Researchers warn that the incidence of diabetes is increasing rapidly in the United States. Even worse, the American Diabetes Association reports that a type of diabetes that normally occurs after age 45 is now on the rise in children and adolescents. Experts say these trends demonstrate yet another reason why Americans need to develop healthier lifestyles.

Results of the San Antonio Heart Study reported in the Archives of Internal Medicine include an almost tripled rate of type 2 diabetes (the form that usually develops in adults) in just seven to eight years. Obesity was strongly linked with diabetes in this population, but did not account for all of the observed increase in diabetes. Experts say the increase in type 2 diabetes in children and adolescents announced last summer by the American Diabetes Association is especially worrisome. Damage that is usually not seen until much older ages could begin occurring in 30-year-olds. Obesity (being more than 20 percent above a healthy weight) is present in most cases of diabetes developing in youth.

The main dangers of diabetes come from the damage that high blood sugar levels cause to organs throughout the body. Diabetes is a leading cause of end-stage kidney disease, blindness, and nerve damage that can lead to amputations. Risk of heart disease and stroke are two to four times higher in people with diabetes.

About 90 to 95 percent of the diabetes that occurs in the United States is called "Type 2 Diabetes". This results from the body's inability to make enough or properly use the hormone insulin to control blood sugar levels (not a total lack of insulin). Besides age, other risk factors for type 2 diabetes include being overweight, lack of regular exercise, family history, and history of diabetes during pregnancy.

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Obesity, especially when excess fat is carried around the waist, increases the tendency for what is called insulin resistance. Insulin resistance is widely acknowledged as the first stage in the development of type 2 diabetes. Researchers say that on again-off again dieting is not the answer. Rather, modest weight loss (not necessarily to "ideal" weight) achieved by regular exercise, a balanced diet, and portion control is recommended.

Besides its weight control benefits, regular exercise is independently related to lower risk of diabetes. Research suggests that it reduces the development of insulin resistance.

Several studies in recent years have suggested that high-fiber diets that include plenty of whole grains can also lower risk of diabetes. In a Harvard University study of over 65,000 women, and a similar study of about 45,000 men, those who ate the most fiber from grain products like bread and cereal developed almost 30 percent less diabetes.

We need to refine our thinking of what makes healthy eating. Loading up on white bread, white rice and low-fiber cereals to follow a low-fat diet is not the goal. These foods are fine to include, but excessive portions raise blood sugar and insulin levels, and still contain calories that add up to cause weight gain. Experts say that every day we should include several servings of whole grains (such as whole wheat bread, brown rice and whole-grain cereals) and at least five servings of fruits and vegetables.

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Weight control, regular physical activity and a high-fiber, mostly plant-based diet can do more than reduce today's trend toward more diabetes. The American Institute for Cancer Research says that these same steps could bring a 30 to 40 percent cut in cancer rates, too.

Karen Collins, M.S., R.D.,C.D.N.