Preventing Diabetes on a Budget

By all accounts, Frances Vasquez ought to be a diabetic. Raised on a diet of fried steak, fried pork chops and lots of rice, her father, mother and two sisters suffered from the disease. At age 47, Frances herself was overweight and was already experiencing high blood sugar.

But over the past 11 years, Frances has been able to avoid diabetes, and her sugars are now normal. By participating in a ground-breaking, government-funded study, she learned how to make exercise and a healthy diet an integral part of her life, avoiding the insulin injections and heart and kidney problems that Plagued her parents when they were in their 50’s.

“At first it was hard, but I took it as a religious (type of) thing,” she said recently. “If I hadn’t done this, I’d be a diabetic for sure.”

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The study, called the Diabetes Prevention Program, included more than 3000 adults, all of whom were overweight and had sugars that were high but not yet in diabetic range. Diabetes is a condition in which the body is unable to control blood sugar, and it often leads to heart disease, kidney failure, blindness and circulation and other problems.

About nine out of 10 diabetics have what’s called type 2 diabetes—their bodies make insulin (which regulates blood sugar), but their cells don’t respond to it adequately. Having a family history and carrying too much weight increase a person’s risk of developing type 2 diabetes. In recent years, diabetes has become an epidemic in the United States, mainly because many more Americans are overweight and obese.

Nearly half of the people who participated in the Diabetes Prevention Program were of ethnic minority ancestry, including African Americans, Native Americans, Asian Americans, Latinos and Pacific Islanders. People in the study were assigned to one of three groups. The people in Frances’ group received intensive counseling on their food intake and physical activity. Another group got information on healthy food and exercise and took a diabetes pill, called metformin, twice a day. A third group was given healthy food and exercise information and took a placebo (or inactive) pill twice a day.

At the end of three years, the people in the intensive lifestyle group cut their risk of developing diabetes by more than half. People in the metformin group also reduced their risk, but by a smaller amount. A 10-year follow-up study found that the people in the intensive lifestyle group delayed developing diabetes by four years and people in the metformin group delayed developing the disease by two years, on average. People in both groups also lost weight, and their blood pressures and cholesterol levels improved.

People in the lifestyle group were expected to walk briskly for 30 minutes a day and write down everything they ate in a journal. They met with a counselor for an hour every week for two years, then less frequently, and attended classes that taught them about different types of food and how to read a nutrition label. They worked with a physical trainer, who showed them how to do simple exercises, such as stretches and jumping jacks, and went for regular walks together. They also received a pedometer and were expected to walk 10,000 steps every day.

As a result of what she learned in the study, Frances stopped going to fast food restaurants. She now bakes meats and fish instead of frying them, and she avoids juices and sodas unless they are sugar-free. She eats two slices of 40-calorie Pepperidge Farm bread, with sugar-free all-fruit jam for breakfast, instead of a bagel with cream cheese. She packs a turkey and tomato sandwich for lunch most days, and goes for a walk during her lunch break from her job as an examiner for the Department of Motor Vehicles. She looks at newspaper ads to see which grocery stores are having specials on fruits and vegetables, and she never goes grocery shopping when she is hungry, because she is more likely to buy something rich or sugary. She still eats rice sometimes, but she prepares it with a small amount of olive or canola oil and flavors it with garlic and onions.

Frances now weighs 10 pounds less than she did a decade ago, though she still would like to lose another 10 pounds to reach a goal weight of 137. (She is five feet tall). She admits to losing her will-power at parties and while on vacation cruises, and says keeping the weight off is tough. But she has enlisted many of her co-workers to walk with her at lunchtime and follow a healthier diet, and she recently bought 99 cent pedometers for 10 of her co-workers who are participating in a weight loss program that she is organizing.

“When you get friends to go (walking) with, it makes it better,” she said. “It’s hard, but if you take 15 minutes out of your lunchtime to exercise, even if you just walk around the block where you work, and avoid the drive-through and learn how to eat, you can do it. It’s very important to take action while you can because being overweight is a walking time bomb.”

Erin N. Marcus, M.D.

general internist and associate professor of clinical medicine at the University of Miami Miller School of Medicine

Jun 17, 10 • Diabetes News