A newly released guideline recommended using lifestyle interventions as first-line treatment among adult patients with type 2 diabetes and prediabetes.
The recommendations were based on extensive evidence that lifestyle changes can prevent progression, improve glycemic control, and, in some cases, achieve remission without medication.
Over 38 million patients in the United States have diabetes, with 90% to 95% classified as type 2 diabetes. An estimated 36.5% of U.S. adults have prediabetes. Combined, diabetes and prediabetes affect nearly 50% of the U.S. adult population. Globally, diabetes prevalence is projected to exceed 1.3 billion patients by 2050.
The guideline organized lifestyle interventions into six pillars: nutrition, physical activity, stress management, sleep, social connections, and avoidance of risky substances such as tobacco and excessive alcohol. These approaches target the root causes of insulin resistance rather than just managing elevated glucose levels.
Nutritional recommendations focused on a whole-food, plant-predominant diet rich in vegetables, fruits, whole grains, legumes, nuts, and seeds. This approach supplies fiber, antioxidants, and essential nutrients while limiting animal products as well as refined and ultraprocessed foods. Physical activity guidelines promoted regular aerobic and muscle-strengthening exercises, along with minimizing sedentary behavior.
Stress management included mindfulness, breathing exercises, and cognitive behavioral therapy. Adequate sleep—defined as 7 to 9 hours per night—was emphasized for metabolic health. The guideline also highlighted the importance of social support and the avoidance of smoking, alcohol misuse, and recreational drug use.
The recommendations were supported by data from eight clinical guidelines, 118 systematic reviews, and 112 randomized controlled trials. These studies showed that lifestyle interventions could lead to improved weight loss, glycemic control, cardiovascular risk reduction, medication deprescribing, and potentially remission. Trials have reported remission rates of 78% at 1 year and 51% at 5 years with intensive lifestyle programs.
Despite the evidence, many patients continue to favor medications. Between 2012 and 2022, the percentage of U.S. adults preferring medication over lifestyle change increased from 16% to 38%. Medications such as insulin, metformin, sodium-glucose co-transporter 2 inhibitors, and glucagon-like peptide-1 receptor agonists remain widely used but carry risks, including gastrointestinal problems, pancreatitis, gallbladder disease, gastroparesis, and rare but serious complications.
The guideline also addressed the economic burden of diabetes. In 2022, total U.S. diabetes-related costs were estimated at over $500 billion, representing 25% of all health care expenditures. Lifestyle interventions may reduce health care spending by lowering the need for medications, hospitalizations, and treatment of complications.
The report emphasized racial, ethnic, and socioeconomic disparities. Minority groups and individuals with lower education, income, or food security experience higher diabetes rates and worse outcomes. The guideline urged health care professionals to consider social determinants of health in diabetes management.
The multidisciplinary guideline team included physicians, psychologists, nurses, dietitians, and patient advocates. They concluded that lifestyle interventions offer a practical, evidence-based strategy to improve outcomes for adults with type 2 diabetes and prediabetes.
