Diabetes is a disease caused by the inability of the body to properly produce insulin, a hormone that helps the body convert food to energy. In type 1 diabetes the body does not produce insulin at all. This type of diabetes is usually diagnosed during childhood. In type 2 diabetes the body does not produce enough insulin or it produces insulin which is ineffective in regulating the body's blood sugar levels. This type of diabetes is usually diagnosed later in life and is commonly called adult onset diabetes.

Diabetes is an important health concern because incidence of the disease worldwide is increasing. It is also associated with other health risks and is expensive to treat and control. Also, diabetes is a major cause of death worldwide.

The number of cases of diabetes is increasing around the world. The incidence of diabetes in 1995 numbered about 135 million worldwide, about 4.0% of the population. Diabetes affected 170 million people in 2000 and is projected to affect about 300 million people by 2025, about 5.4% of the population. India, China, and the United States have the largest number of cases.

In a recent year direct medical expenses in the United States for diabetes totaled $92 billion, up from $44 billion five years earlier, according to the American Diabetes Association. Another $40 billion was spent on permanent disability expenses. Care for diabetes represents about 11% of the total health care expenditures in the United States. In 1997 annual health care costs for a person with diabetes averaged $10,071 and increased to $13,243 by 2002. That annual rate is more than 5 times greater than the average annual health care costs for a person without diabetes. Also diabetes accounted for an annual loss of about 88 million disability days.

The mortality rate for people with diabetes runs about 5.2% of all deaths according to the World Health Organization. In 2000 about 2.9 million deaths worldwide were caused by diabetes. In another 4.5 million deaths diabetes was a contributing factor.

The good news is that type 2 diabetes can be delayed or prevented from ever developing. Before people develop type 2 diabetes, they nearly always develop the condition known as "pre-diabetes." This condition occurs when blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Studies have shown that people with a pre-diabetic condition can control the condition with lifestyle changes or with medicine. With reasonable treatment they can greatly increase their chances that they will never develop diabetes.

The American Diabetes Association created a publication called, "The Prevention or Delay of Type 2 Diabetes." The following are some of the findings and recommendations from the ADA.

About 41 million Americans have the pre-diabetic condition. There are two tests commonly used by physicians to determine whether a person has pre-diabetes. One test is called the fasting plasma glucose test, or FPG, and the other is called the oral glucose tolerance test, or OGTT. Both tests have a normal range and a diabetic range. The range in between indicates the pre-diabetic condition.

The FPG test is more convenient to patients, less expensive, and easier to administer than the OGTT test. On the other hand the OGTT will detect more cases of glucose intolerance and undiagnosed diabetes than the FTP test. Either test should be repeated in 3 year intervals.

Once a diabetic or pre-diabetic condition has been diagnosed, a person has two choices of treatment. One strategy is to use lifestyle modifications such as a change in diet and an increase in physical activity, and the other strategy is to use glucose-lowering drugs that have been approved for treating diabetes. Studies indicate that the drug therapy is about half as effective as the diet and exercise therapy in delaying the onset of diabetes. Lifestyle changes have been proven effective as a way to prevent type 2 diabetes from developing from the pre-diabetic condition. Diet and exercise, in many cases, are able to return the blood glucose levels to the normal range.

Lifestyle changes include a combination of losing 5% to 10% of body weight, reducing total fat calorie intake, reducing saturated fat calorie intake, increasing fiber intake, and exercising at least 150 minutes per week. One study, called the Diabetes Prevention Program study, showed that a treatment using the combination of 30 minutes per day of moderate physical activity and a 5% to 10% reduction in body weight resulted in a 58% reduction in the incidence of diabetes.

The type of physical activity recommended by the ADA includes aerobic exercise, strength training, and flexibility exercises. The goal of the aerobic exercise is to increase heart rate, raise the breathing rate, and exercise the muscles. The goal is to exercise for 30 minutes a day, 5 days per week. The 30 minutes can be split into 10 minute intervals. This type of activity includes brisk walking or running, dancing, swimming or water aerobics, skating, tennis, bike riding, gardening, and house cleaning. Strength training, performed several times a week, helps to build more muscle, making everyday chores easier, and helps to burn more calories, even at rest. Flexibility exercise, simple stretching, helps to keep joints flexible and helps to reduce chances for injury during other activities.

Dietary changes are an important part of a pre-diabetes treatment. A body mass index test (BMI) can be administered and calculated easily. A BMI test result that is greater than 25 means that a person is above their ideal weight and a person with a BMI result greater than 30 is considered obese. The goal in the first instance is to decrease body weight by 5% and in the second instance by up to 10%. It is recommended that a person consult a physician who can help to develop a dietary plan that will achieve the desired weight loss.

The effects of type 2 diabetes are expensive and dangerous to one's health. Fortunately, diabetes can be delayed or prevented by adopting a reasonable program of diet, weight control, and exercise.