Guideline Topline: 14 Key Lifestyle Interventions to Treat, Prevent Type 2 Diabetes
These 14 recommendations from the American College of Lifestyle Medicine comprise the core of the first-ever guideline centered on lifestyle change as a first-line intervention.
Note: The audience for this guideline is "any clinician or healthcare professional in a community or outpatient healthcare setting involved in managing non-pregnant adults with T2D, prediabetes or a history of gestational diabetes mellitus (GDM)."
Lifestyle Interventions for Treatment and Prevention of Type 2 Diabetes and Prediabetes in Adults is not meant to replace existing clinical practice guidelines or standard but to build awareness of the role for lifestyle interventions..."
Recommendation 1: Advocacy for lifestyle interventions. Clinicians should be champions for lifestyle change as the first-line intervention to help manage prediabetes and T2D.
Recommendation 2: Assessment of Baseline Lifestyle Habits includes promoting individual awareness of opportunities for improvement, supporting understanding of the validity and credibility of of lifestyle interventions, and probing for background on prior unsuccessful efforts at and barriers to change.
Recommendation 3: Establishing Priorities for Lifestyle Change with the patient based on SMART goals increases the likelihood of adherence to a care plan that focuses on individual needs and desires.
Recommendation 4: Prescribing Aerobic and Muscle Strengthening Physical Activity is associated with multiple benefits including improved glucose management, cardiorespiratory fitness, sleep quality, cognitive function, mental health, health-related quality of life, and cardiometabolic markers.
Recommendation 5: Reducing Sedentary Time can begin with the suggestion to the patient that even small levels of physical activity to interrupt sedentary time are beneficial and will help improve glucose management.
Recommendation 6: Identifying Sleep Disorders that may not have been previously recognized or diagnosed will help avoid or minimize related complications and provide an opportunity for counseling on optimal sleep hygiene to complement other healthy lifestyle interventions.
Recommendation 7: : Prescribing a Nutrition Plan for Prevention comes with myriad considerations for implementation including patients' poor or no access to plant-based food options, the high cost of healthier food options, food preparation challenges and level of health literacy. Educational materials on composition of a whole-food diet vs standard American diet and other types of fact sheets are recommended.
Recommendation 8: Prescribing a Nutrition Plan for Treatment should be preceded by collaboration with the patient to understand exactly what their health goals are, which will facilitate designing a plan of eating that has a high probability for adherence.
Recommendation 9: Peer/Familial Support and Social Connections may help an individual appreciate and work toward SMART goals and support change in and persistence with lifestyle change.
Recommendation 10: Identifying Need for Psychological Interventions will support the patient with underlying or overt mental health issues in their pursuit of lifestyle change with benefits including stress management and reduction of diabetes distress burden.
Recommendation 11: Tobacco, Alcohol, and Recreational Drug use should be explored but without judgement, a goal being to raise awareness and educate on the potential for harm inherent in use of the substances and to include moderation or cessation in lifestyle change intervention.
Recommendation 12: Achieving Person-Driven, Sustained Positive Behavior Change may involve a multidisciplinary approach to include health and wellness coaches or other professionals, insurance issues notwithstanding.
Recommendation 13: Establishing a Plan for Continuity of Care is essential for sustained success in lifestyle change, with specifics regarding frequency, duration, type and intensity of follow-up based on the specific needs of the individual.
Recommendation 14: Adjusting Pharmacologic Therapy will be a primary and ongoing goal along with managing patient expectations and anxiety about adjustments based on success of lifestyle interventions--topics for regular shared decision making between clinician and patient.
The American College of Lifestyle Medicine (ACLM) has released a clinical practice guideline that, for the first time, places lifestyle modification at the center of care for adults with type 2 diabetes (T2D) and prediabetes.1,2
Appearing in the American Journal of Lifestyle Medicine,¹ the guideline offers clinicians a structured, evidence-based framework for integrating lifestyle-based treatment into routine diabetes management. Unlike prior guidelines that acknowledge lifestyle’s importance but often lack practical direction, this document delivers actionable strategies for implementing and sustaining behavioral change, ACLM stated.1,2
The audience for the guideline is "any clinician or healthcare professional in a community or outpatient healthcare setting involved in managing non-pregnant adults with T2D, prediabetes or a history of gestational diabetes mellitus (GDM)," the authors wrote.2
The 14 recommendations, referred to as "key action statements," support clinicians in promoting lifestyle interventions as first-line management for prediabetes and type 2 diabetes, with an emphasis on the 6 core pillars of lifestyle medicine.
The guideline topline slide show above introduces primary care clinicians to the first codified approach to applied lifestyle change in diabetes care with an at-a-glance summary of the 14 recommendations.
A substantial body of evidence supports the greater efficacy of lifestyle interventions over metformin for preventing progression of prediabetes to T2D.3 A 2022 meta-analysis reported that the effects of the interventions on the risk of impaired glucose tolerance or prediabetes advancing to T2D was "significantly correlated with multiple lifestyle changes," with study participants reaching the greatest number of targets achieving more pronounced effects.4
"Although there are nearly 1,000 guiding documents for diabetes in the medical literature, and more than 350 pages of standards from the American Diabetes Association, they may not offer details and practice advice on lifestyle change," Richard M. Rosenfeld, MD, MPH, MBA, lead guideline author and ACLM director of guidelines and quality wrote.5 This guideline bridges that gap.
