Diabetes Self-Management: Facilitating Lifestyle Change

 

Am Fam Physician. 2017 Sep 15;96(6):362-370.

  Patient information: Handouts on this topic are available at https://familydoctor.org/diabetes-and-nutrition/ and https://familydoctor.org/diabetes-and-exercise/.

Author disclosure: No relevant financial affiliations.

Healthy eating and increased physical activity can prevent or delay the onset of diabetes mellitus and facilitate diabetes management. Current guidelines recommend long-term weight loss of 5% to 7% of body weight and 150 minutes of at least moderate-intensity physical activity per week for most patients with prediabetes and diabetes. Techniques to assess and facilitate adherence to these lifestyle changes can be practical in primary care. During office visits, physicians should assess and gradually encourage patients' readiness to work toward change. Addressing patients' conviction and confidence can be effective in moving them toward action. Long-term goals are best separated into highly specific short-term outcome goals and achievable behavior targets. Lifestyle goals and targets should be tailored to patients' preferences and progress while building confidence in small steps. Screening for diabetes-related attitudes, expectations, and quality of life, and addressing psychosocial factors, both favorable and unfavorable, can facilitate the likelihood of success. Follow-up contact with patients helps maintain and expand progress by reviewing self-monitored goals, targets, and achievements; finding opportunities to encourage and empower; reviewing slips, triggers, and obstacles; and negotiating further customization of the plan.

Approximately 9% to 10% of the U.S. population has type 2 diabetes mellitus, including estimated undiagnosed cases.1 From 1980 to 2014, the prevalence of diagnosed type 2 diabetes in the United States quadrupled. However, the incidence of new cases of diagnosed diabetes peaked in 2008 and has since declined, suggesting that the overall prevalence may gradually level off.2 Older age, obesity, and physical inactivity are risk factors directly related to the development of diabetes.3

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Patients with prediabetes should be referred to a structured intensive lifestyle intervention program (e.g., the National Diabetes Prevention Program).

A

3, 810

Patients with prediabetes who are overweight or obese should be encouraged to lose at least 7% of body weight as a long-term goal.

A

3, 810

Patients with prediabetes should be encouraged to engage in 150 minutes per week of moderate-intensity physical activity (e.g., brisk walking).

A

3, 810

Receptive patients with type 2 diabetes mellitus should be provided a structured intensive lifestyle intervention program (e.g., using the Look AHEAD [Action for Health in Diabetes] intervention materials).

B

3, 11, 12

Patients with type 2 diabetes who are overweight or obese should be encouraged to lose at least 5% of their body weight as a long-term goal.

C

3, 11, 12

Patients with type 2 diabetes should be encouraged to engage in 150 minutes per week of moderate-to vigorous-intensity aerobic exercise over three or more days, with no more than two days between exercise bouts, as well as moderate to vigorous resistance training two or three days per week.

C

3


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Patients with prediabetes should be referred to a structured intensive lifestyle intervention program (e.g., the National Diabetes Prevention Program).

A

3, 810

Patients with prediabetes who are overweight or obese should be encouraged to lose at least 7% of body weight as a long-term goal.

A

3, 810

Patients with prediabetes should be encouraged to engage in 150 minutes per week of moderate-intensity physical activity (e.g., brisk walking).

A

3, 810

Receptive patients with type 2 diabetes mellitus should be provided a structured intensive lifestyle intervention program (e.g., using the Look AHEAD [Action for Health in Diabetes] intervention materials).

B

3, 11, 12

Patients with type 2 diabetes who are overweight or obese should be encouraged to lose at least 5% of their body weight as a long-term goal.

C

3, 11, 12

Patients with type 2 diabetes should be encouraged to engage in 150 minutes per week of moderate-to vigorous-intensity aerobic exercise over three or more days, with no more than two days between exercise bouts, as well as moderate to vigorous resistance training two or three days per week.

C

3


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

Prediabetes, a state of increased risk of developing diabetes,

The Authors

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MARLON RUSSELL KOENIGSBERG, PhD, is a clinical assistant professor of family medicine at the University at Buffalo, Williamsville, NY....

JENNIFER CORLISS, MD, is a clinical assistant professor of family medicine at the University at Buffalo.

Author disclosure: No relevant financial affiliations.

Address correspondence to Marlon Russell Koenigsberg, PhD, UB Family Medicine, 850 Hopkins Rd., Williamsville, NY 14221. Reprints are not available from the authors.

REFERENCES

show all references

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