The National Institutes of Health Publication 11-5337, "I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians," provides information on diabetes - how to prevent it, how to learn how to take care of yourself if you have diabetes, and how to prevent some of the serious problems that can diabetes can cause. Type 2 diabetes is the most common type in American Indians. This type of diabetes can occur at any age, even during childhood. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body cannot make enough insulin. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, blindness, kidney failure, and amputation. Although people with diabetes can prevent or delay complications by keeping blood glucose (also called blood sugar) levels close to normal, preventing or delaying the development of type 2 diabetes in the first place is even better. The results of a major federally funded study, the Diabetes Prevention Program (DPP), prove that we can prevent or delay the disease. This study of 3,234 people at high risk for diabetes showed that moderate diet and exercise, resulting in a 5- to 7-percent weight loss, can delay and possibly prevent type 2 diabetes. More than 170 American Indians participated in the DPP. The DPP tested three approaches to preventing diabetes: making lifestyle changes, taking a diabetes pill, or following the standard diabetes education approach. People in the lifestyle change group exercised about 30 minutes a day, 5 days a week, usually by walking, and they lowered their intake of fat and calories. Those who took the diabetes pill metformin received standard information on exercise and diet, as is done in an Indian Health Service clinic or tribal physician's office. These approaches were compared with the third group who only received the standard information on exercise and diet and took a placebo-a pill without medicine in it. The DPP results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. Average weight loss in the first year of the study was 15 pounds. Lifestyle change was even more effective in those 60 years and older. They reduced their risk by 71 percent. People who took metformin and received standard information on exercise and diet reduced their risk by 31 percent. The Diabetes Prevention Program Outcomes Study (DPPOS) has continued to follow most DPP participants since the DPP ended in 2001. The DPPOS has shown that the benefits of weight loss and metformin last for at least 10 years. Ten years after they enrolled in the DPP, people in the lifestyle change group had reduced their risk for developing diabetes by 34 percent. Those in the lifestyle change group age 60 or older had reduced their risk of developing diabetes by 49 percent. Participants in the lifestyle change group also had fewer heart and blood vessel disease risk factors, including lower blood pressure and triglyceride levels, even though they took fewer drugs to control their heart disease risk. The metformin group had reduced their risk of developing diabetes by 18 percent. Even though controlling your weight with lifestyle changes is challenging, it produces long-term health rewards by lowering your risk for type 2 diabetes, lowering your blood glucose levels, and reducing other risk factors for heart disease.