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Exercise and a healthy diet have been shown to control blood glucose levels in people with type 2 diabetes.

Most of us love to eat and find a lazy life just too good to resist. But the combination of fattening foods and inactivity is making us unhealthier than ever and our lifestyles are triggering what the International Diabetes Federation (IDF) is calling a “health tsunami” of non-communicable diseases, of which diabetes is one.

Diabetes and obesity are a dangerous combination and prevalence of both is increasing at an alarming rate with up to 400 million people likely to develop diabetes (mostly type 2) in the next 15 to 20 years, unless action is taken.

Diabetes is not just a disease of the affluent – the World Health Organisation warns that developing countries will be hardest hit in decades to come and that even now, 70 percent of those living with type 2 diabetes live in low or middle income countries.

South Africa’s rocketing obesity rates are also fuelling a rise in diabetes and the prevalence in some population groups has reached almost 12 percent.

The good news is that diabetes type 2 in obese people can be very successfully controlled with diet and exercise.

A study by Newcastle University in the UK made international headlines this year with the claim that, with a low-calorie diet and exercise, type 2 diabetes could be “reversed”.

Some experts believe that reversal is not possible and that “remission” is more accurate – but as long as weight loss and exercise are maintained, blood glucose levels can be well controlled.

Dr Aslam Amod, a Chatsworth-based endocrinologist and diabetologist, estimates that 70 to 80 percent of type 2 diabetes could be prevented if we tackled obesity.

“In patients in whom obesity is the main driver for diabetes, significant weight loss (by diet or surgery), can result in diabetes being ‘reversed’ as long as the weight loss is maintained, for up to 10 years,” he says.

“There is insufficient data in the long term to say for certain whether this effect will last for ever – it is impossible to say whether the diabetes will return after 15 to 20 years, even if weight loss is maintained.”

If it is that simple, why are more type 2 diabetics not nibbling on nuts and pounding the pavements?

“Most people find it difficult to maintain permanent lifestyle changes – they lose weight initially over six months and regain it rapidly.

“Most type 2 patients will need insulin therapy seven to 10 years after diagnosis but intensive lifestyle modification and weight loss at diagnosis can make a huge impact on the progression in obese people, to the extent that they may require no or very little medication, if they maintain the lifestyle change.”

Amod stresses that this applies only to diabetics who are obese.

Reducing calories and stopping treatment in non-obese type 2 patients or type 1 patients could have fatal consequences, so professional medical advice should always be sought.

Pre-diabetes is also on the increase and Amod says this is the most important stage where lifestyle modification can make a difference.

“If an obese person manages to lose weight and maintain his or her weight loss at this stage (the target is a waist circumference of smaller than 90cm in men and smaller than 80cm in women), they can reverse the pre-diabetes stage and diabetes can be prevented in 60 to 80 percent of cases, provided weight loss is maintained.”

Some people develop type 2 diabetes because the pancreas does not make enough insulin – this is called primary pancreatic beta cell failure, says Amod.

“These people tend to be of normal weight or less overweight than usual, and weight loss does improve the ability of the pancreas to make insulin.

“This is in contrast to obese diabetics who actually make more insulin than normal, but even this extra insulin is not enough to keep their blood sugar normal because their bodies resist the effects of insulin. This is the body’s attempt to stop gaining weight (insulin causes you to store glucose and fat).

“This is a huge misconception – many people believe that they are obese because they have insulin resistance. In fact, they are insulin resistant because they are obese, and this is exactly what the Newcastle study showed – that insulin resistance and pancreatic function are improved when a person loses weight.

“If we try to treat the insulin resistance with medication, without the person losing weight, then by making them more sensitive to insulin, they actually gain more weight.”

Jenny Russell, branch manager of Diabetes South Africa Durban, says she is seeing excellent results from weight loss and exercise in support groups run by the organisation.

“Unfortunately, many people only make contact with us after a cardiac event, stroke or amputation.

“We would like them to make contact sooner so we can help prevent complications.

“It is imperative that diabetics are educated about this devastating silent killer.”

* Call Diabetes South Africa at 084 7177 443 or 0861 222 717 or e-mail durban@diabetessa.co.za See also www.diabetessa.co.za