Originally written for The Washington Post, April 25, 2018

Recent Swedish research about diabetes could change how we think about the disease. The large, long-term study shows that individuals may be able to predict their risk of diabetes 20 years before it develops. Such advance warnings may help people prevent the disease altogether.

The study, published in the online journal Diabetes, Obesity and Metabolism, found 296,439 individuals who weren’t diabetic and followed them for two decades. During that time, 28,244 subjects, or roughly 9.5 percent of the study cohort, received a diagnosis of Type 2 diabetes (T2D). What was especially interesting about the study was that the data revealed the great predictive power of certain biomarkers. For example, the researchers found that patients in their 40s whose body mass index (BMI) was normal, fasting triglyceride were less than 124 milligrams per deciliter (mg/dl) and fasting glucose was less than 81 mg/dl, had a low chance of developing T2D 20 years later (2.2 percent for men and 1.3 percent for women). However, for patients with a BMI greater than 30 (in the obese category), triglycerides greater than 124 mg/dl and/or fasting glucose in the prediabetic range of 100 to 126 mg/dl, the chances of developing T2D were 63.5  percent for men and 69.6 percent for women.

 The authors write “the results of the present study indicate that subtle elevations in metabolic markers are present (albeit levels still in the normal range) more than two decades prior to a diagnosis of T2D.”

This research offers important implications, given how many Americans are affected by diabetes and pre-diabetes. According to the National Diabetes Statistics Report, 2017 from the Centers for Disease Control and Prevention, an estimated 30.3 million people of all ages, or 9.4 percent of the U.S. population, had diabetes in 2015. An estimated 33.9 percent of U.S. adults, 84.1 million people, had pre-diabetes.

Type 2 diabetes is a metabolic disease that occurs when your body has difficulty producing or using a hormone called insulin. Insulin is essential to normal metabolism because it regulates how glucose — the sugar found in our blood that is our main source of a body’s energy — enters our cells. When your body can’t produce or use insulin correctly, you might wind up with glucose — or blood sugar — levels that are too high. Continued elevated blood sugar and T2D can have significant long-term effects on health, such as increased risk of heart disease, stroke and infection, vision disturbances, nerve damage, fatigue and lack of energy and more.

Pre-diabetes is a more vague diagnosis where blood sugar is elevated either at fasting or after a meal, yet not so high that it prompts a T2D diagnosis. It’s been estimated that, if untreated, someone can be prediabetic between seven and 10 years before a formal diabetes diagnosis. The Swedish study results would seem to indicate that individuals can find out whether they are at risk and take actions to head off the disease even earlier. So how should you do that?

The first step is to know your data. Go for an annual physical exam that includes a fasting blood test and get your blood sugar and triglycerides tested. Use this as a moment to weigh in, and you can calculate your BMI with an online calculator at nhbli.nih.gov. Then, keep track of your test result to observe trends over the years; knowing your data and watching how values change is a key part in taking ownership of your health. If you find your BMI, fasting triglycerides, and/or fasting blood glucose levels are elevated, you can take action.

Patients commonly move to one extreme, either jumping in and going on a dramatic — but unsustainable — plan, or doing nothing, because they are overwhelmed. Instead, consider one change at a time to improve your data. Remember, the study was predicting 20 years out, which means you have time to slowly create changes in your eating plan that will allow you to enjoy living without elevated blood sugars in the decades to come.

If you have increased BMI, which is a ratio of weight to height, lowering weight is the only way to lower your number. Following a restrictive plan is rarely sustainable, however. Instead, implement strategies to eat fewer calories, but feel like you’re eating more:

* Add vegetables to all plates, filling at least half your plate at lunch and dinner with a veggie-rich salad, or roasted or sauteed veggies.

* Incorporate vegetables that travel well into your on-the-go snacks, such as carrots, snap peas and celery.

* Experiment with vinegars, spices and herbs, nonfat yogurt, salsa, and lemon juice to add flavor to foods without added fat.

If your triglycerides are elevated, decrease added sugars and saturated fats.

* Start reading labels closely, especially the ingredients. Choose products that have less or no added sugar. Aim to get less than 10 percent of your daily calories from added sugars. Added sugars are ingredients including cane sugar, honey, juice, high fructose corn syrup, agave and molasses.

  * Choose leaner forms of meat, low-fat or nonfat milk and cheese and liquid fats such as olive oil over fats that are solid at room temperature, such as butter and margarine.

When your blood glucose is elevated, increase fiber. Depending on your blood values, you might also want to lower overall carbohydrate intake.

* Add high-fiber starches such as beans and whole grains. Go for foods where you can see the fiber, such as rolled oats, corn on the cob, or rice, instead of quick oats, corn tortillas or rice cereal.

*  Choose fruits and vegetables as often as possible.

* Being mindful of sweets and treats. When you’re paying attention, it’s easier to eat fewer or avoid from time to time.

Over time, these will accumulate into a healthy lifestyle and could support your health 20 years from now.