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

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 place lifestyle interventions at the forefront of type 2 diabetes and prediabetes care. “Lifestyle interventions for the treatment and remission of type 2 diabetes and prediabetes in adults,“Provides a comprehensive and evidence-based roadmap for clinicians to effectively incorporate therapeutic lifestyle behavior interventions as the mainstay of treatment and complements existing diabetes guidelines, many of which mention lifestyle as part of care but often lack specifics. The policy was published in theAmerican Journal of Lifestyle Medicine.

The policy addresses a critical and growing public health crisis as more than half of U.S. adults have diabetes or prediabetes, adding billions in annual healthcare costs. A unique aspect of the guideline is the clear and actionable recommendations for achieving lifestyle changes, including strategies for assessing baseline lifestyle habits, readiness for change and health coaching, as well as a framework for dispensing medications following successful lifestyle interventions.

The policy contains Over 25 original information handouts and resources that can be used by healthcare providers and their patients to facilitate the incorporation of lifestyle medicine into type 2 diabetes care. The aim of the guideline is to empower clinicians and individuals through lifestyle habits and practices to achieve glycemic management of type 2 diabetes and prevent progression from prediabetes or gestational diabetes to actual type 2 diabetes.

“Many clinical practice guidelines recognize the importance of lifestyle factors as a first-class consideration, but fall short in providing clinicians with the practical tools to prescribe sustainable behavioral lifestyle changes,” said endocrinologist and guideline author Mahima Gulati, MD, Dipablm, FACLM. "The new guideline is the first to provide detailed and explicit lifestyle modification strategies for the treatment of prediabetes and type 2 diabetes with the clinical goal of remissions. These strategies are not unique to this unique guideline, but also support other existing chronic disease clinical practice guidelines that recommend lifestyle behavior changes."

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

A growing body of research shows how lifestyle changes can delay or prevent type 2 diabetes and, in some cases, achieve remission so medications can potentially be reduced or eliminated. However, lifestyle behavior interventions remain underutilized, and no previous clinical practice guidelines have explicitly focused on lifestyle interventions and behavior modification as an essential treatment for type 2 diabetes and prediabetes. Additionally, the ACLM guideline is the first to address nutritional recommendations to the specific goal of a person with type 2 diabetes, such as remission, management, or prevention (from prediabetes or gestational diabetes).

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

ACLM's guidelines are not intended to replace existing diabetes management strategies, but rather to complement them with an evidence-based blueprint for how to effectively implement lifestyle interventions. The guideline and accompanying plain text 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 Policy and Quality and Policy Lead Author

Due to its increasing prevalence and enormous health impact, type 2 diabetes is considered a defining disease of the 21st century. More than 38 million people have diabetes, with the vast majority of these cases being type 2 diabetes, and another 97.6 million people have prediabetes and are at risk of progressing to type 2 diabetes. The policy 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 have diabetes at a cost of $1.5 trillion per year.

The new policy builds on ACLM's Expert Findings Statement to Assist Clinicians in Achieving Diabetes Remission from Type 2 Diabetes as a Primary Intervention and the Type 2 Diabetes Bill of Rights, which states that patients have the right to be informed about all treatment options, including lifestyle behaviors. ACLM also offers a Type 2 Diabetes Remission Certificate course, which provides clinicians with intensive, evidence-based lifestyle medicine therapies to send Type 2 Diabetes into remission and reverse insulin resistance.

“The release of the new clinical practice guideline is a milestone for ACLM and for all clinicians involved in the treatment and prevention of 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 core 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."

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