The WHO (World Health Organisation) global report (2016) estimates that 8.5% of the worldwide adult population has Diabetes with around 80% of Type 2 Diabetics (T2Ds) classified as overweight.

Most of the pharmacological interventions preventing Type 2 Diabetes are indirectly through weight loss and without changing the health-related behaviour, it is difficult to achieve results. Personal responsibility, in terms of lifestyle modification and self-management, is key to safely managing or reversing Type 2 Diabetes Mellitus.

The Mediterranean diet aids in weight loss and encourages healthy eating as the food is well proportioned, favouring whole over processed food. With its focus on fruits, vegetables, whole grains, legumes, olive oil and seafood; it helps maintain normoglycaemia (a normal concentration of sugar in the blood) and is associated with a reduced risk of Diabetes.

The Paleolithic or ‘Paleo’ diet is based on foods believed to have been eaten regularly during the stone age. These foods include lean meat, fish, shellfish, fruits, vegetables, roots, eggs and nuts but exclude grains, dairy products, salt or refined fats and sugar. Paleolithic diet improves glucose tolerance, independent of weight-loss, after 12 weeks. Following the Paleolithic diet for three weeks can significantly reduce weight, body mass index (BMI), waist circumference (WC) and systolic blood pressure (SBP).

The Atkins diet is low in carbohydrate and high in protein and fat and it restricts dieters to 20g of carbohydrate until glycemic (the presence of glucose in the blood) control is attained. During a study, the effects of low carbohydrate and low-fat diets were compared in obese and diabetic patients. After one year, weight loss was similar between groups, but effects on dyslipidemia (unhealthy levels of one or more kinds of lipid (fat) in the blood) and glycemic control were more favourable with a low-carbohydrate diet.

Plant-based nutrition has advantages in the prevention and management of Type 2 Diabetes. Vegetarians have approximately half the risk of developing diabetes than non-vegetarians. A low-fat, plant-based diet with little or no meat may help prevent and treat Diabetes, possibly by improving insulin sensitivity and decreasing insulin resistance.

While comparing the low-fat vegan diet with a diet based on the American Diabetic Association (ADA) guidelines,  it is found that people on the low-fat vegan diet reduced their Hba1C levels by 1.23 points compared to a reduction of only 0.38 points associated with the ADA diet. In addition, 43% of people on the low-fat vegan diet could reduce their medication, compared with 26% of those on the ADA diet.

Over 50% of people with Diabetes, mostly Type 2, experiment with nutritional supplements, herbal treatments and other non-vitamin, non-mineral pills and capsules. Due to inadequate evidence in proving the fact that the use of vitamins and mineral supplements can help manage Diabetes affectively, the ADA decided not to endorse their use. However, some evidence seems to exist that supplementation with certain vitamins and minerals can improve glycaemic control, reducing the risk of macro- and microvascular complications.

The Gut flora (the complex community of microorganisms that live in the digestive tracts of humans and other animals) in patients with Type 2 Diabetes differs from that in non-diabetics. Factors affecting gut flora and Type 2 Diabetes include genetics, use of medications (e.g. antibiotics) and diet. Additionally, the consumption of probiotic bacteria that are found in yoghurt and other fermented milk products can beneficially alter the composition of the gut flora. During this process, factors such as obesity, insulin resistance, fatty liver disease and low-grade peripheral inflammation are less well-correlated.

The benefit of exercise in preventing Diabetes has been demonstrated in several studies. Doing regular, moderate physical activity – compared with being sedentary – can lower the risk of developing Diabetes. If you are diabetic, regular physical activity can improve your blood glucose control, reduces your cardiovascular risk factors and contributes to weight loss, improving your overall well-being.

Stress is an independent risk factor for Type 2 Diabetes, with a 2.3 fold risk of developing Diabetes for over 3 years.

Lifestyle changes and pharmacological interventions act both directly, and indirectly through weight loss to prevent the development of Diabetes Mellitus. Lifestyle changes address the issue at its’ heart and are safe, even though difficult to achieve and maintain.