The recommendations focus on helping patients implement lifestyle changes.
New guidelines for the management of type 2 diabetes and prediabetes include tools clinicians can use to help patients stick to lifestyle interventions. The guidelines, released on June 10 by the American College of Lifestyle Medicine , largely mirror lifestyle guidelines by theA panel of practitioners working in lifestyle medicine, including primary care physicians, cardiologists, endocrinologists, sleep experts, dietitians, and exercise medicine specialists, laid out six areas clinicians should help patients manage.
These include sleep and stress, nutrition, physical activity, tobacco and alcohol, and social connection. The new guidelines are intended to “enhance some of the health behaviors that are recommended by all of the leading authorities and medical societies,” said Mahima Gulati, MD, an endocrinologist and visiting associate professor of medicine at the University of Connecticut in Farmington, Connecticut.“Lifestyle interventions are the foundation of diabetes and prediabetes no matter what,” said Nestoras Mathioudakis, MD, co-medical director of the Diabetes Prevention & Education Program at Johns Hopkins Medicine in Baltimore, who was not involved with the new guidelines. “Whether we jump to medications depends on how far off from the goal they are, but doctors should never diagnose someone with diabetes or prediabetes and say, ‘Keep doing what you’re doing, and just here’s some medication.’” Mathioudakis said the recommendation of using SMART goals allows patients to work with their care providers to set achievable milestones that can be reevaluated during visits. “We have to be careful not to overwhelm people,” Mathioudakis said. “I have found with my patients that when I do this counseling, setting small achievable goals at each visit and building as we go is more effective than bombarding them with everything.” Gulati and her team broke their recommendations into two groups. “Strong” recommendations were backed by high-quality scientific evidence, while other recommendations lacked the same level of robust supportive data.tailored to a patient’s baseline. The body recommends using the FITT to set expectations of what that activity should look like while also helping patients reduce sedentary time.using SMART goals that are tailored to a patient’s current eating habits and cultural background, with the goal to eat whole and plant-based foods.counsel patients on the importance of fostering familial support and social connectionsCounsel patients on using alcohol, tobacco, and recreational drugsUtilize coaching, motivational interviewing, and cognitive-behavioral therapythat lays out the frequency and duration of care visits, expectations for how the patient should be involved with setting and working toward lifestyle intervention goals, and whether the patient needs pharmacologic therapies.Evaluating patients for any psychological care needs , which can include depression or anxiety, stress, or mood and affective or psychotic disorders. Treatment for these conditions ranges from medication to mindfulness-based exercises and cognitive-behavioral therapy.Particularly with exercise and nutrition goals, clinicians need to be mindful of a patient’s baseline instead of implementing drastic diet or movement changes at the start. “If you have someone who is drinking 10 cans of soda per day, we aren’t going to get into the nitty-gritty details of a Mediterranean diet right away; we need to start with reducing or eliminating these sugary beverages,” he said. On the other hand, a patient who is well-versed in nutrition may need more sophisticated education about what parts of their diet may unknowingly be contributing to mismanaged blood sugars, he said. The guidelines also recommend prescribing aerobic and muscle strength exercises using the SMART goal framework. Rather than simply telling patients to get more exercise, Gulati and her team recommend giving people examples of specific exercises that count as aerobic or strength training that are suited to each patient. “One thing I thought was really good about these guidelines is they give links to YouTube videos on exercises for older people or those with limitations,” Mathioudakis said.While exercise and nutrition are mainstays of lifestyle interventions for diabetes management, sleep and social connection are newer recommendations that began appearing in official ADA guidelines within the past 5 years.Social connection is another domain that can help or harm a patient’s ability to stick to lifestyle interventions. “How can a patient change their own way of eating if their spouse doesn’t want to eat that way?” Gulati said. “If the patient isn’t able to drive, do they have a support network to ensure they always have a ride to doctor's appointments?” Even with strong social support, people may backtrack on progress, Gulati said. In these cases, she said, never guilt or shame patients, and always include them in decision-making about what their next goals should be. “They may do good on nutrition for a while, but then they fall off, or they had some disruptions in their sleep routine, and now they want to focus on that,” she said. “Priorities may change as time goes on.” This study was supported by the ACLM. The panel members received no financial support for the research, authorship, and/or publication of the guidelines. Various guideline authors reported financial disclosures including receiving consulting fees from Sanofi and LifeScan Diabetes and serving as an advisor to Medtronic, among others.All material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
Diabetes Mellitus Type 2 Diabetes Mellitus Type II Type 2 Diabetes Type 2 DM T2DM T2D Type 2 Diabetes Mellitus (T2DM) Type 2 Diabetes (T2D) Clinical Guidelines Guidelines Exercise Physical Activity Sleep Disturbance Abnormal Sleep Pattern Sleep Disorders Somnipathy Sleep Prediabetes Borderline Diabetes Sleep Apnea Sleep Apnoea Obstructive Sleep Apnea
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