New guideline puts lifestyle interventions at the forefront of type 2 diabetes and prediabetes care

The American College of Lifestyle Medicine (ACLM) has published the first clinical practice guideline to put lifestyle interventions at the forefront of type 2 diabetes and prediabetes care. "Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults," offers a comprehensive and evidence-based roadmap for clinicians to effectively incorporate therapeutic lifestyle behavior interventions as a mainstay of treatment, while also complementing existing guidelines for diabetes, many of which mention lifestyle as part of care but often do not provide specifics. The guideline was published in the American Journal of Lifestyle Medicine.

The guideline addresses a critical and growing public health crisis because over half of U.S. adults have diabetes or prediabetes, resulting in billions of annual health care costs. A unique aspect of the guideline is the clear and actionable recommendations to achieve lifestyle change, including strategies for assessing baseline lifestyle habits, readiness to change and health coaching, and a framework for medication de-prescribing after successful lifestyle interventions.

The guideline contains over 25 original informational handouts as well as resources that can be used by health care providers and their patients to facilitate incorporation of lifestyle medicine into type 2 diabetes care. The guideline's purpose is to empower clinicians and individuals through lifestyle habits and practices to help achieve glycemic management of type 2 diabetes and to prevent the progression of prediabetes or gestational diabetes to actual type 2 diabetes.

"Many clinical practice guidelines acknowledge the importance of lifestyle factors as a first treatment consideration but fall short in providing clinicians the practical tools needed to prescribe sustainable lifestyle behavior changes," said endocrinologist and guideline author Mahima Gulati, MD, DipABLM, FACLM. "The new guideline is the first to offer detailed and explicit lifestyle change strategies to treat prediabetes and type 2 diabetes with the clinical goal of achieving remission. These strategies apply not only to this unique guideline but will also support other existing clinical practice guidelines for chronic disease that recommend lifestyle behavior changes."

Organizations that have endorsed the guideline are the American Association of Clinical Endocrinology, Obesity Medicine Association, American Academy of Physician Associates, American Association of Nurse Practitioners, American College of Clinical Pharmacology, American Academy of Sleep Medicine, the Association of Diabetes Care & Education Specialists, and National Board of Health and Wellness Coaches. It has been designated with an "Affirmation of Value" from the American Academy of Family Physicians and is supported by the Academy of Nutrition and Dietetics.

A growing body of research demonstrates how lifestyle changes can delay or prevent type 2 diabetes and, in some cases, may achieve remission so that medications can potentially be reduced or eliminated. However, lifestyle behavior interventions remain underutilized and no previous clinical practice guidelines have focused explicitly on lifestyle interventions and behavior change as essential treatment for type 2 diabetes and prediabetes. Moreover, the ACLM guideline is the first to tailor nutrition recommendations to the specific goal of an individual with, or at risk for, type 2 diabetes, such as remission, management, or prevention (from prediabetes or gestational diabetes).

The new guideline prioritizes the six pillars of lifestyle medicine-plant-predominant nutrition, physical activity, restorative sleep, stress management, connectedness, and avoidance of risky substances-as key components of the foundation for treatment and remission strategies. Input for the guideline was collected collaboratively from a broad coalition of experts from fields that included primary care, endocrinology, cardiology, psychiatry, sleep medicine, nursing, diabetes education, and dietetics.

ACLM's guideline is not meant to replace existing diabetes management strategies, but rather to complement them by providing an evidence-based blueprint for how lifestyle interventions can be effectively implemented. The guideline and accompanying plain language summary provide a fully actionable framework for assessing, prescribing, and implementing lifestyle changes in a way that is practical and sustainable for both patients and clinicians."

Richard Rosenfeld, MD, MPH, MBA, ACLM Director of Guidelines and Quality and guideline lead author 

Due to its rising prevalence and enormous health impact, type 2 diabetes is considered the defining disease of the 21st century. More than 38 million people have diabetes, with the vast majority of those cases being type 2 diabetes, and an additional 97.6 million people have prediabetes and are at risk to progress to type 2 diabetes. The guideline addresses both of these populations. Diabetes accounts for $413 billion in annual U.S. health care spending while prediabetes accounts for $43 billion. By 2050, more than 1.3 billion people worldwide are expected to be living with diabetes at a cost of $1.5 trillion annually.

The new guideline builds on ACLM's 2022 expert consensus statement to assist clinicians in achieving type 2 diabetes remission using diet as a primary intervention and the "Type 2 Diabetes Bill of Rights," which establishes that patients have a right to be informed of all treatment options, including lifestyle behavior change. ACLM also offers a "Type 2 Diabetes Remission Certificate" course that equips clinicians to use intensive, evidence-based lifestyle medicine therapies to send type 2 diabetes into remission and reverse insulin resistance. 

"The publication of the new clinical practice guideline is a milestone moment for ACLM and for all clinicians involved with treating and preventing type 2 diabetes," said guideline author, family physician and ACLM Board Member Meagan Grega, MD, FACLM, DipABLM. "It elevates lifestyle behavior intervention from a peripheral recommendation to a central approach in diabetes care. This guideline is a game-changer in how we treat one of the most pervasive and debilitating chronic diseases of our time."