In one of two comparison studies presented at the American Diabetes Association’s (ADA) 74th Scientific Sessions, Canadian researchers found a 13 percent lower incidence of diabetes over a 10-year period for people living in “walkable” neighborhoods.
A walkable community is defined by the Federal Highway Administration (FHWA) as one where sidewalks, trails, and street crossings are safe, accessible, and comfortable for people of all ability levels. Additional measures used by the researchers included less sprawl, more interconnected streets, and more local stores and services within walking distance.
According to a second study, which compared neighborhoods instead of individuals, the most walkable neighborhoods had the lowest incidence of obesity, overweight, and diabetes. Rates of these conditions rose 13 percent in the least walkable neighborhoods in the same period.p> Learn More About Type 2 Diabetes »
Diabetes Rates on the Rise
More than 29 million people in the U.S. have diabetes, up from the previous estimate of 26 million in 2010, according to a report recently released by the Centers for Disease Control and Prevention (CDC). Another 86 million adults have prediabetes, with blood sugar levels higher than normal, but not high enough to be classified as type 2 diabetes. Without weight loss and moderate physical activity, according to the CDC, 15 to 30 percent of people with prediabetes will develop type 2 diabetes within five years.
Marisa Creatore, an epidemiologist with the Centre for Research on Inner City Health at St. Michael's Hospital in Toronto, noted in a press statement that one’s environment can influence decisions about physical activity. “When you live in a neighborhood designed to encourage people to be more active, you are in fact more likely to be more active,” she said.
Agreeing “absolutely, without a doubt” that walkable communities could dramatically lower diabetes rates is Jerry Meece, R.Ph., CDE, FACA, owner and director of Clinical Services, Plaza Pharmacy and Wellness Center in Gainesville, TX. “We can spend mega millions of dollars getting new drugs on the market, but if you're taking a drug, and you're not eating properly, and you're not getting exercise, then those drugs are wasted,” Meece told Healthline.
Let's Get Physical
Meece described diabetes management as a three-legged stool, with medication as one leg, nutrition another leg, and physical activity the third leg. “If physical activity is missing, that stool falls apart,” said Meece.
The way to improve on the CDC's projections is not by taking more medicines, but by changing one's diet and activity level, emphasized Meece. "Everybody’s hoping for a cure, but what's going to make a difference is getting people off their rears and more physically active. And you do that by making it the right thing to do, the easy thing to do,” he said.
Illustrating his point, people in the studies who lived in the most walkable neighborhoods were three times more likely to walk or bicycle and half as likely to drive to their destinations.
Meece noted that when health providers tell diabetics to get out and walk or ride a bike, they sometimes forget it’s not always easy for people to do so. “You basically take your life in your own hands a lot of the times, getting down city streets, so for some people, that's all it takes not to get exercise,” he said.
However, Meece cautioned, “You have to be careful when saying people who walk and bike in these cities have a lower incidence of diabetes. I don't doubt that a bit. But the people who are doing so are also the people who probably eat better to begin with. They're more health conscious.”
How We Build Our Cities Matters
The studies’ lead researcher, Dr. Gillian Booth, an endocrinologist and research scientist at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto, noted in the press statement, “We have engineered physical activity out of our lives. Every opportunity to walk, to get outside, to go to the corner store, or walk our children to school can have a big impact on our risk for diabetes and becoming overweight.”
However, she cautioned that solving the obesity and diabetes epidemics will require public policy changes as well as individual attention. “We have to take a more population-based approach to the problem, given the environment we live in,” she said.
Meece added ,“We need to develop walking/riding trails. We need to make intersections possible instead of cul de sacs and dead-ends. You can plan these, but it costs money. It takes time, it takes planning, and it takes community involvement.”
In addition to saving lives and helping people live healthier, walkable neighborhoods could be less costly in the long term. “But the key question is less costly for whom? Is it less costly to a city? No. Is it less costly to Medicare? Yes,” said Meece, adding that the problem is that hospitals, community governments, Medicare, and others all pull from different money pots.
“No one’s saying, let’s spend $25 million to develop a walking trail, and that will save us money; because those dots are never connected. But someone has to connect those dots," Meece said. "It’s the only way we’re going to be successful in making walkable neighborhoods a reality.