Diabetes Prevention Guide
En español | While it’s true that your age or a family history of diabetes can affect your chances of developing the disease, your lifestyle plays a critical role, too. In fact, you may be surprised by how much a small number of daily habits can significantly raise your risk. Keep reading to see which matter most — and how to stay out of the danger zone.
1. Skipping breakfast
There’s been a lot of back-and-forth over the value of breakfast to your health. But a large review of studies published in 2019 in The Journal of Nutrition pretty much concluded that those who skip breakfast are at greater risk of getting diabetes than those who sit down for their oatmeal or eggs. It appears the magic isn’t the meal itself but in how those who eat breakfast were able to maintain a lower body mass index (BMI).
That’s likely because skipping breakfast sets you up to overeat the rest of the day, says Melinda Maryniuk, a registered dietitian and owner of Diabetes and Nutrition Consultants in Boston. “Even if you don’t feel hunger pangs, you think you’re entitled to more — snacks, a bigger serving — because breakfast wasn’t eaten.”
A study presented at ENDO 2021, the Endocrine Society’s annual meeting, suggests that when you eat breakfast may also play a role. Analyzing data from more than 10,000 people who participated in the National Health and Nutrition Examination Survey (NHANES), researchers at Northwestern University found that those who ate breakfast before 8:30 a.m. had lower blood sugar levels and less insulin resistance, which could reduce the risk of developing type 2.
Not a fan of traditional breakfast foods? Keep in mind that “there are no rules about what foods need to be eaten at breakfast — choose things that are easy and you enjoy,” Maryniuk says. Melted cheese in a tortilla with avocado? Sure, that can be breakfast. A high-protein smoothie made with yogurt or cottage cheese and berries? That can be breakfast, too. Just make sure you include protein and fat (egg, cheese, tofu, nut butter), as well as a fiber-rich carb like whole fruit or whole-grain toast, she adds. And coffee lovers, drink up: A large review of studies published in Nutrition Reviews found the risk of type 2 diabetes decreased by 6 percent for each cup-per-day increase in coffee consumption.
2. Sitting for longer than 30 minutes at a stretch
You already know that regular exercise is key to warding off a diabetes diagnosis. What you may not know is that sitting for prolonged periods — at the computer, on the couch, behind the wheel — carries risks of its own.
A large study of more than 475,000 people, published in 2021 in Diabetes Care, found that replacing just 30 minutes a day of sedentary behavior with physical activity was associated with a 6 to 31 percent lower risk of type 2 diabetes. The researchers found that strenuous sweat sessions showed the greatest benefit.
That’s why the American Diabetes Association (ADA) recommends everyone — even people who don’t have diabetes — get up every 30 minutes and do some form of light activity.
“Many studies now show that interrupting sitting with frequent movement improves how well your metabolism works and increases insulin sensitivity,” says Sheri Colberg, professor emerita of exercise science at Old Dominion University in Norfolk, Virginia, and author of The 7 Step Diabetes Fitness Plan. “Most people with prediabetes or type 2 diabetes have some degree of insulin resistance; moving frequently may lower it.”
To break the sedentary habit, start by noting how much time you spend sitting. Then look for ways to reduce that amount: Set the alarm on your phone to stand up and move for a few minutes every half hour; do stretches during commercials while watching television; pace the house during phone calls.
3. Drinking more than a glass of wine or two daily
Nothing wrong with having a glass of wine. But go beyond the one-to-two drink mark and things suddenly change. “Within limits, alcohol is linked with a number of health benefits including reduced inflammation, decreased clots and decreased insulin resistance, which is linked to type 2 diabetes,” explains Maryniuk, who notes these gains are seen most in women and in non-Asian populations.
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To reap only the rewards of a daily tipple, follow the recommendation of the ADA and other health organizations and limit consumption to no more than one drink per day (for women) and a maximum of two per day (for men). While the links between drinking a moderate amount of alcohol and reducing your risk for diabetes are not definitive, “we do know that too many calories can lead to weight gain, and carrying excess weight is a risk factor for type 2 diabetes,” Maryniuk says. “It’s easy for the plan to have ‘one drink a day for my health’ to turn into two drinks — plus cheese and crackers and chips and dip. Before you know it, the possible health benefits have been wiped away with the additional calories and likely weight gain.”
Plus, too much alcohol can lead to chronic inflammation of the pancreas, which can impair its ability to secrete insulin, potentially leading to diabetes, according to the Mayo Clinic.
4. Skimping on shut-eye
It isn’t the occasional bout of insomnia that wreaks havoc here. It’s the night-after-night, chronic sleep deprivation that raises your risk for diabetes. In a study published in 2020, in Diabetologia, researchers looked at the DNA of nearly 900,000 people and found that those with insomnia were 17 percent more likely to develop type 2 diabetes than those without.
How so? “With ongoing sleep loss, your hormone levels can get thrown out of balance,” Maryniuk says. As a result, “the body may release more stress hormones, such as cortisol, which push up blood sugar. In addition, less insulin is released after meals leading to higher blood glucose levels. These two factors over time increase blood glucose — and raise the risk of getting diabetes.”
That’s not all: Research shows that poor sleep (in terms of both quantity and quality) also increases your appetite and reduces your level of satiety, causing you to crave carbs and sweets in particular. Besides affecting insulin and blood sugar levels, that can lead to weight gain.
Add this to the long list of incentives to give up cigarettes: Smokers are 30 to 40 percent more likely to develop diabetes than nonsmokers, and heavy smokers have an even greater risk, according to the Centers for Disease Control and Prevention (CDC). Experts can’t establish a direct cause-and-effect link, given how other risk factors — like stress, diet, levels of physical activity and distribution of body fat — are hard to separate out. But a review of studies published in a 2019 issue of Diabetology & Metabolic Syndrome suggests that cigarette smoking was the sole culprit in at least 25 million cases of diabetes worldwide.
Struggling to kick the habit? Talk to your doctor about what method makes sense for you. A 2020 report from the U.S. Surgeon General suggests that a combination of behavioral support, smoking cessation meds (like Chantix and Zyban) and nicotine replacement therapy (such as patches, lozenges, nasal spray and gum) may double your chances of quitting.
6. Eating processed foods
Highly processed foods — such as many cereals, deli meats and microwaveable dinners — have long been linked to an increased risk for things like cancer, depression and cardiovascular disease. A recent study in JAMA Internal Medicine suggests that diabetes should be added to the list. Each 10 percent increase in the amount of ultraprocessed foods in participants’ diets was associated with a 15 percent higher risk of developing diabetes. At least part of the reason has to do with weight gain. Researchers found that those who consumed more processed foods tended to eat more calories overall, have lower quality diets and be more likely to be obese and inactive.
“Typically, more highly processed foods don’t provide the fullness that whole foods provide,” explains Kara Mitchell, a registered dietitian and certified diabetes educator at the Duke Health and Fitness Center in Durham, North Carolina. “More highly processed foods tend to correlate with higher calorie intake. Too many calories leads to excess weight; excess weight leads to increased risk of insulin resistance.”
An easy way to spot an ultra-processed food: Check the list of ingredients. If you see a long list of unpronounceable ingredients, that’s a tip-off.
7. Lacking quality connections with others
If there’s one lesson COVID-19 has taught us all it’s that spending extended amounts of time away from close friends and family can take a toll. After almost a year into the pandemic, more than 42 percent of people surveyed by the U.S. Census Bureau reported symptoms of anxiety or depression, up from 11 percent the previous year, Nature reports.
Now research suggests that prolonged loneliness can also raise your risk for type 2 diabetes. In a study published in 2020 in the journal Diabetologia, researchers found that the absence of quality connections with people — as opposed to simply living alone or lacking contact with others — may play a role in developing type 2 later in life. Although they aren’t quite sure why, they say that focusing more on the quality of your social relationships, as opposed to the quantity, may help lower your risk for type 2.
Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Men’s Health and Reader’s Digest.
Editor's note: This story, originally published Jan. 8, 2021, has been updated to include new information.