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Diabetes type 2

Lifestyle modifications

NUTRITION

  • Limiting caloric intake to initiate weight loss, if overweight/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 minimising 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)

  • Saturated fats: < 10% of daily calories (1)

  • Sugars: Limit intake (1)


PHYSICAL ACTIVITY

  • > 150 min / 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 preferrable 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 CVD 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

Resources

Evidence Pyramid

EXPLANATION TO EVIDENCE PRESENTATION

Evidence based on guidelines and evidence based Clinical Decision Systems is written in BOLD

Evidence based on meta analysis or systematic reviews is written in BOLD and CURSIVE

Evidence based on randomized controlled trials is written in plain font

Evidence based on observational / cohort studies is written in CURSIVE

Figure: Evidence pyramid

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