Diabetes is defined as having certain levels of blood sugar, either fasting or postprandial.

The underlying process for diabetes is decline in capacity to properly metabolize carbs. This capacity declines with age in persons with propensity towards diabetes, until finally they are unable to handle carbs that they eat and show high levels of BG, at which point a diabetes diagnosis is made.

Now, consider two pre-diabetic twin brothers, Abraham and Benjamin, whose carb handling capacity declines exactly the same over time.

Then, Abraham decides to “go on a diet, eat less and exercise”, and Benjamin does not go on a diet.

Then, as Abraham and Benjamin’s carb capacity declines, Benjamin finally shows diabetic blood sugars. Abraham is now slimmer, is “eating less” than Benjamin, so, even though he has same capacity as Benjamin, he is not straining that capacity as much. So, Benjamin is declared diabetic and Abraham celebrates that he has “prevented diabetes”.

In reality, Abraham has not prevented anything and is postponing his high blood sugar until such time as his loss of carb capacity catches up with his lower weight and lower calorie needs. That’s good for him, as he is able to enjoy slim life and postpone diabetic complications. What I want to say is that there is no genuine “diabetes prevention” here.

Does it make sense?

If so, then, the three year diabetes prevention trial does not really show that diabetes prevention is possible, as it claimed. It is a valuable study, but perhaps it makes too far reaching conclusions.

Possibly, all that weight loss and exercise does, is buy us a few valuable years. People who are doing Atkins for life, can probably even find that out numerically, by tracking the change in the level of carbs that they can eat without regaining weight and without blood sugar swings. If this level needs to be adjusted downward periodically, then can extrapolate the trend and see when it gets low enough.