How to Achieve Healthy Aging While Reducing Your Risk of Diabetes

With Eran Segal, PhD, W. Timothy Garvey, MD, and Derek LeRoith, MD, PhD

Sure, you think you’ve heard it all when it comes to your risk of type 2 diabetes. However, you might be cheered by recent findings from several experts about what you can do to improve your health outlook based on their presentations at the 16th World Congress on Insulin Resistance Diabetes and Cardiovascular Disease in Los Angeles, California.1-3

In fact, these diabetes specialists offer some advice to help you tackle weight loss for those still looking for a way to achieve the weight loss that has so far eluded you as well as some strategies that may help you age better, particularly when it comes to preserving your memory and reducing the risks associated with type 2 diabetes and obesity.

Seniors who are active and watch their weight will be healthier longer.Metformin may help people reduce the risks associated with diabetes and allow them to preserve their memory as they age. Photo: 123rf

For Better Blood Sugar Follow Your Gut

Could a personalized diet improve your blood sugar and your weight? It certainly seems like it.1

Here's the back story. For years, experts have looked at the gut microbiome—the bacteria—both good and bad— that naturally exist in the intestinal tract, and its effect on many aspects of health, including your body weight and blood sugar, among other measures.

Now, Eran Segal, PhD, professor of computer science and applied mathematics at the Weizmann Institute of Science in Rehovot, Israel, and his research team discovered that people can have very different blood glucose responses after eating the same foods.4,5 It appears that you may eat foods that you think are appropriate but that still cause your hemoglobin A1c levels to be unpredictable; while your spouse or a friend may consume the same diet with blood glucose levels that are beautifully stable in the healthy range.

Dr. Segal has devised a method to design a personalized diet created by predicting what your individual blood glucose response will be to specific foods. This model, or algorithm, accounts for the way foods affect your gut microbiota, then incorporates your physical activity and usual diet.

So far, the research has evaluated more than 1,000 people, wearing continuous glucose monitors to track blood sugar levels and matching that to changes in the bacteria present in their gut, 2 says Dr. Segal.

"When the same person eats the same meal on different days, the results are highly reproducible," he tells EndocrineWeb. However, when different people eat the same meal, their post-meal blood glucose response may be very different.

So by following the personalized diet, individuals have a better likelihood of improving post-meal glucose levels, a healthy goal that bodes well for overall diabetes control and weight management.

In an ongoing clinical trial that has enrolled 100 people with prediabetes out a planned total of 200 people, Dr. Segal's team is comparing those who eat a low-fat Mediterranean eating plan with those who follow a personalized diet based on the gut microbiome model.5

A key goal of the study is to see if the individuals on the personalized diet are able to achieve glucose levels considered normal in someone without diabetes. So far, he says, the current participants have demonstrated a decrease in post-meal glucose levels that are more sustained than those on the standard diet.5

For anyone interesting in learning more about the potential of a personalized diet, Day 2 is a company that licensed Dr. Segal's technology to analyze individual microbiomes and recommend a favorable diet to support a steady blood glucose level. Since this methodology is still very new, you might discuss the value of considering this concept for yourself with your doctor.

A Healthier Weight Is Possible When All Strategies Are Employed

For anyone facing overweight or obesity, you probably realize that weight loss will improve blood sugar levels if you already have type 2 diabetes. But the benefit of reducing your weight can also help delay a diagnosis of prediabetes from advancing, and reducing the risk of the complications associated with diabetes,2 according to W. Timothy Garvey, Butterworth Professor and director of the UAB Diabetes Research Center at the University of Alabama in Birmingham.

"If we don't make a greater impact in preventing diabetes, too many people are going to be in deep difficulty as time goes on," says Dr. Garvey during a presentation at WICR 2016.

Take heart, he says, the amount of weight loss needed is not a lot. Based on the results of the Diabetes Prevention Program, a change in weight (pounds lost) of just 5% is good, and 10% would be great.(x) "With a weight loss of 10%, it would mean preventing at least 80% of those at risk from developing diabetes."   

That is possible with modest lifestyle changes and the addition of available medications, particularly for weight loss, Dr. Garvey says.

Currently available anti-diabetes medications including metformin, acarbose, pioglitazone, rosiglitazone, reduce the risk of T2D by 31% to 72% when taking it for two to three years.

Equally favorable results are achieved for people who take medications approved for obesity to delay or prevent type 2 diabetes. Among the weight loss interventions using medications, here is how much various regimens help, Dr. Garvey says, citing published studies.

  • Orlistat (Xenical), over a 4-year period, reduced the risk of getting type 2 diabetes by 37% compared to not taking it.4
  • Phentermine/topiramate (Qysmia) reduced the onset by 79% over two years compared to not taking it.5
  • Liraglutide (Victoza), compared to placebo, taken over 3 years reduced the risk by 80%.6
  • Bariatric surgery 75% over 10 years

However, while medications are widely used to treat people once they develop type 2 diabetes, of the 29 million people diagnosed with type 2, 86% are on prescription medications, he tells EndocrineWeb; on the other hand, obesity affects 92 million people, yet fewer than 2% are on medications.  

With 40% of the adult population at risk of diabetes, there is an urgency to getting more people on board, using all the available strategies to promote weight loss. This is the only way to prevent the progression of chronic diseases that begin with overweight, the onset of both metabolic syndrome and/or prediabetes ultimately developing cardiometabolic disease—having type 2 diabetes and/or cardiovascular disease.Guo

Dr. Garvey makes a strong case for a shift in thinking—Everyone who needs to lose weight should before you develop diabetes. Let your doctor help.

You Can Take Actions to Grow Older and Healthier

You can't stop the birthdays, but there’s more reason to believe that you can stem the negative effect that type 2 diabetes may have on your cognitive function, says Derek LeRoith, MD, PhD, professor of medicine and director of research at the division of endocrinology, Mt Sinai Hospital and Icahn School of Medicine in New York City.1

He presented an update on the link between diabetes, metabolism, and aging, including a new focus on what you can do to lessen the risk of memory loss (ie, cognitive decline, Alzheimer’s disease) at WICR 2018.

The key may be the most common medication for T2D: metformin. Now, there are other promising reasons to take metformin, including stem cell regeneration, to inflammation and stress all of which impact how well you can maintain your health and achieve optimal health as you age. MILES

Since the first intervention for most everyone who receives a diagnosis of diabetes is to take metformin, there is now even more reason to take this medication: Not only does metformin appear n seem to reduce the risk of death in people with T2D, from early reports, it seems to have an aging-delaying effect, specifically in inhibiting cognitive decline and Alzheimer’s disease. (TAME)campbell

Memory loss that occurs with aging can be made worse, he says, by the effect of diabetes.

Therefore, keeping a stable A1c level is likely to help a lot, he says. Citing findings from his research, Dr. blood sugar patterns over time appear linked with cognitive performance in older adults with type 2 diabetes.7

To establish this association, Dr. LeRoith and his research team evaluated 835 older adults with type 2 diabetes and found that the group with the lowest A1c levels-- at about 6 or 6.8%--at the start of the study performed the best on cognitive tests over 8 to 10 years of follow-up.7

The role of diet remains a significant factor in helping in maintaining a healthy cognitive function, too, he says. One growing area of understanding concerns foods known to have advanced glycation end products (AGEs), which are linked with poorer learning as well as greater deposition of amyloid beta, the plaque found in people with Alzheimer's disease.

Foods cooked at high temperatures (ie, grilling, charbroiling, toasting, searing, and frying) that lead to scorching and blackening, produces AGEs. The foods that appear most susceptible to producing AGEs are red meat, cheese, and butter.1

While you might want to resist the blackened chicken stick and French fries, you can enjoy a cup of coffee or two. Caffeine may be a plus for brain health, too, says Dr. LeRoith. He tells EndocrineWeb that he drinks three cups of coffee a day, but he can't say for sure what amount is ideal or too much.

Incorporate New Research Findings to Improve Your Health

In a nutshell, here are three key takeaway messages imparted by the experts who presented new research findings at the WCIR 2018 meeting:

  • Metformin may not only help your blood sugar but may delay aging and brain health decline, although the research on that is ongoing.7
  • If you are overweight, take the initiative to discuss adding a prescription medication to assist you in losing weight, and keeping it off; and if you are obese, you might consider bariatric surgery, to reduce the risks of complications common with type 2 diabetes.
  • Work with a dietitian or certified diabetes educator,

Dr. LeRoith is on the scientific advisory board of AstraZenea, Merck & Co. and Oramed Pharmaceuticals. Dr. Segal is a scientific consultant for Day 2.


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