ACLM Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults Guideline Summary - Guideline Central
Summary of Key Action Statements
Document Overview

Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults

American College of Lifestyle Medicine


Publication Date: Jun 10, 2025

Page Last Updated: Mar 6, 2026

Recommendation Grading System

Grades of Aggregate Evidencea
GradeOCBM levelTreatmentHarmDiagnosisPrognosis
A1Systematic reviewb of randomized trialsSystematic reviewb of randomized trials, nested case-control studies, or observational studies with dramatic effectbSystematic reviewb of cross-sectional studies with consistently applied reference standard and blindingSystematic reviewb of inception cohort studiesc
B2Randomized trials, or observational studies with dramatic effects or highly consistent evidenceRandomized trials, or observational studies with dramatic effects or highly consistent evidenceCross-sectional studies with consistently applied reference standard and blindingInception cohort studiesc
C3 - 4Non-randomized or historically controlled studies, including case-control and observational studiesNon-randomized controlled cohort or follow-up study (post-marketing surveillance) with sufficient numbers to rule out a common harm, case-series, case-control, or historically controlled studiesNon-consecutive studies, case-control studies, or studies with poor, non-independent, or inconsistently applied reference standardsCohort study, control arm of a randomized trial, case series, or case-control studies, or poor-quality prognostic cohort study
D5Case reports, mechanism-based reasoning, or reasoning from first principles
Xn/aExceptional situations where validating studies cannot be performed and there is a clear preponderance of benefit over harm

a Adapted from Oxford Centre for Evidence-Based Medicine (OCEBM) Work Group.
b A systematic review may be downgraded to level B because of study limitations, heterogeneity, or imprecision.
c A group of individuals identified for subsequent study at an early, uniform point in the course of the specified health condition, or before the condition develops.

Strength of Action Terms in Guideline Statements and Implied Levels of Obligation
StrengthDefinitionImplied Obligation
Strong RecommendationA strong recommendation means the benefits of the recommended approach clearly exceed the harms (or, in the case of a strong negative recommendation, the harms clearly exceed the benefits) and that the quality of the supporting evidence is high (Grade A or B).a In some clearly identified circumstances, strong recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits strongly outweigh the harms.Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.
RecommendationA recommendation means the benefits exceed the harms (or, in the case of a negative recommendation, the harms exceed the benefits), but the quality of evidence is not as high (Grade B or C).a In some clearly identified circumstances, recommendations may be made based on lesser evidence when high-quality evidence is impossible to obtain and the anticipated benefits outweigh the harms.Clinicians should also generally follow a recommendation but should remain alert to new information and sensitive to patient preferences.
OptionbAn option means that either the quality of evidence is suspect (Grade D)a or that well-done studies (Grade A, B, or C)a show little clear advantage to one approach versus another.Clinicians should be flexible in their decision-making regarding appropriate practice, although they may set bounds on alternatives. Patient preference should have a substantial influencing role.

a Adapted from American Academy of Pediatrics (AAP) classification scheme.
b Option is similar to the “weak recommendation” used in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.

Document Overview

Document Title
Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults
Authoring Society

American College of Lifestyle Medicine

Document Publication Date
Jun 10, 2025
Page Last Reviewed/Updated
Mar 6, 2026
Document Type
Guideline
Country of Publication
United States
Full Text Freely Available
Yes
Full Text Guideline
journals.sagepub.com/doi/full/10.1177/15598276251325488
Source Citation

Rosenfeld RM, Grega ML, Karlsen MC, et al. Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: A Clinical Practice Guideline From the American College of Lifestyle Medicine. American Journal of Lifestyle Medicine. 2025;19(2_suppl):10S-131S. doi:10.1177/15598276251325488

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives

Diabetes is a defining disease of the 21st century because of its rising prevalence, association with obesity, and enormous health impact. Abundant evidence shows that lifestyle interventions can delay or prevent type 2 diabetes (T2D) in adults, offer relief, and sometimes achieve complete remission. Despite this empowering message, there are no clinical practice guidelines that focus primarily on lifestyle interventions as first-line management of prediabetes and T2D. Our objective, therefore, is to offer pragmatic, trustworthy, and evidence-based guidance for clinicians in using the 6 pillars of lifestyle medicine—nutrition, physical activity, stress management, sleep, social connectedness, avoidance of risky substances—for managing adults with T2D and in preventing T2D in adults with prediabetes or a history of gestational diabetes mellitus.

Scope
Diagnosis, Prevention
Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus

D003924 - Diabetes Mellitus, Type 2

D011236 - Prediabetic State

D000070497 - Healthy Lifestyle

Keywords
diabetes, lifestyle, prediabetes
Target Patient Population
Adults with diabetes and prediabetes
Target Provider Population
Primary care providers, endocrinologists, cardiologists, and other clinicians caring for adults with diabetes and prediabetes
Inclusion Criteria
Male, Female, Adult, Older Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Diabetes Educator, Nurse, Nurse Practitioner, Physician, Physician Assistant
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