Maximizing lifestyle changes to manage type 2 diabetes
Four dietary plans can reduce A1C levels but may differ in long-term outcomes. Intensive lifestyle interventions may even make remission possible.
PRACTICE RECOMMENDATIONS
› Recommend a reduced-calorie diet that is generally plant based and low in carbohydrates as part of the treatment plan for type 2 diabetes. B
› Counsel all patients with type 2 diabetes to engage in physical activity for at least 150 minutes per week at moderate intensity and to add resistance training on at least 2 days to improve glycemic control. B
› Teach patients techniques to reduce stress and improve sleep quality. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Consider high-intensity interval training
Multiple randomized controlled trials highlight the benefits of high-intensity interval training (HIIT) (TABLE 219-21) compared with moderate-intensity continuous training (MICT) on improving A1C. A meta-analysis showed a weighted mean difference in A1C of 0.23% (95% CI, –0.43 to –0.02%).28 Also, a patient could spend less time performing HIIT as opposed to MICT to achieve the same benefits. For example, a patient typically performing 30 minutes of MICT may only need to perform 15 minutes of HIIT,a time-saving option for patients.20,22
Interrupt sedentary behavior
Risk for incident type 2 diabetes increases when someone is sedentary for more than 6 to 8 hours daily or watches TV for 3 to 4 hours (relative risk [RR] = 1.12).29 Recommendations for interrupting a sedentary lifestyle include standing from a seated position at least every 30 minutes and engaging in a light activity during the break interval for at least 3 minutes.19 Most studies have reliably shown that interrupting sedentary behavior reduces postprandial and 24-hour average blood glucose levels.19 Interrupted sitting/sedentary behavior has also been shown to reduce resting blood pressure in patients with type 2 diabetes.30
O ther important lifestyle factors
Encourage 7 to 8 hours of sleep
There is a U-shaped association between glycemic control and sleep quantity based on a meta-analysis by Lee et al 31 that showed a 0.23% increase in A1C in patients with insufficient sleep (< 4.5-6 hours/night) and a 0.13% increase in patients with ≥ 8 hours of sleep per night. Patients should be encouraged to obtain 7 to 8 hours of sleep per night to help maximize their diabetes control.
Address stress reduction
Although evidence for stress reduction interventions on glycemic control is mixed, there does seem to be a benefit in diminishing emotional distress in patients with diabetes. A systematic review by Noordali et al32 demonstrated that patients who received mindfulness-based interventions had improvements in stress, anxiety, and depression symptoms which resulted in improved quality of life. These psychological benefits may subsequently lead to positive behavioral changes.
Assist patients with smoking cessation
A large meta-analysis showed that active smoking increases the risk of cardiovascular events in patients with type 2 diabetes (RR = 1.44; 95% CI, 1.34-1.54).33 Former smokers still have an increased risk (RR = 1.09; 95% CI, 1.05-1.13), but it is lower than that of current smokers, so patients should be encouraged to quit smoking.3,33
Continue to: How can I get my patient to change?
