Lifestyle modifications

NUTRITION

  • 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)

PHYSICAL ACTIVITY

  • 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)

WEIGHT LOSS

  • 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

  • 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)

SMOKING

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

References

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

esources

EXPLANATION TO EVIDENCE PRESENTATION

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