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Lifestyle Therapy for Diabetes Mellitus

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Lifestyle Medicine

Abstract

Lifestyle therapy is the cornerstone of diabetes treatment and is designed to work alone or in concert with any medical therapy to achieve the following treatment goals: (i) control glycemia to prevent microvascular complications, (ii) prevent acute complications and hypoglycemia, (iii) prevent cardiovascular disease events by improving risk factors such as dyslipidemia and hypertension, and (iv) improve functionality and quality of life. Medical nutrition therapy (MNT) and diabetes self-management education and support programs are critically important components of lifestyle therapy in patients with type 2 diabetes mellitus (T2D) and type 1 diabetes mellitus (T1D), and these interventions should be individualized and developed by the health-care team in collaboration with the patient. MNT can be accomplished by any one of several healthy meal plans, which can be selected based on personal and cultural dietary preferences. Lifestyle therapy includes physical activity that optimally encompasses both aerobic and resistance exercises and a reduction in sedentary behavior, and takes into account patients’ preferences and capabilities. While the conventional practice of MNT and lifestyle intervention recognizes the benefits of weight loss, the approach has lacked a concerted approach in optimally using therapeutic options directed at weight loss as a primary treatment goal. This chapter emphasizes a reconfigured approach to lifestyle therapy for T2D designed to achieve and sustain clinically meaningful weight loss as a primary objective. Weight loss can dramatically benefit patients with diabetes who are overweight or obese by enhancing glycemic control concomitant with reduced need for glucose-lowering medications, by improving the cardiovascular disease risk profile, and enhancing quality of life.

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Abbreviations

ALA:

α-linolenic acid

AACE:

American Association of Clinical Endocrinologists

ADA:

American Diabetes Association

AHA:

American Heart Association

BMI:

Body Mass Index

CVD:

Cardiovascular disease

CDE:

Certified Diabetes Educator

CPAP:

Continuous positive airway pressure

DASH:

Dietary approaches to stop hypertension

DHA:

Docosahexaenoic acid

DSME&S:

Diabetes self-management education and support

ECG:

Electrocardiogram

EPA:

Eicosapentaenoic acid

ER:

Extended release

FDA:

Food and Drug Administration

GI:

Glycemic Index

HDL:

High-density lipoprotein

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

IOM:

Institute of Medicine

LADA:

Latent autoimmune diabetes of adults

LAGB:

Laparoscopic adjustable gastric banding

LDL:

Low-density lipoprotein

MNT:

Medical nutrition therapy

OGTTs:

Oral glucose tolerance tests

RD:

Registered dietitian

SGLT2:

Sodium/glucose cotransporter-2

STAMPEDE:

Surgical Treatment And Medications Potentially Eradicate Diabetes Efficiently

T1D:

Type-1 diabetes

T2D:

Type-2 diabetes

TDD:

Total daily dose

VLCDs:

Very-low-calorie diets

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Authors and Affiliations

  1. Department of Nutrition Sciences, University of Alabama at Birmingham, GRECC, Birmingham VA Medical Center, UAB Diabetes Research Center, 35294-3360, Birmingham, AL, USA

    W. Timothy Garvey MD, FACE

  2. Addison Gilbert Hospital, Gloucester, MA, USA

    Gillian Arathuzik RD, LDN, CDE

  3. Lahey Outpatient Center, Danvers, MA, USA

    Gillian Arathuzik RD, LDN, CDE

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  1. W. Timothy Garvey MD, FACE
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  2. Gillian Arathuzik RD, LDN, CDE
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Correspondence to W. Timothy Garvey MD, FACE .

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Editors and Affiliations

  1. New York, USA

    Jeffrey I. Mechanick MD

  2. Chicago, USA

    Robert F. Kushner MD

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Garvey, W., Arathuzik, G. (2016). Lifestyle Therapy for Diabetes Mellitus. In: Mechanick, J., Kushner, R. (eds) Lifestyle Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-24687-1_22

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