Type 2 diabetes remains one of the most prevalent medical conditions in the United States, with 25.8 million Americans listed as diabetic and 79 million identifying as prediabetic in 2013, according to the American Diabetes Association. The Virginia Department of Health estimated in a 2012 report that 8.7 percent of adults across the state have diabetes. And unfortunately, these numbers are on the rise. While those with Type 1 diabetes typically stop producing insulin in childhood, those with Type 2 either see declining insulin production or develop insulin resistance later in life. Type 2 diabetes diagnoses are most typically partnered with a prescribed lifestyle change, primarily because it is so strongly associated with obesity, which has been shown to directly contribute to the increased insulin resistance in cells, according to Dr. Ayotunde Dokun, an endocrinologist at the Medical Center. “A hypothesized mechanism is that when people are overweight, their bodies have to store fat in tissues that are not meant to store fat — like skeletal muscle, a major consumer of glucose,” Dokun said. “When this occurs, skeletal muscle cells are more resistant to insulin — the hormone that facilitates glucose uptake by cells — and high blood glucose results.” The key to tempering insulin resistance, then, is often sustained weight loss, which helps remove fat from cells where it should not be stored. Dietary modification is an important step in this process. There is no optimal diet, Dokun said, because different methods have varying effectiveness from person to person. Still, Dokun did say caloric reduction is an important dietary principle. Physicians can help patients to determine how many calories to consume each day and work with them to meet that level of intake.