If your doctor has warned you that you're at risk for developing type 2 diabetes, often due to excess weight or a higher than normal blood sugar level, the statistics can scare you. And they should. If you have pre-diabetes (above normal blood sugar), you are more likely to get diabetes in the next 10 years and to have a heart attack or stroke. 1
What to do? Getting nutrition counseling is a wise step, and may reverse your risk, according to a new report that evaluated 69 published studies on lifestyle-based diabetes prevention programs.
Bottom line? Nutrition education helped people lose weight and reduce their blood sugar levels.2 Overall, ''nutrition education is effective for reducing diabetes risk,'' says study author Brenda Davy, PhD, RDN, professor of human nutrition, foods and exercise at Virginia Tech University, Blacksburg. Healthy eating information helped people lose weight, and experts know that dropping just 5 to 7% of excess weight (10 to 14 pounds if you weigh 200) can slash your diabetes risk. 1
Davy and her team took a closer look at the 69 published studies on lifestyle diabetes prevention programs to see what worked. "Most of these studies were not just nutrition education, they did include physical activity," Davy says.
"Overall, we had about a 2 kilogram (4.41 pound) weight loss at 12 months across the board," Davy says, referring to average results for all programs she evaluated. However, if the nutrition education was delivered by a registered dietitian instead of another health care provider, the average weight loss increased by another two pounds. And in U.S.-based studies that included nutrition education by an RDN, people lost about five more pounds.
That may not sound like a great deal of weight loss, but Davy stresses that even modest weight loss can have an impact on diabetes risk. Those in the programs also saw a drop in blood sugar levels when they took a two-hour blood glucose test and a hemoglobin A1C test. 1
Whether the programs are in-person or technology-delivered did not matter much in terms of weight loss, Davy found. Many actually preferred the programs not done in person, she found, perhaps due to time saving.
Costs were only included in eight studies, Davy says, and only five figured costs per person. In those, the average was $385 overall, but those led by dietitians cost less. Programs based on technology delivery cost the least.
The new report is published in the March issue of the Journal of the Academy of Nutrition and Dietetics.1
The weight loss results are ''very promising," says OnTrack Diabetes Medical Advisory Board Member Susan Weiner, MS, RDN, CDE, CDN, with a private consulting practice on Long Island, New York. She reviewed the new findings.
However, she says, ''we need to look at the next 12 months," as keeping the weight off long term is crucial to reducing diabetes risk.
A major reason that counseling by a dietitian works, Weiner says, is because it is individualized. "We listen to where the person is and help them make one change at a time, with specific, not vague goals," Weiner says.
"A vague goal would be 'eat healthy,''' she says. Of course, everyone has heard that. She prefers a specific goal. For instance, she might give a person healthy recipes, suggest they make those dinners twice a week to eat at home, and take the leftovers to work.
To improve people's diet, she focuses on ''specific swaps," rather than simply telling them to eat healthy snacks. For instance, she might suggest an ice cream lover ''doll up'' a Greek yogurt with slivered nuts topped off with cinnamon.
Weiner also give specific instructions about how to eat health at restaurants:
• Check out the menu online before going and try to choose the healthier options.
• In a group, order first so you won't be tempted by others' less-healthy choices.
• If bringing half your dinner home typically means you will have a midnight gorge, order an appetizer size portion instead.
If you're ready for diet help, check first with your health insurance plan to see if it's covered.Unfortunately Davy finds that nutrition counseling is often not covered by insurance plans.
However, if you've tested for high blood sugar, with a diagnosis of pre-diabetes, your plan may offer a group class with nutrition counseling.3
Another option: check your nearby hospital to see if it has an outpatient dietitian who might be available for consults. "A referral from a doctor from within the system might help,'' Davy says.
Efforts are underway to improve coverage. For instance, Senator Gary Peters (D-Michigan) plans to re-introduce his bill, Preventing Diabetes in Medicare Act. It would amend the Social Security Act by extending coverage under Medicare for medical nutrition services to those patients with pre-diabetes or with risk factors for developing type 2 diabetes.4
Another option is to seek the services of an RDN or a CDE, certified diabetes educator (some of whom are also RDNs). Costs range, but plan to spend about $100 to $200 a session, on the upper end if the professional is both an RDN and a CDE.
More than 200 YMCAs across the U.S. offer the Diabetes Prevention Program, including strategies for healthy eating, losing weight and increasing exercise. Some financial assistance is offered to those who qualify. 5