When and how will we be able to prevent type 2 diabetes?
The prevention of type 2 diabetes in global terms depends upon the prevention of overweight and obesity and the performance of healthy amounts of exercise. These two factors are responsible for the overwhelming majority of cases of type 2 diabetes in the world today, especially those in younger people. However, it is not clear that this can be achieved by individual education. Most adults who are overweight are aware that they overeat and take insufficient exercise, yet few are able to address these issues successfully in a long-term way. This is not because they are lazy or weak-minded, but because humans, and other species, have been conditioned throughout their evolution to defend themselves against starvation and backbreaking labor, both of which are injurious to survival. It is not surprising therefore that strong drives exist within us to take in as much food energy as we can to protect us against impending famine, and to seek a life of ease to protect us from injury and environmental exposure. It is only within the past century or two that sufficient food to lead to overweight has been available year-round for all but a fortunate few. Not surprisingly, therefore, human conditioning has not yet been able to adjust to this very recent change. It is likely that significant reductions in weight and increases in exercise will come from social changes that build these into our environment and lifestyles. Some of these are already beginning to occur. Many states and school districts are increasing the amount of exercise in the core school curriculum and removing ready access to snacks and sweetened beverages on campus. Urban planners are considering new ways to make walking to school, work, and local shops appealing and limiting the access of automobiles to the inner city. Restaurant chains are attempting, with some success, to offer alternatives to calorie-dense high fat food items. It is important than such alternatives are appealing in taste and satisfying to hunger, or they will not be chosen. Of course, modern medicine has a role to play in the prevention of type 2 diabetes, by developing safe and effective medications to suppress appetite or prevent weight gain. Also, drugs that can be taken by people at high risk to prevent early abnormalities in blood sugar from developing into full-blown diabetes will be valuable. However, since type 2 diabetes is largely a disease of the industrialized urban world, the healthiest and most generally effective way to prevent it will be to make the environment of the future less conducive to those habits that lead to its occurrence.