Prevention is always better and cheaper than a cure. According to World Health Organization (WHO) type 2 diabetes can be prevented by 30 minutes of daily moderate exercise and a healthy diet.

https://www.theparliamentmagazine.eu/printpdf/3574

Think the best way is diet control and mild excersise. Cut on fat, especially saturated and ones containing omegs 6. Reduce carbo and increase protein content, but not drastically. Increase fiber, walk abt 25 mins a day.

As every body know once it happens there is no return back. only one has to manage it in order to prevent its further aggrevation and prevent development of complications. prevention is always better.

Yes, these disease are largely a result of lifestyle choices, yet even the most educated and professional individuals have enormous (pardon the pun) difficulty following the apparently simple advice to "eat less, exercise more." Why is this? The answer lies in approaching the problem from a multi-factorial perspective and understanding that as long as biomedicine targets the individual for what is a societal problem, we will not only make NO progress, but only add to this growing problem. Structural factors such as the "obesogenic," capitalist culture we live in play a major role in the development of obesity and diabetes. See my publication for a full explanation of how this happens. Yes, education certainly is a factor - but this has been clearly shown to have very little, if any, impact of the diabetes 'epidemic' facing this country today.

Rigorous Genome Wide Assessment Studies (GWAS) of diabetes have made it clear that 5-10% of this classic chronic disease is caused by inherited or medical factors and 90-95% by lifestyle and personal choices.

The big problem is method. Specifically, the false assumption that inherited or medical causes that are analyzed that use one skill-set (A) – the key metrics of which are biomarkers – while lifestyle and personal choices use a totally different skill-set (B) – the key metrics of which are attitudes, behaviors, beliefs, values and lifestyles - and that one can commute freely between the different assumptions of A and B without compromising the data, conclusions and recommendations for treatment. A is the medical model. B, unknown to those who do A has been effectively used by marketing organizations for decades to create the persuasive communications that still drive junk food use regardless of all the thousands of pages of “good advice” that A has bestowed on us.

Two examples of different attitude sets that every clinician has heard repeatedly are: the VICTIM: “I’ve just tried and tried, doctor, and I just can’t get my hemoglobin A1c levels down. Oh, whatever can I do, doctor.” And the LAWYER: “It’s my right to live my life the way I want so I’m going to continue eating what I want, when I want and as much as I want. We’re all going to die anyway doc.”

The problem is that there are two false assumptions here. The first is that all clinicians/researchers are alike. The second is that all consumers/patients are alike. Both assumptions are wrong. The observations, data collection procedures, conclusions and recommendations are radically different for A and for B. And researching A as if it were B guarantees a GIGO situation that leaves researchers in a state of confusion asking, Why can’t educated and professional people just follow “good advice?”

Why is because, as all effective brand managers know – but will never tell you because it’s “proprietary information” – every consumer attitude segment needs to be addressed relevantly and persuasively their own unique way, otherwise they turn a deaf ear.

And, as marketers would also say, “If you don’t have the capabilities to do just that based on years of experience of doing it effectively, you shouldn’t be in the attitude-change industry, whether it's potato chips or diabetes.”

It may sound harsh, Rosslyn, but “good advice” has zero to do with what keeps 6 attitude segments from responding differentially to good medical advice. How people respond to what you think may be “good advice” depends on whether they are: 1) Very High responders, 2) High responders, 3) Average responders, 4) Low responders, 5) Very low responder, and 6) Rejectors (like the LAWYER). And you better know how to differentially nuance your advice to each segment, or "not be in the attitude-change industry.".

And that, unfortunately, is neither known nor ably done by well-intentioned clinicians or biological researchers. It's done by people who have specialized in being expert persuaders. And, as the World Health Organization has made abundantly clear, chronic diseases, being caused by lifestyle and personal choices, are “outside the health sector.” There's an awful lot of people don't a lot of busy work who haven't accepted the basic piece of good advice that persuasion is outside their area of expertise and that it might be more effective to simply hire those who are.

Dr. A-F

By guidelines, lifestyle modifications are recommended as 1st line "therapy" for newly diagnosed Type II patients. I assume that weight management, proper diet, and exercise would be the generally accepted methods for prevention as well. In my experience as an academic clinical pharmacist who reviews patient profiles, this is not easy to accomplish for a lot of people. Perhaps the availability of so many medications for diabetes provides some disincentives for lifestyle changes in our growing sedentary population in the US.

Unfortunately Edward the major problem is non-adherence, especially beyond the first year and among those who are most affected by a slow economy, which are usually the ones whose lifestyle put them most at risk for diabetes. Under adverse conditions, over 50% of diabetics may not take their medications as prescribed. This is particularly the case in Developing Countries where non-adherence can exceed 70%.

After 35 years of working with chronic diseases, for me attitude-sets ultimately determine whether a patient will/will not adhere to the indicated treatment - Rx, lifestyle mod or both - and whether they'll progress to the advanced stages of their chronic disease and a premature death or live a long healthier life than their genetic susceptibilities. Like personality, attitude-set doesn't change during a person's lifespan, regardless of what we clinicians say, especially in the average 7 minutes we have to see them.

You're right; it's hard for a lot of people to change how they make decisions. Attitudes are harder to change than behavior because they're not as tangible as behavior. Attitude modification is a specialty area that the unqualified should not attempt because: (1) it's outside their area of practice, (2) poorly executed treatment exacerbates the patient's illness, and (3) it's time clinicians accepted the right patients have to make their own choices and to let the chips fall where they may. Not because that's "harsh," but because that's reality.

The rate of growth of those with chronic diseases is 80 times that the rate of production of Primary Care Physicians (PCPs). Here's reality right now: (1) the system is overwhelmed, (2) there aren't enough qualified clinicians to meet the demand, (3) no pill exists that reverses chronic disease producing lifestyles, habits and decision processes, and (4) the budgets do not exist now nor will they ever exist going forward. What's the solution? Clearly it's not business as usual - going to a PCP for a magic bullet while the decision process continues to be that of the Victim, or the Lawyer. The Titanic is sinking and a lot of people are still running around the deck looking for the magic life jacket when they should be getting ready to swim, and hard.

Dr. A-F

hello friends,

daibetes is very dengerous form of diseases,increase sugar level in you blood it effect on your kindney and other organs.if you want to maintain blood sugar level and prevention of diabetes and obesity.i will give you some simple method.

1. walking dail at least 1 and half k.m.

2.maintain your diet chart. some vegitables like lady finger,and alove vera jucie

3.Avoid milk and milk products ,rice

4.Avoid meat and non veg, junk food like burger and all that

5.avoid alcohal and tabecco.

6.dont take tansion and any kind of metal pressure

7.used also medication tecq.

8.take your medicine properly as per your doctors

9..If your rbs is 150 to 220 before meal in a age of 45 to 50.so pls carefull.apply this diet plan

Type 2 diabetes is a multifaceted problem where 1. insulin production may be too low, for which generally one would use glinidines or sulphonylurea. 2. liver regulation of glucose levels malfunctions (metformin) and 3. the most common one, insulin receptors do not function. (Glitatsones)

Insulin receptor function is lost after long term high insulin levels which can be result of wrong diet as discussed above, but take into consideration also stress related high cortisol levels which will increase insulin production. High cortisol will increase the production of amylin which at long run will cause beta-amyloid to collect in the pancreatic islet. After this insulin production decreases. High cortisol levels will make it difficult to lose weight.

Insulin receptor function can be bypassed to some degree by alphalipoic acid which is able to activate the translocation of GLUT 4 from the microvesciles to the sarcolemma, at the same time activating AMPK. The activation of AMPK plays an important, albeit not an exclusive, role in the induction of GLUT 4 recruitment to the plasma membrane (Davies et al,1990).

In addition, there is some demonstration that AMPK may regulate glucose transport through GLUT 1. Increased glucose uptake will result in an increase in glycolysis and ATP production.

Vitamin C (even 500 mg is enough) will decrease stress related cortisol changes.

Pancreatic cells are continually destroyed and restored at high speed by stem cells. Normally for islet beta-cell mass regulation gut release GLP-1 and Gastrin are necessary. Gastrin plays a key role in islet beta-cell differentiation and regeneration

Gastrin has the ability to regenerate the body's own insulin-producing cells (islet beta cells in the pancreas). Gastrin can also synergize with other agents that can regulate blood glucose such as GLP-1 or DPP-IV inhibitors to correct hyperglycemia in diabetes patients.

Therefore, unless these factors are taken into consideration even the most rigorous diet and exercise will only keep the disease at a manageable level. Experience has shown that type 2 diabetes is indeed also possible to cure, but is not always simple.

Thank you Anu. Let's go beyond what the clinical practice guidelines say a moment.

The real world of global DM in 2013 is that 80% of all deaths are accounted for by the poor, and 20% by those who have salaried, long-term jobs and full medical coverage that is equally life-long so that the patient can pay for the chronic, costly care that lifelong multifaceted DM requires, especially at its advanced stages.

That 80% who are poor – thx to poverty-making global financial crises like those of 1987, 1997 and 2007 – now means “a person who doesn’t have a reliable source of income to pay for the reliable (“consistent”) multidisciplinary team Tx that DM requires. Particularly the Rx drug regimen you recommend, since, in the real world, Rx drugs are not free. Reliability and consistency are absolutely critical to Tx of DM - inconsistent Tx for any chronic disease is no Tx at all.:

However, adherence by DM patients to any consistent Tx regimen, especially Rx drug regimens, is among the worst worldwide. Especially when a patient’s money situation is unreliable. Again, inconsistency is the single best way to insure that DM and its associated risks never remit but progress to advanced stages and premature death. To start a drug regimen without first insuring that the patient can turn it into consistent action until biomarkers are stable and self-sustainable with no further need for Rx drugs, is not merely a travesty, it is dumb. Among the 80% poor, non-adherence to “evidence-based” drug regimens, within 6 months averages 70+% and gets progressively worse after Year 1.

Despite your disquisition on DM mechanisms and how they should be Tx’d, if as clinicians we’re committed to reducing DM biomarkers, we must know if a Rx drug regimen is actionable in our real patient, with their real monetary limitations. I cannot just rattle off what the DM Cookbook says and hope 80% of the patients will be marveled by our wisdom and then print the money they need for the drugs

A wise foreign endocrinologist once told me, “Among the poor, WHY the evidence-based Tx we Rx is less important than WHAT we recommend returns them to work and a normal home life." That means that the patients’ DM lab chemistries actually drop, remain stable for a year, become self-manageable by the patient without drugs for another year, and then for the rest of their life they can go back to work, to feeding their family, and to having a normal marital and family life without any further need for medical services at all.

Sadly, it’s time clinicians came to the realization that modern medicine has been overwhelmed. Not technologically but demographically. The world’s population is growing 100 times faster than the rate at which we produce physicians. For every DM patient we see in our office today there are 100 in the lobby waiting for us tomorrow. And only 20% can afford to come more than once. In short, there aren’t enough doctors to prescribe, and patients to pay for, the Tx you recommend.

Henceforth, particularly for the 80%, when we Rx we need to do so on the basis of two United States Marine Corps standards: (1) “Make do with what you got” and (2) “The patient's biomarkers are now stable, and there is no further need for medical services.” Do the numbers and you’ll see that merely reading from the DM Cookbook while nice is totally inactionable and non-sustainable.

True, vitamin C as supplement is not free, but 500 mg from diet is manageable. Alphalipoic acid is available in dark green leafy vegetables, including spinach and collard greens; broccoli; animal foods such as beef steak; and organ meats such as calf's liver. Admittedly beef can be costly but collard greens on the other hand are often not. GLP-1 is released from the K-cell of the intestines as long as the intestinal flora and lumen are functioning correctly. These can be helped by again using sources from the diet. In Sri Lanka, I found that in the fishing villages the poorest people were the most eager to use natural ingredient which they were able to get from their own backyard- Gotu Kola, cabbage and onion for instance. So in fact which is then more costly, the regular medications or using dietary factors to regulate the body's own corrective abilities?

On the other hand it is sometimes (more often than not) necessary to with the easiest and fastest way to simply stabilize the condition, but it does not hurt to give the patient the choice to actually also get better...

I agree. The answer ultimately comes down to consistency, as this classic RCT in JAMA concluded:

“Despite a substantial percentage of participants who could sustain meaningful adherence levels, no single diet produced satisfactory adherence rates and the progressively decreasing mean adherence scores were practically identical among the 4 diets. … These findings may suggest to some clinicians that the degree to which a patient exhibits features of the metabolic syndrome might guide the degree of carbohydrate restriction to recommend. In the long run, however, SUSTAINED ADHERENCE TO A DIET RATHER THAN DIET TYPE was the key predictor of weight loss and cardiac risk factor reduction in our study.” [emphasis added]

Dansinger ML Gleason JA, Griffith JL, Selker HP, Schaefer EJ (2005). Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA, Jan 5;293(1):43-53.

Dr. A-F

Thank You John,

Even in my 50s I still wear rosy glasses when faced with the realities of everyday life, I keep hoping that at least some patients have the good sense to learn to look after themselves- which thank goodness a good portion has begun to do so. It takes a lot of explaining and extra time, but I have found it worth my while. I must be a bad doctor because I care a lot about my patients ( at least I am always reminded to detach myself from patients) but at least they listen and follow instructions that way. So, even though I get a bit more tired that way - it's the result that count.

John,

There's a High-Income Country (HIC) mindset you've missed. "Poor" means "no money whatsoever," so your idea of "topiramate-metformin-simvaststin-lipoic acid --ace inh- appropriate probiotic" Tx is inactionable for all but 20 people out of a 100 worldwide.

Where I work with rural subsistence manual labor farmer families with usually no years of for formal education 3 things would happen with your HIC Tx: (1) first it would be incomprehensible and you would get a look that says, "Are you for real, don't you know how poor we are?" (2) you would get a very polite 'Thank you' and a smile, (3) the whole family would go away and never again return to our free clinic because the perception would be that the clinic has become a "rich peoples' clinic" who no longer understand and are able to help "poor people." There would be no long discussions about why they feel that way, folks with survival language skills don't get involved in long "arguments" so they wouldn't complain and they wouldn't engage in impolite efforts to educate you. It takes very scarce money to pay for the transportation to get a clinic. The problem we're having now is people can't afford the transportation to get to a free clinic so we're going to have to go find the more serious cases now.

Anu has experienced this in Sri Lanka. "Rich peoples' medications" are suspect, so you need to know the local folk remedies well, then do show-and-tell usually the wife what plants she should use, in teas or "infusions," and how often, and then you might get the adherence needed to begin to impact DM. Come, John, come live with these folks, with no electricity or running water, eating 2 times a day b'c the third time you give to your kids so they don't get dizzy at school. I'd say that within 2 weeks your "topiramate-metformin-simvaststin-lipoic acid --ace inh- appropriate probiotic" will sound not only absurd but offensive.

It's the rainy season now. We're lucky to get 2 hours of sun per day. The bugs are dense now and the area around the house is deep mud. Clean drinking water is hard to find, so you always have some Clorox on hand - 4 drops per liter makes it drinkable but it has that unmistakable smell of Clorox as you swallow it.

Come see the 80%,

Dr. A-F

When I went to work in the fishing village, the people considered themselves so poor that they did not deserve a doctor. First week was indeed polite smiles and a few cuts and bruises until they relized I was not giving up on them. After that I was swamped with patients and also eager helpers in searching for local resources. They were proud of whst they were able to achieve with the little they had. I had to hold courses stsrting with what to do with a drowned fisherman and how to clean wounds and keep them clean to avoid amputations. It was impossible to say do not eat rice, since that was often the only thing available. Had to figure out all usable local things.

Now in a western country I often hear complaints when I tell my patient to cut down of chocolates and ice-cream. Have to adapt to a different set of people who still need to be educsted.... Still hoping for the best

Wonderful feed back. Thank you so much. at the eand of the day what it comes down to is leading a healthy lifestyle so as to prevent a plethora of diseases. I personally believe that the funding agencies or the govt. Institutes should focus more into bringing general awerness about the crucial aspect of leading a healthy lifestyle to prevent type 2 diabetes.

I find it so ironic that millions and millions of dollars are being invested into diabetes 2 research where it can be easily prevented if people learn to make healthy lifestyle choices. The govt can take initiatives in:

1) bringing about incentives for people who are free of diabetes from health insurance companies.

2) encouraging the work places to be a diabetes free zone

3) and inculcating children the importance of active and healthy lifestyle.

Maybe people can add more to the points above

At present, there is evidence that type 2 diabetes can be prevented. The DPP study, the FINNISH Diabetes Study as well as the Da Qing study and the Indian Diabetes Prevention Program (IDPP) studies have all conclusively shown that diabetes can be prevented in upto 60% of people with pre-diabetes (Impaired Glucose Tolerance or Impaired Fasting Glucose) by life style modification and were indicated by using Metformin. At present, there is no cure for type 2 diabetes. However, in some individuals prolonged remission can be induced by bariatric surgery. Also, in some individuals with type 2 diabetes where it is induced by stress, after amelioration of the stress the type 2 diabetes may go into remission. However, it is very difficult to call this as a cure as the disease can come back again.

Dr. V. MOHAN, M.D., FRCP (London, Edinburgh, Glasgow, Ireland), Ph.D., D.Sc., D.Sc (Hon. Causa), FNASc, FASc, FNA, FACP, FACE

Chairman & Chief Diabetologist

Dr.Mohan's Diabetes Specialities Centre

WHO Collaborating Centre for Non Communicable Diseases Prevention & Control

IDF Centre of Education

President & Chief of Diabetes Research

Madras Diabetes Research Foundation

No:6B, Conran Smith Road, Gopalapuram

Chennai, India Pin:600086

Ph:91-44-43968888,Fax:91-44-28350935

Email : [email protected]

Website: www.drmohansdiabetes.com, www.mdrf.in,www.mdrf-eprints.in

Official Facebook Page: http://www.facebook.com/drmohansdiabetesinstitutions

Twitter: twitter.com/DMDSC

Skype: drvmohan

I agree with Dr Mohan. Though there have been researchers stating that there is a possible cure for type II diabetes, it is just all about controlling it rather than eliminating it once it has occurred. Life style changes, diet, food habits can supplement the necessary minerals that the body requires for efficient production and usage of insulin. However, since the fact that the system has lost its full efficiency in producing and using insulin, one cannot look at "cure" of the disorder.

Treatment is not that difficult ... Have a look at attached file .. More scientific research can be found on my forum dedicated to novelty treatment based on recent research results forum at www.tew.nu

Please look into : Parma consensus statement on metabolic disruptors . You can findet in RG . Or Google .

People working in different disciplines will have divergent opinions about the concern raised by Dr. Indumati Sharma. Number of professions  are facing challenges of their survival today. The divergent views expressed which says yes there is a cure or there is no cure for Diabetes-II only keep suffer in confusion as what to do. It would be better for the people therefore, to take care of them self and follow a healthy life style as far as possible so that disease does not afflict them. Because it is their life. This life should not become subject matter for others to do business and prosper. Literally I do not blame any one for this modern trend but the present environment.  

As commented by experts, it can't be cured. But with proper life style, exercise and food, we can manage the same. Some people are living with Type II for more than 30 years with medicine. 

Diabetes is a metabolic and lifestyle disorder & it can be well controlled by adopting Healthy dietary pattern together with physical activity.

Following Published report discuss all the Ayurvedic dietary and lifestyle guidelines for prevention of type 2 diabetes and available factual research evidence validating it.

Article Diet and Lifestyle Guidelines for Diabetes: Evidence Based A...

We also attempted several investigations to explore the role of Yoga and meditation in diabetes...Many documented works are under publication process...The following is one among our published reports in pubmed....

Article Yoga: As an adjunct therapy to trim down the Ayurvedic drug ...

Prevention is always better and cheaper than a cure. According to World Health Organization (WHO) type 2 diabetes can be prevented by 30 minutes of daily moderate exercise and a healthy diet.

https://www.theparliamentmagazine.eu/printpdf/3574

Diabetes II is difficult to treat because it is a group of diseases synergistic with each other and one of them leads to the other ways of prevention by staying away from its causes and most importantly a healthy diet and exercise and lack of anxiety and psychological comfort and complete relaxation and anxiety

Following

Preventio is better than cure