More moderate to vigorous physical activity could reduce type 2 diabetes risk

From medicalnewstoday.com

• Recent research suggests that higher levels of moderate-to-vigorous physical activity (MVPA) may more effectively reduce the risk of type 2 diabetes compared with lower MVPA levels.
• These findings were strongest in adults 62 years or younger, though older adults still saw benefits in reducing the risk.
• Experts advise that aerobic exercise and resistance training can be beneficial in helping reduce the risk of type 2 diabetes and manage prediabetes.

Physical inactivity is a known risk factor for type 2 diabetes. There are around 40 million people in the United States with some type of diabetes, and type 2 diabetes accounts for around 90% to 95%Trusted Source of all diabetes cases.

Type 2 diabetes can develop if the body does not make enough insulin or if it does not respond to insulin correctly. Overweight, age, and conditions such as prediabetes and metabolic dysfunction-associated steatotic liver disease (MASLD) are also risk factors.

New research published in August in Diabetes, Obesity and MetabolismTrusted Source suggests that moderate-to-vigorous physical activity (MVPA), in particular, could help reduce the risk of type 2 diabetes in adults.

The researchers examined data from almost 88,000 participants in the UK Biobank. They found that individuals in the lower-MVPA group had twice the relative risk of developing type 2 diabetes compared with those in the higher-MVPA group.

The largest relative risk reduction was observed in adults under 63 years of age.

Higher levels of moderate-to-vigorous physical activity could help reduce the risk of type 2 diabetes, according to recent research. GCShutter/Getty Images

Higher MVPA could significantly reduce risk of type 2 diabetes

With a hazard ratio of 2.07, lower MVPA volume was associated with almost twice the risk of type 2 diabetes compared with higher MVPA volume.

The higher MVPA group accumulated a median of 409 minutes of exercise per week. The study authors note that all participants in this group met the World Health Organization (WHO)’sTrusted Source guidelines of at least 150 minutes of moderate aerobic activity per week.

The lower MVPA group accumulated a median of 121 minutes of exercise per week. Around 37% of participants in this group reached the WHO’s minimum recommendation of 150 minutes per week.

Opel Baker, MBChB, general practitioner at the Mayfield Clinic, spoke with Medical News Today about the significance of these findings.

“An HR of 2.07 is clinically meaningful. […] Importantly, this is an observational study, so it shows a strong association rather than proving that lower activity directly caused diabetes,” said Baker, who was not involved in the study.

“Nevertheless,” Baker added, “it reinforces something we see in general practice: physical activity is one of the most powerful and accessible tools we have for improving insulin sensitivity and reducing diabetes risk.”

David Cutler, MD, board certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA, who was also not involved in the study, told MNT:

“An HR of 2.07 doesn’t mean that an individual person’s probability of diabetes literally doubles. It means that the rate of developing diabetes was approximately twice as high in the lower-activity group after adjustment.”

He added, “This data reinforces the message that physical activity isn’t merely a treatment for diabetes — it is an important component of diabetes prevention. This is not new information. Regular exercise improves insulin sensitivity, helps control visceral fat, improves skeletal-muscle glucose uptake, and favourably affects lipid metabolism.”

Adults 62 years or younger saw greatest risk reduction

The study found that the relationship between physical activity levels and type 2 diabetes was stronger among younger adults.

Compared with people who had higher levels of MVPA, those aged 62.7 years or younger with lower levels of MVPA were 2.44 times more likely to develop type 2 diabetes.

Among adults aged 62.7 or older with low MVPA, they were 1.65 times more likely to develop the condition.

‘One of the most interesting findings in this study is the impact of age on the benefits of moderate-to-vigorous physical activity,” said Cutler.

“At first glance, the lower HR (hazard ratio) in older participants (1.65 vs 2.44 in younger participants) might suggest exercise is less beneficial in the elderly. But those numbers can be misleading. The authors found that, although the relative association became weaker with age, the absolute difference in diabetes incidence became larger with age. That’s an important clinical distinction.”

Baker also spoke with MNT about these findings.

“What I find particularly interesting is that the relationship wasn’t identical across different age groups. The relative association between lower activity and diabetes risk was stronger in younger participants. […] But that doesn’t mean exercise becomes less important as we age,” he said.

“In fact, the absolute difference in diabetes rates between the more and less active groups became larger with age. It suggests that staying active throughout life may be particularly important because baseline diabetes risk rises with age. It is never too late to become more active,” he added.

Prediabetes management with higher MVPA

The study authors note that higher MVPA volume was associated with a lower risk of type 2 diabetes among people with prediabetes.

Baker said that exercise with prediabetes should be thought of as “management rather than simply prevention.”

He explained that “exercise improves insulin sensitivity, meaning the body becomes better at using glucose. For someone with prediabetes, increasing activity can therefore help bring blood glucose back toward the normal range and reduce progression to type 2 diabetes.”

He added, “The important point is that there isn’t necessarily a completely different exercise prescription for someone with prediabetes. The starting point should be realistic and sustainable, then gradually built up according to the person’s fitness, health, and goals. Strength training is also valuable because maintaining and building muscle helps with glucose disposal.”

Does the exercise type and duration matter?

The research did not focus on the type of exercise. Instead, it looked at the intensity of the workouts, with greater amounts of moderate to vigorous physical activity generally yielding stronger results.

Cutler advises that, “[f]or diabetes prevention, there is good rationale for combining aerobic exercise (brisk walking, cycling, swimming, jogging, hiking) with resistance exercise (weights, resistance machines, bands, body weight exercises).”

He added that “resistance exercise is particularly interesting because skeletal muscle is a major site of glucose disposal. Increasing or maintaining muscle mass and improving muscle insulin sensitivity can therefore be metabolically important.”

The study authors found that participants in the higher MVPA group had a median of 409 minutes of exercise each week, compared with 121 minutes in the lower MVPA group.

We asked Baker how achievable these numbers are for the average person compared with the WHO’s recommendation of 150 to 300 minutes of moderate aerobic activity per week for optimal health and well-being.

“I wouldn’t want people to look at the 409-minute figure and think they have failed if they aren’t exercising for nearly seven hours a week. That was the median activity level of the higher-MVPA group in this particular study, not a recommended target,” Baker explained.

“The researchers also defined their higher and lower activity groups according to the age-specific median, rather than using 409 minutes as a clinical threshold. For the average adult, 150 minutes of moderate activity a week remains a very sensible and achievable target, alongside muscle-strengthening activity on at least two days."

https://www.medicalnewstoday.com/articles/more-moderate-to-vigorous-physical-activity-could-reduce-type-2-diabetes-risk 

This Habit Could Cut Your Type 2 Diabetes Risk in Half, New Study Says

From eatingwell.com

Keep your cardio routine, but don’t skip the weights 

KEY POINTS 

• Experts recommend you engage in both aerobic and muscle-strengthening exercise each week.
• Individuals who incorporate both types of exercise may have a lower type 2 diabetes risk.
• Moving throughout the day and performing body-weight exercises are good places to start.

If you’ve ever gone to the gym to exercise, chances are you’ve witnessed firsthand the divide between those doing cardio and those doing strength training. On one side of the gym, you have the aerobic exercisers logging miles on the treadmill, shuffling on the elliptical or riding a stationary bike. On the other, you’ve got resistance trainers repping out chest presses, dropping into weighted squats or curling dumbbells into biceps curls.

And while neither the cardio-lovers nor the strength-trainers are right or wrong, there can seem to be a divide between the two. That’s despite recommendations that adults should get both types of exercise each week—at least 150 minutes of moderate-intensity aerobic activity, plus two days of muscle-strengthening activity. Research also suggests that engaging in both types of physical activity is associated with a lower risk of several chronic conditions, including heart disease, high blood pressure, type 2 diabetes and certain types of cancer.

Now, new research adds to the case for incorporating both aerobic exercise and resistance training. A recent study published in the Journal of Science and Medicine in Sport found that people who regularly engaged in both aerobic and muscle-strengthening activities had a lower risk of developing type 2 diabetes along with several chronic conditions.

                                                          Credit:  Design elements: Getty Images. EatingWell design

How Was the Study Conducted?

Researchers gathered data for this study from the HABITAT (How Areas in Brisbane Influence Health and AcTivity) cohort, a large study of more than 11,000 adults ages 40 to 65 living in Brisbane, Australia. The cohort followed participants over nearly a decade, with surveys conducted in 2007, 2009, 2011, 2013 and 2016.

For this analysis, researchers used a sample size of about 8,000 individuals from the HABITAT cohort. The researchers looked at participants’ physical activity and health history. Participants reported their physical activity by tracking how much time they spent walking and doing moderate- and vigorous-intensity physical activity, as well as how often they participated in muscle-strengthening activities like weight lifting and other exercises designed to increase strength.

Researchers then grouped participants into categories based on whether they met the recommended amount of aerobic activity, muscle-strengthening activity, both or neither. The recommended amount of aerobic activity was at least 150 minutes of moderate-intensity activity per week, while the recommendation for muscle-strengthening exercise was at least two days per week.

In addition to tracking their physical activity, participants also reported whether they had been diagnosed with long-term health conditions, defined as conditions lasting six months or longer. For this study, researchers were specifically interested in the development of diabetes (both type 1 and type 2), cardiovascular disease, high blood pressure and cancer.

Overall, the aim of this study was to investigate the combined effects of meeting both aerobic and muscle-strengthening exercise guidelines and whether that had an impact on the incidence of those four major chronic diseases.

What Did the Study Find?

Researchers found that meeting both aerobic and muscle-strengthening activity guidelines was associated with about 50% lower odds of developing type 2 diabetes. There was also a potential association with lower risk of developing high blood pressure, cancer and heart disease, though those findings were less consistent.

In terms of the types of physical activity participants engaged in, the results looked like this:

• Aerobic activity only: About 50% of participants met only the aerobic activity guideline from 2007 to 2011, falling to about 40% from 2011 to 2016.
• Muscle-strengthening activity only: About 1% of participants met only the muscle-strengthening guideline throughout the study period.
• Both aerobic and muscle-strengthening activity: About 12% met both guidelines from 2007 to 2011, increasing to about 23% from 2011 to 2016.
• Neither activity guideline: About 37% of participants met neither guideline throughout the study period.

Together, these numbers highlight how much more common aerobic activity was than strength training among participants. And, although the percentage meeting both guidelines increased over time, muscle-strengthening activity alone remained uncommon.

The strongest and most consistent finding was the association between meeting both physical activity guidelines and lower odds of developing type 2 diabetes. Some findings also pointed to lower odds of heart disease, cancer and high blood pressure among participants who met one or both activity recommendations, but those associations were less consistent.

How Does This Apply to Real Life?

Researchers emphasized the importance of promoting both types of activity in public health initiatives to highlight the value of this combined approach for chronic disease prevention. The study also highlights a potential gap in physical activity, as aerobic activity was much more common than muscle-strengthening activity among participants. Making sure people understand that resistance training is an important part of a health-promoting exercise routine could help close that gap.

It’s probably no surprise that regular physical activity is associated with better health outcomes and a lower risk of developing certain chronic conditions like type 2 diabetes. This study adds to a growing body of evidence that both aerobic activity and muscle-strengthening exercise have a place in a well-rounded physical activity routine. While it may feel overwhelming to incorporate both types of exercise into your schedule, we’ve rounded up a few simple strategies to help you bring more movement into your week in an approachable, sustainable way.

• Break up movement throughout the day. It’s not necessary to get all your aerobic activity from one long sweat sesh. Instead, consider things like taking the stairs instead of the elevator, going for a 20-minute walk during lunch or squeezing in a few jumping jacks between meetings.
• Start with body-weight exercises. You don’t need a home gym—or a gym membership—to strength-train. Exercises like squats, lunges, push-ups and planks can help build muscle using your own body weight.
• Build a routine you can maintain. Schedule workouts at times that realistically fit into your week. Staying consistent is the most important.
• Make it social. Take a workout class with a friend, join a walking group or find a strength-training buddy. Having someone to move with can make physical activity more enjoyable and provide extra motivation.
• Don’t forget recovery. More exercise isn’t necessarily better. Give your muscles time to recover between aerobic and strength-training sessions, especially when you’re starting a new routine.

Our Expert Take

The results from a recent study published in the Journal of Science and Medicine in Sport suggest that meeting both aerobic and muscle-strengthening activity guidelines may be particularly beneficial for type 2 diabetes prevention. While the study found some associations between physical activity and lower odds of heart disease, high blood pressure and cancer, those findings were less consistent. That said, these findings add to a growing body of research that suggests that the combination of both activity types is important in chronic disease prevention.

https://www.eatingwell.com/exercise-diabetes-risk-study-12064005

Diabetes prevention starts as early as conception, experts say

From kcl.ac.uk

Preventing type 2 diabetes could require action much earlier in life, according to experts calling for a new approach to protecting metabolic health 

A new perspective article in Nature Medicine, led by Andreas Birkenfeld, Medical Director of the Department of Internal Medicine IV at University Hospital Tübingen and Transcampus Professor of Diabetes at King’s College London, argues that preventing type 2 diabetes (T2D) should move beyond waiting until people develop abnormal blood glucose levels and instead focus on maintaining healthy metabolism throughout life.

Around 90–95% of people living with diabetes have type 2 diabetes, which develops through a complex combination of genetic, biological, environmental and lifestyle factors. While current prevention approaches often focus on people who have already developed prediabetes, the authors argue that this may miss opportunities to intervene earlier.

The researchers propose a life-course approach that recognises T2D as a gradual process, with metabolic changes accumulating over many years before the disease develops. They suggest that prevention should focus on identifying periods when people are more metabolically vulnerable and providing targeted support to preserve or restore metabolic health.

The paper brings together an international group of experts who identified ten priorities for improving diabetes prevention. These include redesigning screening approaches across the life course, recognising differences between individuals, developing clearer stages of disease progression and ensuring prevention strategies are accessible across different socioeconomic settings.

The authors argue that, rather than focusing only on preventing progression to diabetes, a key goal should be prediabetes remission, which means restoring and maintaining normal blood glucose levels (normoglycaemia).

The researchers also highlight that diabetes risk is not constant throughout life. Instead, there are periods when people may be more susceptible to metabolic changes. The first opportunity for prevention may begin before conception. Evidence suggests that the metabolic health of both parents, including factors such as obesity, may influence a child’s future metabolic health.

Pregnancy is another important window. During pregnancy, the body naturally becomes more resistant to insulin to support the developing baby. Some women are unable to compensate for this increased demand and develop gestational diabetes. Women who experience gestational diabetes have a substantially increased risk of developing type 2 diabetes later in life, making the period after pregnancy an important opportunity to monitor metabolic health.

The authors also highlight childhood and adolescence as important stages for protecting metabolic health. Increasing sedentary behaviours, including prolonged screen time, alongside changes in diet and activity levels, may contribute to future diabetes risk.

Later life stages, including midlife and menopause, represent further periods of increased vulnerability. For women, changes in hormone levels during menopause can contribute to changes in body composition and metabolism, which may increase diabetes risk.

We think it is no longer sufficient to wait until someone has prediabetes or diabetes before taking action. We need to recognise the stages of life when people are more metabolically vulnerable and use these as opportunities to tailor prevention and protect metabolic health.

Professor Andreas Birkenfeld, Medical Director at University Hospital Tübingen and Transcampus Professor of Diabetes at King’s College London

The article suggests that prevention should become more personalised, using information such as family history, changes in weight over time, pregnancy-related diabetes and emerging biomarkers to better understand an individual’s risk. The authors also call for future prevention research to look beyond blood glucose measurements alone and consider wider health outcomes, including cardiovascular and kidney health.

https://www.kcl.ac.uk/news/diabetes-prevention-starts-as-early-as-conception-experts-say

Diabetes Guide: Types, Symptoms, Causes and Treatments

From wtop.com/news

When you look at the numbers, the rate of diabetes in the U.S. is alarming. One in eight adults in the United States has diabetes, according to 2026 estimates from the Centers for Disease Control and Prevention. On top of that, an estimated 42% of adults have prediabetes, a condition that frequently progresses to diabetes if unmanaged.

What makes the growing prevalence of diabetes so concerning is that living with diabetes puts people at higher risk for other serious health problems. Diabetic retinopathy, for instance, is the leading cause of blindness in working-age adults and can lead to end-stage renal disease. Furthermore, if you have diabetes, you’re twice as likely to have heart disease or a stroke than someone who doesn’t have the disease. 

Types of Diabetes

There are several different types of diabetes. The most common are Type 1 and Type 2 diabetes.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease in which the body’s immune system mistakenly attacks and destroys insulin-producing cells, known as beta cells, in the pancreas. Once these cells have been attacked, the body is unable to manufacture enough insulin on its own. Insulin is responsible for:

— Converting energy by turning sugar from carbohydrates into usable fuel

— Storing glucose for your body to use for future activities

— Regulating blood sugar levels so they don’t spike or drop too low

Formerly known as juvenile diabetes and insulin-dependent diabetes, Type 1 diabetes requires lifelong management.

Type 2 diabetes

While Type 1 diabetes is characterized by a complete lack of insulin, Type 2 diabetes develops when the body becomes resistant to the insulin it does produce. This is far and away the most common type of diabetes. About 95% of people with the disease have Type 2 diabetes, also known as noninsulin-dependent diabetes, the CDC reports.

Prediabetes

Almost half of the U.S. adult population, about 115 million adults, have prediabetes, the CDC notes. If left untreated, prediabetes can lead to Type 2 diabetes.

But prediabetes is not just a warning sign for diabetes; it is its own independent health condition. The insulin resistance that occurs in prediabetes can also lead to cancer, coronary artery disease, dementia and many of the other health conditions that diabetes can cause.

Gestational diabetes and other secondary types

While Type 1 and Type 2 account for nearly all diabetes cases, gestational diabetes and other secondary types of diabetes also occur.

— Gestational diabetes: This type develops during pregnancy in people who do not already have diabetes, affecting between 5% and 9% of pregnancies in the U.S. annually, according to the CDC. Gestational diabetes can raise the risk for a number of health issues, including high blood pressure during pregnancy and having a large baby, which can increase the chance of injuries during delivery to the mother or child. A cesarean section is sometimes needed in these situations.

— Type 3 diabetes: Some researchers have theorized that there is a Type 3 diabetes that causes Alzheimer’s disease. These researchers believe Alzheimer’s disease is caused by a kind of insulin resistance and insulin dysregulation in the brain. However, most health associations and many clinicians do not recognize Type 3 diabetes as an official diagnosis.

— Type 3c diabetes: Type 3c diabetes, often misdiagnosed as Type 2 diabetes, is a little-known form of diabetes also known as pancreatogenic diabetes. This form of diabetes occurs when the pancreas stops producing enough insulin, which can happen with illnesses such as pancreatic cancer, pancreatitis or hemochromatosis. Type 3c diabetes is estimated to affect 5% to 10% of all people with diabetes, according to research published in the Journal of the American Academy of Physician Assistants in 2022.

— Maturity onset diabetes for the young: This rare and inherited form of diabetes is caused by a gene mutation that disrupts insulin production.

— Latent autoimmune diabetes in adults: This form, often called Type 1.5, is a slow-progressing autoimmune condition frequently misdiagnosed as Type 2 diabetes.

Causes and Risk Factors

Depending on the type, diabetes can have multiple causes and risk factors.

Type 1 diabetes risk factors

The exact cause of Type 1 diabetes is unknown. However, the following factors may contribute to risk:

— Family history: Individuals with a parent or sibling with Type 1 diabetes have a slightly increased risk of developing the condition.

— Previous viral illness: A viral illness can trigger the immune system, which can lead to the development of Type 1 diabetes.

— Age: While Type 1 diabetes can appear at any age, it occurs at two noticeable peaks: The first peak occurs in children between ages 4 and 7, and the second peak is in kids between ages 10 and 14.

“While most people are diagnosed with Type 1 diabetes in their teens and 20s, people can develop Type 1 diabetes at any time. I once diagnosed a person in her 70s,” says Dr. Gillian Goddard, a New York City-based board-certified endocrinologist, nutritionist and adjunct assistant professor of medicine at the NYU Grossman School of Medicine.

Risk factors for Type 2, prediabetes and gestational diabetes

Because Type 2 diabetes, prediabetes and gestational diabetes share insulin resistance-related root causes, their risk factors overlap:

— Genetics and family history: If one parent has Type 2 diabetes, for instance, your chance of developing Type 2 diabetes is between 35% and 40%, Goddard says. If both parents have it, that probability surges to 60% or more.

— Lifestyle factors: Eating an unhealthy diet, combined with inactivity and having excessive fat, particularly around the abdomen, can contribute to your risk of developing prediabetes, gestational diabetes and Type 2 diabetes.

— Ethnicity: Individuals who identify as Black, Hispanic or American Indian have a higher risk of developing Type 2 diabetes.

— Gestational-specific age risk: Women over 25 are also more likely to develop gestational diabetes.

Symptoms and Early Warning Signs

Learning to recognize the early warning signs of diabetes can help you map out any preventive measures and potential treatment options.

Common symptoms of diabetes (all types)

— Increased thirst

— Frequent urination

— Bed-wetting in children who previously didn’t wet the bed at night

— Extreme hunger

— Unintended weight loss

— Irritability and other mood changes

— Fatigue and weakness

— Blurred vision

— Slow-healing sores

— Frequent infections

— Areas of darkened skin, typically around the armpits and neck

— Increased yeast infections

— Increased urinary tract infections

— Numbness or tingling in the hands and feet

Diabetic ketoacidosis symptoms

In addition to the symptoms above, people with diabetes with very high sugar levels may develop a condition called diabetic ketoacidosis, which has symptoms like:

— Nausea

— Vomiting

— Stomach pains

— Fruity odour to breath

— In severe cases, rapid breathing, known as Kussmaul respirations, which requires prompt emergency evaluation

Type 1 diabetes progression

Early symptoms of Type 1 diabetes are often easy to miss, says Dr. Bethany Gottesman, an endocrinologist at Phoenix Children’s Hospital in the greater Phoenix area.

“If you are diagnosed with Type 1 diabetes, there was nothing you did or did not do that caused the diabetes or could have prevented it,” she points out.

Type 1 diabetes has no cure and requires lifelong management. With modern technology, life expectancy for individuals with diabetes is now close to normal ranges.

Type 2 diabetes and prediabetes progression

Prediabetes and Type 2 diabetes typically progress slowly and develop over time, Gottesman says.

“After years of making increased amounts of insulin, eventually the pancreas can no longer produce enough to keep blood sugars in the normal range. So even though the body may still be making a lot of insulin, it is not enough to meet that person’s needs,” Gottesman explains.

Gestational diabetes progression

Many women may not have noticeable signs or symptoms of gestational diabetes because of their overlap with pregnancy-related issues, such as increased urination and fatigue.

Typically, gestational diabetes resolves after childbirth, but it does increase the likelihood of developing Type 2 diabetes later in life.

Diagnosis and Diagnostic Testing

Your primary healthcare provider can diagnose diabetes with an array of blood tests.

Test Type	Normal Range	Prediabetes Threshold	Diabetes Threshold	Details
A1c test	Below 5.7%	5.7% to 6.4%	6.5% or higher	The A1c test measures your blood sugar level over the past three months by tracking glucose attached to red blood cells.
Fasting blood sugar test	Below 100 mg/dL	100 to 125 mg/dL	126 mg/dL or higher	Your blood is taken first thing in the morning after you’ve avoided eating overnight, and it requires a follow-up A1c test if elevated.
Random blood sugar test	N/A	N/A	200 mg/dL or higher	This blood sample is drawn at a random time, regardless of meals, which requires a follow-up A1c test if elevated.
Oral glucose tolerance test for gestational diabetes	Below 140 mg/dL after one hour	140 to 189 mg/dL	190 mg/dL or higher at one hour	One hour after drinking a glucose solution, a lab technician checks your glucose levels. Borderline results require a follow-up three-hour test with three blood draws.

Treatment and Medical Management

Healthcare providers tailor treatments and medical management for the specific type of diabetes and the individual’s health needs.

Insulin

Insulin is an injectable peptide hormone that mimics the hormone naturally produced in the pancreas to regulate blood sugar.

Insulin treatments for diabetes may include:

Insulin Type	Example	Onset and Peak
Fast-acting	Humalog	Onset within 15 minutes and peaks an hour after injection, lasts up to four hours
Intermediate-acting	NPH or Humulin N	Onset within one to three hours after injection, reaches peak effectiveness between four and eight hours, lasts up to 12 hours
Long-acting insulin	Glargine	Onset after an hour, lasts 24 hours or longer

Insulin is a necessary and effective first-line treatment for Type 1 diabetes. People with Type 2 and gestational diabetes, however, often produce some insulin in their body, so they may not need insulin injections as part of their disease management regimen.

Noninsulin oral medications

Metformin is often the first drug prescribed for those with Type 2 diabetes and is sometimes prescribed for those with prediabetes. Metformin improves the body’s efficiency with the insulin that it does make.

Other medications that may help people with Type 2 diabetes lower their blood glucose levels include:

— Alpha-glucosidase inhibitors

— Biguanides (including metformin)

— Bile acid sequestrants

— Dopamine-2 agonists

— DPP-4 inhibitors

— Meglitinides

— SGLT2 inhibitors

— Sulfonylureas

— Thiazolidinediones

— Oral combination therapy

GLP-1s and dual GIP/GLP-1 agonists

The biggest recent advancement in treatment of Type 2 diabetes is more effective, long-acting GLP-1 and dual GIP/GLP-1 receptor agonists, Goddard says.

GLP-1 medications, such as semaglutide (Ozempic and Wegovy) and dual GIP/GLP-1 agonists tirzepatide (Mounjaro and Zepbound), are also injectable peptides, like insulin. These medications stimulate insulin production, slow gastric emptying and help regulate appetite.

“They not only lower blood sugar and help with weight gain, they also reduce the risk of cardiovascular disease, kidney disease and liver disease, all of which people with Type 2 diabetes are at increased risk for,” Goddard adds.

Blood glucose monitoring technology

People with diabetes need to monitor their blood sugar levels to manage their disease. 

The most cost-effective and common method is through a glucose meter, or glucometer. After you draw blood with a small finger prick, the glucometer measures your current blood sugar level.

There are also continuous glucose monitors, such as the Dexcom or FreeStyle machines, which are closed-loop systems that communicate with insulin pumps.

“These monitors adjust the rate at which insulin is given. It has been a huge step forward and uses technology to do a lot of work that patients and doctors used to do manually,” Goddard says.

Lifestyle Modifications and Prevention

Advanced medical technology and treatment are necessary for diabetes care, but lifestyle modifications and prevention strategies are still foundational for lowering the A1c naturally and protecting metabolic health.

The first step is creating goals for diabetes self-care, says Carole Jakucs, a board-certified diabetes nurse educator based in Los Angeles.

“We help patients identify what lifestyle habits they feel are important to change and what is doable and realistic for their lifestyle,” she explains.

Some of the goals that Jakucs suggests include:

— Exercise and physical activity: “One simple way to control post-meal blood glucose spikes is to take a 10-minute, moderate to brisk-paced walk after each main meal. If walking after each meal is not possible, then walking at least 15 minutes after the two largest meals or walking 30 minutes a day after the largest meal each day also helps,” she says. Generally, adults should aim for 30 minutes of aerobic activity five days per week.

— Dietary strategy and nutrition: Include lean protein with meals and snacks to delay gastric emptying, lessening your post-meal blood glucose spike. “Eating enough protein also helps to support muscle mass and increase satiety, which helps control appetite to prevent overeating,” Jakucs adds. Eating more fiber is also beneficial for blood sugar control and general health. If you are unsure what to eat, Jakucs recommends the “diabetes plate method”: Fill half your plate with non-starchy vegetables, such as greens, broccoli or squash; fill one quarter with lean protein, such as chicken; and fill the last quarter of your plate with a high-fiber carbohydrate, such as brown rice or quinoa.

— Carbohydrate counting: Counting carbs is especially important for anyone who is on mealtime (bolus) insulin and whose doctor has prescribed an insulin-to-carb ratio for dosing their bolus insulin appropriately.

— Weight loss if overweight or obese: “We know that if a person loses at least 5% to 10% of their weight, if they are overweight or obese, (that) can help reduce their level of insulin resistance and increase insulin sensitivity. This helps to lower their blood glucose,” Jakucs says.

— Quality sleep and stress reduction: “Emotional and physical stress and lack of sleep raise blood glucose because these raise the level of cortisol, the stress hormone, which triggers more glucose release from the liver,” Jakucs says. Aim for at least seven hours of quality, restorative sleep each night.

Long-Term Complications and Outlook

Diabetes, when left untreated, can cause long-term complications throughout the body:

— Heart and blood vessel disease

— Nerve damage (neuropathy)

— Kidney damage

— Eye damage, including cataracts, glaucoma and blindness

— Skin and mouth conditions

— Pregnancy complications, including risk of miscarriage, stillbirth and birth defects

— Slow healing of cuts and blisters

— Hearing impairment

— Sleep apnoea

— Alzheimer’s disease

— High blood pressure

Microvascular complications

Microvascular complications are when high blood sugar damages the body’s smallest blood vessels.

As glucose cells flow through the bloodstream, they injure the delicate linings of blood vessels. When glucose levels are consistently elevated, these vessels become weak and restrict blood flow. This can impact the eyes and the kidneys, which have vascular networks containing small capillaries and vessels.

Macrovascular complications

Diabetes also impacts larger blood vessels through inflammation and plaque build-up (atherosclerosis).

This effect causes narrowing and restriction of major vessels, blocking oxygen and leading to heart attack, stroke and peripheral artery disease.

Diabetic foot health

Food health is also a window into your overall diabetes management.

Because long-term elevated blood sugar damages both nerves and blood vessels, it damages the nerves and vessels in the feet. At the periphery of the body, the nerves in the feet are often the first to go, says Dr. Mikel Daniels, a board-certified podiatric surgeon and president and chief medical officer of WeTreatFeetPodiatry, with practices in Maryland, Washington, D.C. and Pennsylvania.

“They stop feeling pain, heat and pressure,” he adds. “I have patients who will walk in with a complaint of a blister that has opened into an ulcer through several layers of skin.”

Unmanaged diabetes can lead to:

— Absent pulses in the feet

— Shiny skin on the legs

— Thick nails

— Calluses and corns

— Skin ulcers

— Fungal infections in the toenails

Proper shoes, insoles, offloading (reducing pressure on the foot through special shoes, cushions or mobility devices) and diabetes management can change everything with your foot health, Daniels says.

To maintain your diabetic foot health, Daniels recommends checking your feet every day. Watch for:

— Colour changes, such as redness, darkening or streaks travelling up the foot or leg

— Redness around a callus or wound

— Pale or bluish colour

— Swelling

— Warmth

— Skin breakdown, such as cracks, blisters or open areas, regardless of size

— Drainage, such as blood or fluid

— Odour

— Temperature changes, such as one foot warmer than the other

— Nail and skin changes, such as thick, crumbly nails, fissures in the heel, white or soggy skin or dry and cracked skin

— Changes in shape, such as toes drifting or arch collapsing

If you notice any of these changes during an at-home foot check, message your primary care provider (PCP) or podiatrist right away. Even a small change, if left untreated, can lead to loss of function in the foot and sometimes require amputation.

https://wtop.com/news/2026/08/diabetes-guide-types-symptoms-causes-and-treatments/