By: Colin Bullen
Wreaking Havoc with your Health
Type 2 diabetes occurs when the body doesn’t produce enough insulin to function properly, or the body’s cells doesn’t react to insulin. This means glucose stays in the blood rather than being used as fuel for energy. The body stores the excess in little bundles called glycogen in the liver and muscles, which partly explains why type 2 diabetes is often associated with obesity.
Diabetes is diagnosed when fasting glucose levels reach 126mg/dL, but risk increases once people reach 100 mg/dL, at which point they are classified as ‘prediabetic’. The way the body processes glucose is important to understand because high levels of glucose in the blood over extended periods can cause significant health problems, notably with eyes, the heart and nerves.
The King of the Non-Communicable Diseases
Type 2 diabetes might justifiably be regarded the king of the non-communicable diseases – the class of diseases most affected by the behaviors we practice on a day-to-day basis. In 1990, the percentage of Americans diagnosed with diabetes (type 1 and type 2) was 2.5% of the population. By 2015, this had risen to 7.4%, a nearly threefold increase driven entirely by type 2. Given that undiagnosed diabetes is common, current estimates predict that around 9.4% of the population (30 million Americans) has diabetes, 90-95% of whom have type 2.
This dramatic spike in prevalence has resulted in some rather alarming predictions of future prognosis, with publications in some reputable journals suggesting that the current prevalence figures could double, or even triple, by 2050 – 2060. In contrast, more recent publications suggest that prevalence and new diagnoses of diabetes have started to stabilize, as seen in the illustration below. Whether prevalence of diabetes increases or stabilizes, diabetes has a negative impact on a large part of the population, including serious health consequences.
To improve diagnostic accuracy and provide more useful information to sufferers, classic diagnostic tests, like the fasting plasma glucose (FPG) and AIC tests (whic measures average blood sugar for the previous two to three months), are being replaced by continuous monitoring devices like the Freestyle Libre. This type of glucose monitoring is useful for patients wanting to monitor their glucose levels on an ongoing basis, to help preempt and avoid hypoglycemic shock episodes.
Making the Change: Controlling Type 2 Diabetes Through Behavior Change
Type 2 diabetes is caused by a combination of lifestyle and genetic factors – some cultures are more susceptible than others. Given that genetics are not changing rapidly, we can be confident that the increase in type 2 diabetes is almost entirely caused by our behaviors. Equivalently, it can also be controlled through behavior change. The Behavioral Research and Applied Technology Laboratory research suggests that a wide range of behavioral changes can reduce blood sugar levels and hence reduce the prevalence of diagnosed diabetes significantly.
- Exercise and reduced sedentary behavior (less sitting) both demonstrate 30% reductions in blood sugar levels, and diabetes prevalence.
- Practicing mindfulness has been shown to reduce blood sugar and diabetes by around 15%, while getting a good night sleep (around 7-8 hours) increases improvement in symptoms around 10%.
- The research on healthy eating is patchy, which is partly due to the difficulty of setting up reliable experiments on eating habits and diets, as well as having to rely on people’s ability to stick to prescribed dietary regimes. However, we have seen strong empirical evidence supporting the impact of the ketogenic diet, for instance, in controlling blood sugar levels in diabetic and prediabetic populations.
Compared to other lifestyle habits, exercise and movement have the largest impact on blood sugar levels and hence diabetes prevalence. At least one study notes that exercise benefits are best achieved through strength rather than cardio workouts, and most reveal a benefit from combinations of cardio and strength, so if you are increasing your exercise to reduce blood sugar, weights should be included in your workout. Two minutes of activity every 20 minutes reduces sedentary behavior, which in turn improves glycemic control. Although physicians recommend that exercise should still be combined with drug therapy, clinical trials confirm that exercise has the potential to be at least as effective at controlling blood sugar as medicines – and with pleasant rather than unpleasant side effects.
Reducing the Cost and Suffering
Diabetes is a costly disease, both in terms of the medical cost and in terms of the human suffering. Organizations looking to change the health risk profile of their employee populations would do well to address this risk. Based on US population data, it’s likely that more than 60% of the diabetic population are not exercising. If the finding is that prevalence can be reduced by 30% through exercise, this would suggest that a reduction of at least 2% in diabetes prevalence is achievable in a typical US population just through changing exercise behavior. We believe that a comprehensive healthy behavior change program will have an even greater impact.
Setting up a change-ready environment that allows employees to adopt healthier behaviors regarding exercise, healthy eating, mindfulness, and sleep hygiene will result in significant improvements in an organization’s health risk profile. The cost and productivity benefits will manifest over time and can be accurately predicted. Any organization looking to evaluate the impact of investing in these changes or wanting to understand more about how to create healthy and change-ready cultures should contact Change Craft on firstname.lastname@example.org.
Colin Bullen is the founder and director of Change Craft, a global business established to help organizations execute effective and successful wellbeing change. In business, he’s the technician, evaluator, and strategist. A true road-less-traveled devotee, he qualified as an actuary in 1992 in the UK before spending 13 years in South Africa where he met Chicago-based business partner Hanlie van Wyk. During this time, he has steadily broadened his métier into health, well-being, leadership, strategy, assessment, and data.
Colin has a deep passion for helping companies find their human touch, whilst accelerating their performance and focusing their vision. Colin is also one of the creators of the behavioral research database that is BRATLAB and has been a driving force behind early successes in Change Craft.