such as sulphonylureas, biguanides, thiazolidinediones, or acarbose. Hence, if the efficacy and safety of berberine are confirmed, it can serve as a new class of anti-diabetic medication.

This pilot study was to assess the efficacy of berberine in human subjects with type 2 diabetes. Berberine was given to both newly diagnosed diabetic patients and poorly controlled diabetic patients alone or combination with other hypoglycemic agents for three months. HbA1c, blood glucose and HOMA index were used to determine the efficacy of berberine.

The subjects were recruited from diabetes outpatient department of Xinhua Hospital by advertising in the clinic. Ninety-seven Chinese volunteers were screened, and 13 subjects were excluded from the study due to failure to meet the recruitment criteria. Thus, 84 subjects (49 women and 35 men) with type 2 diabetes were included in the study. All participants received written and oral information regarding the natural and potential risks of the study and gave their informed consent. The experimental protocol was approved by the ethics committee of Xinhua Hospital. The monotherapy study was designed to compare berberine with metformin (study A, n = 36). The combination therapy was aimed at evaluating additive or synergistic effects of berberine on the classical anti-diabetic agents (study B, n = 48).

Major inclusion criteria were hemoglobin A1c (HbA1c) > 7.0% or fasting blood glucose (FBG) > 7.0 mmol/L, BMI > 22 kg/m2, age 25-75 years, and a negative pregnancy test for female patients. A total of 36 patients who were newly diagnosed for type 2 diabetes were assigned to study A. After a two-month phase during which the patients were treated with diet alone, they were randomly assigned to receive berberine or metformin. A total of 48 type 2 diabetic patients inadequately treated with diet plus sulfonylureas, metformin, acarbose or insulin therapy alone or with a combination were assigned to study B (). The dose of the medications was stable for at least 2 months before enrollment in the study and remained unchanged throughout the study. All participants were instructed to maintain their lifestyle habits during the course of the study.

Baseline characteristics of administration of hypoglycemic agents

Each study involved a 13-week treatment. For study A, 18 subjects took 500 mg berberine three times daily at the beginning of each major meal or 500 mg metformin three times daily after major meals. For study B, 500 mg berberine three times daily was added to their previous treatment for 3 months. If heavy gastrointestinal side-effects occurred, the dose of berberine was reduced to 300 mg three times daily.

Patients were evaluated weekly for the first 5 weeks of treatment and then every 4 weeks until the end of study. The primary efficacy end point was glycemic control as determined by HbA1c levels. Secondary efficacy parameters included changes in fasting blood glucose (FBG), postprandial blood glucose (PBG), plasma triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) concentrations. Adverse events were recorded throughout the study by direct questioning.

Blood glucose was determined by a glucose oxidase method (Roche, Basel, Switzerland). Serum insulin and C-peptide were determined by radioimmunoassay (Linco Research, St. Charles, MO). HbA1c was analyzed using the high-pressure liquid chromatography (BioRad, Hercules, CA). Plasma triglyceride, total cholesterol, HDL-C, LDL-C, alanine thansaminase (ALT), glutamyl transpeptidase (-GT) and creatinine concentrations were determined by enzymatic assays (Roche, Basel, Switzerland). The HOMA method was used to compare differences in the profiles for insulin resistance (HOMA-IR) and for -cell dysfunction (HOMA- cell) [7]. Ten insulin-treated subjects were excluded from the HOMA analysis.

HOMA-IR = fasting insulin (U/ml)fasting glucose (mmol/L)/22.5

HOMA- cell = [20 fasting insulin (U/ml)] / [fasting glucose (mmol/L) - 3.5]

Descriptive statistics and analysis were performed in SPSS 12.0 for Windows. In study A, the significance of the differences between means of metformin and berberine groups was analyzed by Wilcoxon Rank Sum Test. The statistical differences between baseline and endpoint were calculated using Wilcoxon signed rank test. In study B, the significance of the differences among different time points was analyzed by repeated measure ANOVA. The level was set at 0.05.

In study A, 36 patients were included and randomly assigned to metformin or berberine treatment. Three patients of the berberine group and two patients of the metformin group withdrew from the study because of treatment failure. In study B, 48 patients were included, and 5 subjects were excluded from the study before week 13. Among the five subjects, three failed to complete the study in lack of efficacy, one failed in lack of participation time, and one was excluded due to lack of compliance (pill count < 80%). Thus, 74 participants were eligible for the final analysis.

In newly-diagnosed diabetic patients, berberine reduced blood glucose and lipids (). There were significant decreases in HbA1c (by 2%; P < 0.01), FBG (by 3.8 mmol/L; P < 0.01) and PBG (by 8.8 mmol/L; P < 0.01) in the berberine group. The FBG (or PBG) declined progressively during the berberine treatment, reaching a nadir that was 3.7 mmol/L (or 8.7 mmol/L) below baseline by week 5, and remained at this level until the end of the study (). Triglycerides and total cholesterol decreased by 0.24 mmol/L (P < 0.05) and 0.57 mmol/L (P < 0.05) with berberine treatment. It seemed there was a declining trend of HDL-C and LDL-C; however, no significant differences between week 1 and week 13 were observed in the berberine group. Compared with metformin, berberine exhibited an identical effect in the regulation of glucose metabolism, such as HbA1c, FBG, PBG, fasting insulin and postprandial insulin. In the regulation of lipid metabolism, berberine activity is better than metformin. By week 13, triglycerides and total cholesterol in the berberine group had decreased and were significantly lower than in the metformin group (P<0.05).

Both berberine and metformin decreased FBG and PBG of type 2 diabetic patients significantly from week 1 to week 13. A, means SEM of 15 patients treated with berberine alone. B, means SEM of 16 patients treated with metformin alone. C, means SEM of 43 patients with combination-therapy including berberine.

Monotherapeutic effects of metformin and berberine

In the first 7 days of treatment, berberine led to a reduction in FBG from 9.6 2.7 mmol/L to 7.8 1.8 mmol/L (P<0.001; ) and in PBG from 14.8 4.1 mmol/L to 11.7 3.6 mmol/L (P<0.001). During the second week, FBG and PBG declined further, reached a nadir that was 2.1 mmol/L (7.5 2.1 mmol/L) and 3.3 mmol/L (10.5 2.5 mmol/L) below the baseline, respectively, and remained at this level thereafter.

In the combination-therapy for 5 weeks, berberine led to a reduction in HbA1c from 8.1% to 7.3% (P < 0.001; ). FBG and PBG declined remarkably, too (P < 0.001). Fasting insulin and HOMA-IR reduced by 29.0% (P < 0.01) and 46.7% (P < 0.001), respectively. Blood lipids including triglyceride, total cholesterol and LDL-C decreased and were significantly lower than baseline. In the absence of weight change, waist and waist/hip of the patients declined significantly. No significant changes in the criteria were observed between week 5 and week 13 except the increment of fasting C-peptide (P < 0.05) and postprandial C-peptide (P < 0.01). During the study, fasting C-peptide of the patients with insulin treatment went down then up and postprandial C-peptide increased by 70.5% (P<0.01) at 13 weeks.

Berberine in combination-therapy

Incidence of gastrointestinal adverse events was 34.5% during the 13 weeks of berberine treatment including monotherapy and combination-therapy. These events included diarrhea (n: 6; percentage: 10.3%), constipation (4; 6.9%), flatulence (11; 19.0%) and abdominal pain (2; 3.4%). The side effects were observed only in the first four weeks in most patients. In 14 (24.1%) patients, berberine dosage decreased from 0.5 g t.i.d. to 0.3 g t.i.d. as a consequence of gastrointestinal adverse events. Of the 14 patients, ten were treated with metformin or acarbose in combination with berberine. The rest were treated with insulin combined with berberine. None of the patients suffered from severe gastrointestinal adverse events when berberine was used alone. In combination-therapy, the adverse events disappeared in one week after reduction in berberine dosage. The data suggest that berberine at dosage of 0.3 g t.i.d. is well tolerated in combination-therapy.

Liver and kidney functions were monitored in this study. No significant changes of plasma ALT, -GT and creatinine were observed during the 13 weeks of berberine treatment (). None of the patients were observed with pronounced (more than 50%) elevation in liver enzymes or creatinine.

The hypoglycemic effect of berberine was reported in 1988 when it was used to treat diarrhea in diabetic patients in China [8]. Since then, berberine has often been used as an anti-hyperglycemic agent by many physicians in China. There are substantial numbers of clinical reports about the hypoglycemic action of berberine in Chinese literature. However, most of the previous studies were not well-controlled and experiments were not well-designed. Additionally, none of them used HbA1c as a parameter due to poor research conditions. Thus, the anti-diabetic effect of berberine needs to be carefully evaluated.

In this pilot study, berberine significantly decreased HbA1c levels in diabetic patients. The effect of decreasing HbA1c was comparable to that of metformin, a widely-used oral hypoglycemic agent [9, 10]. In monotherapy, berberine and metformin all improved glycemic parameters (HbA1c, FBG and PBG). But their effects on lipid metabolism were different. Berberine decreased serum triglyceride and total cholesterol significantly. HDL-C and LDL-C levels of patients treated with barbering were also reduced but the decreases did not reach statistic significance. Whether berberine has a lowering effect on HDL-C needs further investigation. Compared with berberine, metformin had little effects on these lipid parameters.

In combination with other agents, berberine exhibited consistent activities in improvement of glycemic and lipid parameters in diabetic patients. Insulin sensitivity was enhanced by berberine as the HOMA-IR value was reduced by nearly 50%. This effect may be related to fat distribution by berberine because waist and waist/hip of the patients were decreased significantly in the absence of weight change. Interestingly, both fasting and postprandial C-peptides increased significantly in patients when berberine was used together with insulin, which suggests that long-term berberine treatment may improve insulin secretion of the patients with consequent failure of oral hypoglycemic agents. The effects of berberine on islet function need further studies.

The mechanism of berberine on glucose metabolism is still under investigation. We and others have demonstrated that berberine has an insulin sensitizing effect in vivo and in vitro [3, 4, 5, 11, 12]. In diet-induced obese rats, berberine reduced insulin resistance, similar to metformin [13, 6]. In hepatocytes, adipocytes and myotubes, berberine increased glucose consumption and/or glucose uptake in the absence of insulin [3, 6, 14]. Berberine enhancing glucose metabolism may be due to stimulation of glycolysis, which is related to inhibition of oxidation in mitochondria [6]. Berberine may also act as an alpha-glucosidase inhibitor. It inhibited disaccharidases activities and decreased glucose transportation cross the intestinal epithelium [15, 16]. This may contribute to the adverse gastrointestinal effects of berberine in some patients. This side effect was often observed when berberine was used in combination with metformin or acarbose, which also have similar gastrointestinal side effects by themselves. Thus, when combined with these two agents, the dosage of berberine should be reduced to 0.3 g t.i.d. to avoid the severe flatulence or diarrhea.

Berberine is proposed to have potential as a therapeutic agent for lipid lowering. In this pilot study, berberine reduced serum cholesterol, triglycerides and LDL-C. This activity is similar to that reported elsewhere in vivo [17, 18]. However, further studies including outcome studies in humans are needed to confirm this activity and its benefit. The mechanism of berberine regulating lipid metabolism has been investigated by several groups. In hamsters with hyperlipidemia, berberine reduced serum cholesterol and LDL-C, and increased LDL receptor mRNA as well as protein in the liver [19]. These effects were partly due to stabilization of LDL receptor mRNA mediated by the ERK signaling pathway [20]. In addition to up-regulation of the LDL receptor, berberine was reported to inhibit lipid synthesis in human hepatocytes through activation of AMPK [21].

In summary, that berberine is a potent oral hypoglycemic agent with modest effect on lipid metabolism. It is safe and the cost of treatment by berberine is very low. It may serve as a new drug candidate in the treatment of type 2 diabetes. However, this is a pilot study. The efficacy of berberine needs to be tested in a much larger population and characterized as a function of the known duration of the diabetes. Further studies are needed to evaluate the action of berberine on type 2 diabetes in other ethnic groups.

Financial support for this study was provided by Xinhua Hospital. This study is partially supported by NIH grant (P50 AT02776-020002) to J Ye.

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Efficacy of Berberine in Patients with Type 2 Diabetes - PMC

1. First Drug to Delay Type 1 Diabetes Approved by FDA  Smithsonian Magazine
2. FDA approves first treatment to delay onset of type 1 diabetes  CNN
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First Drug to Delay Type 1 Diabetes Approved by FDA - Smithsonian Magazine

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Learn how to prevent and manage diabetes - Lincoln Journal Star

As the population ages, experts are working to understand factors that influence healthy aging and encourage a better quality of life. Type 2 diabetes (T2D) is a chronic metabolic disorder that can impact long-term health outcomes.

A new study published in the Journal of the American Geriatrics Society found that older adults diagnosed with T2D who had high levels of psychological resilience were more likely to have better physical functioning, higher quality of life, and a lower likelihood of frailty and self-reported disability.

Psychological resilience, or just resilience, depends on peoples ability to respond and adapt to complex events like stress or trauma. It has to do with bouncing back after experiencing hardship.

Anamara Ritt-Olson, Ph.D., an associate professor of health, society, and behavior at the School of Public Health at the University of California, Irvine, not involved in the study, explained resilience to MNT in this way:

Resilience is the incredibly common ability to both withstand and bounce back from adversity. It is the armor that we wear to weather the difficulties of life. We are often put in the spin cycle of life, but resiliency allows us to come out relatively unharmed.

Both internal and external factors impact resilience. People are different, so their levels of resilience are also different. For example, adults with greater levels of social support are more likely to have more robust levels of resilience.

Resilience can impact many aspects of peoples lives, including how they cope with chronic conditions. T2D is a chronic metabolic disorder that affects the bodys ability to use glucose for energy.

It requires careful long-term management. If left unmanaged, it can lead to severe health complications like diabetic nephropathy and heart disease. Experts are still researching the best disease management methods and factors influencing long-term health outcomes.

Experts in this current study wanted to examine how psychological resilience impacted health in older adults with T2D.

The study included over 3,000 older adult participants with T2D. These participants were originally enrolled in a clinical trial that compared different diabetes management interventions. Current study authors followed up with these participants on average fourteen and a half years later. They measured a few different components among the participants:

Overall, researchers found that higher levels of psychological resilience were associated with better health outcomes, including lower numbers of hospitalizations, better physical functioning and quality of life, and fewer symptoms of depression.

Study author KayLoni Olson, Ph.D., noted the following study highlights to MNT:

In this study, we found that among older adults with Type 2 diabetes, individuals who reported a greater degree of psychological resilience (being able to bounce back after stress) also reported better overall aging-related health. This includes metrics like fewer hospitalizations in the previous year, lower likelihood of meeting criteria for frailty, and greater mental well-being.

However, researchers also found some variation between the association of resilience with some metrics. They note that this indicates that some associations may differ based on race [or] ethnicity.

This particular study had a few limitations indicating the need for more in-depth research.

First, the study cannot determine causality. It was also a cross-sectional study, which means that the authors could not determine the directional relationship of the variables.

Other limitations are related to particular study and analysis methods. For example, they did not look at all of the sociocultural factors that may impact resilience. They also didnt examine specific aspects of aging, like cognitive function. The majority of participants were white and female, which can limit the generalization of the studys findings.

Dr. Ritt-Olson offered the following insights and words of caution:

Their findings suggest that when older adults build their resiliency, they will find benefits it both their mental and physical strength. They may even be able to avoid hospitalizations. There are challenges with the study that the authors also acknowledge, for example, their measure of resiliency is about your general perception of how quickly you bounce back. We can overestimate our abilities to bounce back, and it isnt tied to an actual event that one needed to adapt to.

Regardless, the study offers insight into the important relationship between the mind and the body. Further research can confirm the impact of psychological resilience and provide longer-term follow-up.

The current study cant tell us if psychological resilience causes better overall health or vice versa, which means that additional research is important for teasing these relationships apart, Dr. Ritt-Olson noted.

In the short term, incorporating concepts like resilience into the study of aging may not only contribute to a more holistic understanding of the aging experience but may also help expand the narrative around aging so that individuals feel empowered as opposed to passive participants. This intersects with efforts within the aging research community to define healthy aging not just by the absence of health-related issues but also by the quality of later years of life.

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Resilience may improve health among older adults with type 2 diabetes - Medical News Today

WEDNESDAY, Oct. 12, 2022 (HealthDay News) -- The earlier a woman is diagnosed with diabetes, the sooner she may enter menopause, new research shows.

Rates of diabetes have grown steadily, so researchers wanted to understand the long-term implications of premenopausal diabetes on women's reproductive health.

Their study of more than 11,000 women found that being diagnosed with type 1 diabetes before age 30 or type 2 diabetes between 30 and 39 were both linked to earlier onset of menopause.

A diagnosis of type 2 diabetes after age 40, however, was associated with later menopause, compared to women without diabetes.

The researchers found no significant association between diabetes during pregnancy (gestational diabetes) and age at menopause.

"Even after adjusting for covariates associated with age at natural menopause, we still find an association between early diagnosis of diabetes and earlier menopause and a later diabetes diagnosis with a later age at menopause as compared to those who did not have diabetes," said lead study author Vrati Mehra, of the University of Toronto.

"We hope our work lays the foundation for more research in this area so we can better understand and prevent the long-term impacts of diabetes on the human body and the reproductive system," she added.

The findings are scheduled to be presented in Atlanta Thursday at a meeting of the North American Menopause Society (NAMS). Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal.

NAMS medical director Dr. Stephanie Faubion said the research adds to growing evidence about the collective toll diabetes takes on the human body.

"In this case, it shows that young women living with a diagnosis of diabetes are more susceptible to accelerated ovarian aging and early menopause," Faubion said in a society news release.

More information

The U.S. Centers for Disease Control and Prevention has more on diabetes.

SOURCE: North American Menopause Society, news release, Oct. 12, 2022

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Years of Diabetes Could Speed Onset of Menopause | Health | derbyinformer.com - The Derby Informer

Among people with type 2 diabetes (T2D) attending diabetic retinopathy (DR) screening in Denmark, markers including insulin use were important predictors for the development of present, incident, and progressive DR.

A multivariable model indicated that patients who used insulin were 2.3 times more likely to have DR and they had a 1.92.4 times higher risk for DR-development or progression, while the use of cholesterol-lowering medicine was associated with a lower presence of DR.

However, through the follow-up period in 2013 2018, the nationwide cohort reported a considerably lower prevalence, incidence, and progression of DR, when compared with earlier reports.

Potential explanations for this might include that the recent years have led to better treatment and optimized risk factor control in diabetes, which might decrease the onset and progression of DR, said Jakob Grauslund, MD, PhD, Department of Ophthalmology, Odense University Hospital.

Duration of diabetes was reported as a leading indicator of DR and proliferative DR (PDR), being 2.45 and 9.79 times more frequent in patients with a duration of more than 20 years than those who were diagnosed within 10 years.

The team of investigators evaluated the prevalence and incidence of DR along with associated markers in patients with type 2 diabetes in the Danish DR-screening program between 2013 and 2018. Stages of DR were defined according to the International Clinical Diabetic Retinopathy Disease Severity Scale as levels 0 (no DR), 13 (mild, moderate, and severe non-PDR), or 4 (PDR).

Investigators linked data from the national Danish Registry of Diabetic Retinopathy (DiaBase) to various national health registries in order to retrieve information on diabetes duration, marital status, comorbidity, insulin use, and systemic medication.

The study included all 153,238 people with T2D (56.4% male) from the study period, with a mean age of 66.9 years and duration of diabetes at 5.3 years.

The rates of use of insulin, non-insulin glucose lowering drugs, blood pressure lowering therapy and cholesterol lowering therapy at the first screening episode were reported as 15.8%, 86.5%, 77.8%, and 77.3%, respectively. Most patients did not have DR at their first screening (91.2%).

The prevalence and 5-year incidences of DR, 2-step-or-more progression of DR and progression to PDR were 8.6%, 2.8%, 0.7%, and 0.2%, respectively.

Multivariable regression models indicate the prevalence of DR was associated with male sex (odds ratio [OR], 1.30; 95% CI, 1.25 1.36), age (OR, 0.77; 95% CI, 0.74 - 0.81 per 10 years of age), duration of diabetes (OR, 3.07; 95% CI, 2.96 3.18 per 10 years), and the use of insulin (OR, 2.34; 95% CI, 2.24 - 2.44).

The prospective part of the study determined the leading marker of incident DR and progression to PDR were duration of diabetes (hazard ratio [HR], 1.98; 95% CI, 1.87 - 2.09; HR, 2.89, 95% CI, 2.34 - 3.58 per 10 years of duration) and use of insulin (HR, 1.88; 95% CI, 1.76 - 2.01; HR, 2.40, 95% CI, 1.84 - 3.13).

Meanwhile, the use of cholesterol-lowering medication was considered a protective marker (HR, 0.87; 95% CI, 0.81 0.93; HR, 0.70; 95% CI, 0.52 - 0.93).

The study, Presence and development of diabetic retinopathy in 153,238 patients with type 2 diabetes in the Danish Registry of Diabetic Retinopathy, was published in Acta Ophthalmologica.

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Insulin Use May Predict the Development of Diabetic Retinopathy - MD Magazine

Type 1 diabetes is a condition that they both say is tough to deal with, not because of the physical ailments, but the social anxieties while at school.

CUYAHOGA COUNTY, Ohio Olivia and Marabelle are two Northeast Ohio teens that many would describe as typical teenagers.

If it wasn't for the beeping of their insulin pumps, you'd never know about the daily routine that has become just another part of their every day life.

Oliva and Marabelle were both born with type 1 diabetes.

A condition that they both say is tough to deal with, not because of the physical ailments, but the social effects they deal with while relying on those insulin pumps.

They don't try to do anything to bring attention to their condition while in school, but the loud beeping of the pumps bring attention to them whether they want it or not.

Oliva said, "When my pump would beep [in class], kids would freak out. When does it usually go off if my blood sugar is high or low. Or sometimes if I forget to turn my insulin back on after a shower.

They say it hasn't only been a struggle with feeling different compared to their classmates, but incidents with teachers thinking their devices are cell phones being used in class causes anxiety when the machines are working to provide them their necessary medicine.

Oliva continued, "One time I was giving myself insulin in class, my teacher was walking around and said 'Do I see a phone?' The whole class turned around. She looked under my desk and saw my pump and said, 'never mind'"

Technology has come a long way in helping children born with type 1 diabetes manage their insulin intake. Phones now connect to pumps via Bluetooth and help monitor blood sugar levels easier than ever before.

However one issue that still remains that technology hasn't come up with a solution for, the social ramifications of feeling "different" in a way not many others can understand.

Marabelle's mother Kari says schools are made aware of conditions like type 1 diabetes and should make sure every staff member knows about the accommodations allowed to these students by law.

"When [students] have something similar [to type 1 diabetes] they get a 504 plan through the school that gives them extra accommodations for test taking if they are over 300 they have the option to postpone. If they are not aloud to eat in class they can because they need it to stay healthy.

More than 200,000 kids have type 1 diabetes in the United States. It is an every day battle to stay healthy not only physically, but mentally and emotionally too.

Marabelle shares that she just wants to be looked as as a normal teen, "I'm not as different as you think I can still do normal stuff and that my pump beeping isn't a big deal."

The Juvenile Diabetes Research Foundation (JDRF) will be holding its "One Walk" event coming up on Sunday, October 16 at Cleveland Metroparks Zoo. Money raised for the event will go towards JDRF's battle to conquer type 1 diabetes. Click here to register or make a donation.

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2 Northeast Ohio teens born with type 1 diabetes deal with social anxieties of their condition at school - WKYC.com

What and how you eat directly impacts your risk of developing type 2 diabetes. So, it's simple logic to make a habit of reducing the stuff that most directly leads to the deadly disease: sugar.

An estimated 34 million Americans have diabetes, more than 10% of the U.S. population, according to the National Institutes of Health. Another 88 million adults or 34.5% of Americans have prediabetes, a disorder characterized by blood sugar levels that are high but not yet to the level indicating type 2 diabetes.

When your body doesn't produce enough insulin or uses it ineffectively to keep your blood sugar in a healthy range, that's called insulin resistance. Your cells become numb to the hormone and can't efficiently use glucose for energy. Insulin resistance often leads to type 2 diabetes.

The disease is so common (as the numbers above suggest) that many people may not be aware of how serious and frightening it is. Type 2 diabetes is associated with obesity, cardiovascular disease, nonalcoholic fatty liver, and dementia.

If understanding the devastating potential outcomes of a diabetes diagnosis has renewed your interest in being more aware of your sugar intake, great! But here's another idea: Instead of focusing on cutting carbs and sugars out of your diet, establish eating habits that prevent diabetes. Since sacrificing the foods you love can be so unpleasant, focus on how you can eat healthy without denying yourself. That gets to the most crucial eating habit for avoiding diabetes, according to many nutrition experts:

"The diet we should all be on is the optimal diet of people with diabetes," says registered dietitian nutritionist Wendy Bazilian, Dr.PH, RDN, a doctor of public health and exercise physiologist certified by the American College of Sports Medicine. "You want a stable, steady release of blood glucose to enter the cells to make energy efficiently."

This is because stable blood sugar is critical to optimal metabolic health. And it affects many facets of your overall healthyour energy, sleep, mood and cognition, and immune system function.

"Uneven eating patterns, like skipping meals and eating heavily at dinner because you're starving, cause too many blood sugar spikes, which increases risk for diabetes," says registered dietitian Catherine Sebastian, MS, RD, manager of health communications at The Wonderful Company.

That advice may sound radical, but it's very logical and doable, because it's essentially the same healthy eating style that supports heart health, reduces inflammation, prevents weight gain and obesity, and reduces risk of certain cancers.

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Another important thing to consider when "eating like you already have diabetes" is that you don't need to cut out carbs completely.

"Cutting out carbs is a misconception," says Sebastian. "You want carbohydrates that contain fiber. And you should always have a protein source in every meal."

And some fat, adds Dr. Bazilian. "Have protein, fat, and carbs in your meal." Having the three macronutrients ensures you're getting nutrients, including fiber, that slow the absorption of sugars into the bloodstream as well as promote satiety.

Making a habit of eating like someone who already has diabetes can be challenging, just as establishing any routine can be. The key is to make a decision to commit to your health and well-being before making any changes to your day-to-day life, says Nick Frye, MS, a licensed clinical professional counselor and behavioral counseling manager for OPTAVIA, a weight loss and health coaching company.

The first step is finding your "why," "which is what we call the fundamental choice," he says. "It's an intentional commitment to identifying and following your north star. It's a mindset shift that sets direction and foundation for future action. All other habits to come are made in service to your fundamental choice."

So, for example, if eating like a diabetic is the habit you want to adopt, the first step is to determine what you want to get out of that habit. If it's "to optimize my health and avoid diabetes," personalize it with something emotionally meaningful to you, like "so I can be healthy enough to dance at my granddaughter's wedding in 20 years."

"Mindfully and intentionally become the author of your story," suggests Frye. "Skipping this mental exercise and jumping prematurely into action may deliver temporary success but is likely to result in long-term failure."

Remember Newton's First Law of Motion? A body at rest will remain at rest unless acted upon by an outside force. Well, that's the principle behind habit creation: you must start moving and then keep moving. Frye recommends starting small with micro-habits because "small, repeatable behaviors lead to significant results. Habits set people up for sustainable change."6254a4d1642c605c54bf1cab17d50f1e

You can find advice on how to eat like a diabetic on the American Diabetes Association website and elsewhere. But to start, build these micro-habits into your day and see where they take you.

"Put something in your mouth, break your fast," advises Carly Knowles, MS, RDN, a registered dietitian nutritionist with Organic Valley, an independent cooperative of organic farmers. "It fixes so much. It sets a mindset shift that food is a priority."

Knowles also works in private practice with women with gestational diabetes. She says her golden piece of advice to them is to eat for energy in the morning. "It's not so important what you eat but that you eatcould be five almonds or a few spoonfuls of yogurtsomething. Otherwise, you may get to lunch with a blood sugar crash, causing brain fog, cravings, and binge eating."

If you're trying to avoid white bread by switching to 100% whole wheat but are having trouble making the switch, go half and half. "Make half of your daily grains whole grains and half refined grains that are enriched," suggests Elana Natkier, MS, RD, a registered dietitian and consultant to the Grain Foods Foundation.

Eating the enriched bread won't increase your risk of diabetes, and it will ensure you're getting the added iron, folate, vitamin A, and thiamine. Natkier points to a 2019 analysis of studies in Advances in Nutrition, which found no association between refined grain intake and risk of type 2 diabetes when comparing the highest and lowest intake groups.

Brazilian also recommends establishing this micro-habit: Stand up after you finish a meal. The act alone marks a transition and signals to your brain that the meal is completed. "Standing up starts the mechanics of digestion and it starts to tell our cells to open up to receive blood sugar," Bazilian adds. For the same reason, go for a walk after every meal. She cites a study in Sports Medicine, showing that even just two minutes of walking after a meal can improve blood sugar levels when compared to sitting or laying down.

Have a glass of water before every meal. It'll likely satisfy the intense hunger and help you avoid overeating. "Eating too much food can also make your blood sugar out of balance," says Bazilian. Too much of any one macronutrient can be detrimental to health, too.

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The Most Crucial Eating Habit To Prevent Diabetes - Eat This, Not That