Being overweight is the key factor in type 2. Most people can prevent it by not gaining weight. And most people with the type 2 disease can eliminate symptoms by losing some weight. Genetics is certainly a factor -- many overweight people never develop the disease -- but 85 percent or more of people diagnosed with type 2 diabetes are overweight or obese.
In genetically predisposed people, being overweight causes insulin resistance. Metabolism does not handle excess calories very well, and this means calories from any source, not just carbohydrates.
FAST FOOD, SOFT DRINKS
Children and adults who habitually consume fast food as well as soft drinks tend to take in more calories and weigh more and are more likely to develop symptoms than people who eat healthier diets and are more active.
This makes healthy eating and physical activity the most important approaches. The vast majority of overweight people at risk of type 2 diabetes can prevent symptoms by losing a few percent of their body weight and doing a couple of hours a week of moderate -- not necessarily vigorous -- physical activity. The same works for treatment. Some people will still need medications, but the drugs work better with diet and physical activity.
As the Centers for Disease Control and Prevention puts it: "[A]ll diabetes-care programs should make healthy weight a priority."
Dietary advice for type 2 diabetes is the same as advice for everyone else: Eat a wide variety of relatively unprocessed foods, especially vegetables, fruits, and whole grains, and don't consume too much junk food or too many sugary beverages.
Scientists may argue endlessly about the relative importance of calories, sugars, and refined carbohydrates in the diets of people with type 2 diabetes, but everyone agrees that eating less of all three would help resolve symptoms.
Why isn't weight loss better recognized as a treatment strategy? Paula Deen's announcement said nothing about losing weight.
The ADA does talk about weight loss on its website, but you must search hard through several complicated screens before you find, "Losing just a few pounds through exercise and eating well can help with your diabetes control and can reduce your risk for other health problems."
I can't help wondering if the lack of prominence given to weight loss might have something to do with the influence of pharmaceutical companies.
A few years ago, I gave a talk on the importance of weight loss in control of type 2 diabetes at an ADA annual meeting. Although many conference talks dealt with drug treatment, mine was the only one on diet -- except for a session on sugars sponsored by Coca-Cola.
The exhibit hall was packed with drug company representatives dispensing free pens, writing pads, books, lab coats and stethoscopes -- all with corporate logos.