One-fourth of people don’t know they have diabetes—a scary fact, given the complications of chronically high blood sugar: heart attack, stroke, sight-robbing eye disease, kidney failure, foot amputation. Worse, another 86 million adults have prediabetes, a condition of elevated blood sugar just below the threshold for diabetes.

The vast majority of cases are type 2 diabetes, a condition characterized by insulin resistance, meaning cells fail to respond to insulin. In type 1 diabetes, the pancreas doesn’t make enough insulin.

The good news is type 2 diabetes is largely preventable. A seminal 2006 study demonstrated that intensive lifestyle modification reduced the risk of developing diabetes by 58 percent, as compared to a 31 percent risk reduction achieved with the antidiabetes drug metformin.

• Lose excess body fat. Being overweight is a big risk factor for diabetes. In contrast, every kilogram (2.2 pounds) of weight lost reduces diabetes risk by 16 percent.
• Follow a plant-based, low-calorie diet. Eat a variety of fruits and vegetables—a dietary pattern studies show reduces diabetes risk. Foods to avoid are those rich in trans fats (also called hydrogenated fat), saturated fat, and sugar.
• Drink water. Studies link sugar-sweetened beverages with obesity and diabetes. Cut them out of your diet and the risk of both conditions falls.
• Move your body. Physical inactivity raises the risk of diabetes. Exercise renders cells more sensitive to insulin. The aforementioned 2006 study had volunteers exercising moderately 150 minutes a week. Brisk walking does the trick.
• Stress less. The stress response triggers the release of several hormones that increase blood sugar. Studies show that mindfulness meditation improves the ability to cope with stress. Physical activity and social support also help relieve stress.
• Sleep well. Chronic sleep deprivation and poor quality sleep increase the risk for diabetes and obesity. For tips on sleeping better, see this Remedy Chick’s blog. If you have continued problems sleeping, contact your doctor.
• Keep medical appointments. Warning signs of type 2 diabetes are less dramatic than those of type 1 diabetes. That’s why it’s important to see your doctor regularly.