Key steps to managing diabetes

Our survey revealed what lifesytle changes, testing strategies, and drugs worked best

Published: November 2009

Our survey of 5,012 people with type 2 diabetes reinforced a point: It's not necessarily hard to keep your blood sugar in check, but it does take commitment. The payoff: Lowering the impact of the disease on your energy level, sex life, and other activities, and a reduced risk of diabetes complications, including amputations, blindness, and heart disease.

In our survey, respondents who were successful in managing the disease had significantly fewer complications. Forty percent of them reported they had no diabetes complications at all, compared with 13 percent of those who were unsuccessful in handling the disease. And other research has found that some people can live with diabetes for 40 to 50 years without complications. Here's what works.

Lifestyle changes

Most cases of type 2 diabetes are triggered by obesity and inactivity, so it's not surprising that lifestyle changes are among the most effective ways to control blood sugar levels. Even small changes can make a substantial difference. Research has found that losing just 5 to 8 percent of your body weight and adding 30 minutes of moderate physical activity such as walking to your daily routine can significantly improve your ability to manage your disease.

Our survey confirms those findings: Successful respondents were twice as likely as those who were unsuccessful to report having lost weight since their diagnosis.

It's not that the unsuccessful respondents didn't try to lose weight—nearly all reported cutting back on sugar, for example. It's that they were less likely to use strategies associated with success. If you'd like help changing your diet or adding exercise to your routine, check out our I could do better at eating right and I could do better at exercise tools.

Testing and monitoring

Keeping track of your blood sugar may require less testing than you think. While patients and their physicians often assume that diabetes management requires frequent home monitoring, recent research suggests that it doesn't benefit many patients, adds to the cost of treatment, and can lead to anxiety and depression. In our survey, the successful respondents were no more likely to check their blood sugar at home than those who had more trouble managing their disease.

But there are a couple of situations where more frequent monitoring makes sense. Patients who use insulin should check their blood sugar at home so they can adjust doses if necessary and guard against dangerous drops in blood sugar levels. And those with a new diagnosis may want to monitor blood sugar levels at first to understand how they fluctuate with meals, exercise, stress, and medications. Our recent tests of home monitors found that the more expensive models were not necessarily the most accurate or easiest to use. Check out our blood-glucose meter Ratings to see which brands performed best.

Your doctor will probably want to monitor you at least every six months with an HbA1c test, which shows your average blood sugar over time. Keeping your HbA1c levels near normal—less than 7 percent—increases the risk of blood glucose dipping dangerously low (hypoglycemia). But the benefits of that tight control—mainly a reduced risk of diabetes-related damage to the eyes, kidney, and nerves—clearly outweigh the risks for people with the less common type 1 form of diabetes and most people with type 2 disease. People with a limited life expectancy and those who are struggling with multiple health problems needn't obsess about strict control.

Drugs that work

When it comes to diabetes medication, the latest is not necessarily the greatest. Evidence suggests that the newer, more expensive classes of drugs—including glitazones, meglitinides, and nateglinides (Prandin, Starlix); alphaglucosidase inhibitors (Glyset, Precose); gliptins (Januvia, Onglyza); and the injectable exenatide (Byetta)—are no more effective or safer than the old standbys of diabetes treatment, metformin (Glucophage and generic) or another class of drugs called sulfonylureas.

In addition, unlike those other choices, metformin helps lower LDL (bad) cholesterol and triglycerides, doesn't seem to cause weight gain, and is less likely to cause a dangerous drop in blood sugar levels.

Most people should usually start with metformin, using one of the others as backup or additional drug if necessary. If lifestyle changes plus pills aren't sufficient, insulin injections should be considered. Of the 24 percent of our survey respondents taking insulin, most reported being satisfied with how easy it was to administer, regardless of the method used. While insulin injection pens and automatic pumps scored lower than needles in terms of cost, they scored much higher in convenience. If you need insulin, discuss the different delivery systems with your physician. And for a thorough discussion of the multiple medications sometimes used, see our Best Buy Drugs report.

A support network

Eighty-six percent of our successful respondents said they relied on the emotional support and understanding of family and friends to help them manage their disease. But they were also less likely to classify that support as "very helpful" than other strategies, such as taking medication and managing their diet. That underscores the point that successful diabetes management depends mainly on you, not those around you.

While those closest to you can offer encouragement, they may not understand everything you are going through or be in a position to offer the most helpful advice. That's why it's also important to broaden your support network to include anyone who can provide the information or encouragement you need. Research suggests that social support may be most helpful when it includes medical professionals and peers who share similar challenges.

People have benefited from group-education sessions with a physician, for example, and meeting with their peers either in person or on the Internet. So think about including health-care professionals with expertise in the field, including a diabetes educator, a social worker, a dietitian, and an exercise trainer among the professionals you consult.

See our complete guide to preventing and treating diabetes.

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