Are Diabetes Risk Reduction Recommendations Followed by the General Population?

by Bianca Garilli, ND

Guidelines for reduction of diabetes risk consist of recommendations such as:

• Losing 5-7% of your starting body weight if overweight
• Following a healthful diet by lowering caloric intake, choosing water in place of sweetened beverages, and reducing fat in the diet, particularly trans fat
• Engaging in 30 minutes of exercise 5 times weekly¹

More specific recommendations are discussed on the National Institutes of Diabetes and Digestive and Kidney Disease website including resources for following the Choose MyPlate  program. The Choose MyPlate  program encourages the following diet tips:

• Fill half of your plate with fruits and vegetables
• Fill one quarter with a lean protein, such as chicken or turkey without the skin, or beans
• Fill one quarter with a whole grain, such as brown rice or whole-wheat pasta²

These recommendations are easily and freely accessible online and should be a part of routine preventive patient care practice. However, the dramatic rise in rate of prediabetes and diabetes in the United States indicates lack of awareness and/or implementation of these guidelines within the general population.

A March 2018 article published in Diabetes Care examined the proportion of American adults without type 2 diabetes (T2D) that engaged in lifestyle behaviors known to reduce the risk of this chronic disease. Data was collected from 3,679 individuals aged > 20 years old without T2D enrolled in the 2007-2012 National Health and Nutrition Examination Surveys (NHANES) who had provided two days of dietary data and self-reported leisure-time physical activity. This information was analyzed to determine if the participants met T2D risk reduction goals which included:

• Consuming ≥ 4 MyPlate recommendations (adequate consumption of fruits, vegetables, dairy, grains, meat, beans, and eggs)
• Not exceeding maximum allowances for alcoholic beverages
• Reducing consumption of added sugars, fat, and cholesterol
• Meeting physical activity recommendations (≥150 min/week)

Results from this cross-sectional analysis indicated approximately 21% of participants met fruit intake goals; 20% met vegetable intake goals and 13% met dairy goals. Half met the goal for total grains, although only 18% met the goal for whole grains.  Over half (54.2%) met the meat/beans goal and 40.6% met the oils goal. Approximately one third, 37.8%, met the physical activity goal and 58.7% met the weight loss/maintenance goal.

When reviewed in full, only 3.1% met the majority of T2D risk reduction goals with younger age and lower educational level associated with lower probability of meeting these objectives.³

Why is this Clinically Relevant? 

• Making recommendations in clinical practice does not always ensure that the recommendations will be followed in daily life
• Consider utilizing an in-office diet recall or an out-of-office diet diary and reviewing with patients while in office focusing on consumption of high fiber, low-glycemic index food choices
• Lifestyle recommendations should include “how-to-implement” support for home, office and/or school in order to facilitate the adoption of recommendations into daily living
• Encourage patients to schedule visits with nutrition specialists and lifestyle coaches in order to create lifestyle modifications which can be followed long term
• Create and review SMART goals and progress at each visit

Link to Abstract

1. American Diabetes Association. Lower Your Risk. http://www.diabetes.org/are-you-at-risk/lower-your-risk/. Accessed March 12, 2018.
2. NIH. NIDDK. My Game Plan to Prevent Type 2 Diabetes https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes/game-plan. Accessed March 12, 2018.
3. Siegel K, Bullard KM, Imperatore G, et al. Prevalence of major behavioral risk factors for type 2 diabetes. Diabetes Care. 2018;Mar 2:pii dc171775.