Dear Medicine: Diabetes Prevention Is Not Your Battle to Fight

Abstract

Dear Medicine, You need help. We know that you have been trying to handle chronic diseases, especially diabetes, by yourself; however, there are 422 million adults with diabetes worldwide, and prevalence continues to grow. 1 We are writing to let you know that prevention is not your battle to fight. While Type 1 Diabetes—an autoimmune disease—has been increasing, Type 2 Diabetes (or T2D) still causes the lion’s share of cases (90 to 95% according to the Centers for Disease Control and Prevention 2). It is clear that genetics, lack of physical activity, stress, and sleep patterns play a role, but there is a growing consensus that T2D’s principal trigger is the type of food we eat. 345 This relationship can be conceptualized as a bathtub, as shown in Figure 1. The food that we put in our bodies can be thought of like water flowing into a bathtub; the food we eat must be metabolized at a certain rate in the same way that water must flow out of the tub to avoid overflowing. However, in this case, it is not as simple as “calories in, calories out.” The metabolism rate—or drain capacity—is affected by the amount, type, and glycemic load of the food we eat. Consuming high-glycemic load food causes the secretion of excess insulin, which ends up circulating in the blood, causing fat accumulation and insulin resistance, which over time cause T2D. Independent of genetics or physical activity, the unhealthy food pouring out of this faucet is the principal driver of the T2D epidemic 6 7 So, Medicine, why act as if it is the same to focus on the faucet as on the drain?