Diabetes type 2

Lifestyle modifications


  • Limiting caloric intake to initiate weight loss, if overweight or obese (1)
  • Focus on “minimally processed plant foods, such as whole grains, vegetables, whole  fruit, legumes, nuts, seeds and non-hydrogenated non-tropical vegetable  oils, while minimizing the consumption of red and processed meats, sodium, sugar-sweetened beverages and refined grains” (3)
  • Mediterranean diet and DASH diet have the best supportive evidence for DM2 management (1)
  • Mediterranean diets, vegetarian and vegan diets have shown both reduction in body weight, HbA1c, delayed requirement for diabetes medications, and benefits for cardiovascular health (2)
  • Limit saturated fats to < 10% of daily calories (1)
  • Limit sugar intake (1)


  • 150 min or more per week of moderate to vigorous aerobic exercise (1)
  • Exercise should be spread out over at least 3 times per week with maximum 2 consecutive days without exercise (1)
  • 20-30 min of resistance exercise 2-3 times per week performed on non-consecutive days (1) Resistance exercise improves blood glucose levels (2)
  • Vigorous physical activity may be contraindicated in proliferative diabetic neuropathy, and may be preferable in severe peripheral neuropathy (1)
  • Avoid prolonged sitting (1)
  • Physical activity after meals are beneficial for glycaemic control (2)


  • Overweight/obesity: Weight loss improves HbA1c (2)
  • Primary target weight loss for most people with DM2: 5-15% (2)
  • 5-10% weight loss causes metabolic improvements (2)
  • 10-15% weight loss, or more may lead to remission of DM2, and have benefits for cardiovascular disease events and mortality (2)


  • Sleep disorders are common among patients with DM2. Sleep apnoea is present in 50% of diabetes type 2 patients (2)
  • Adequate vs poor sleep reduces HbA1c, blood pressure, blood lipids, possible symptoms of depression and improves quality of life (2)


  • Diabetes patients who smoke should be offered help with smoking cessation (1)


1) https://bestpractice.bmj.com/topics/en-us/24/management-approach

2) ADA & EASD consensus report 2022: https://link.springer.com/article/10.1007/s00125-022-05787-2

3) https://link.springer.com/article/10.1007/s00125-023-05894-8



Figure: Evidence pyramid

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD font

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE font

​Evidence based on randomized controlled trials is written in PLAIN font

Evidence based on observational / cohort studies is written in CURSIVE font