The American College of Lifestyle Medicine (ACLM) released a new set of guidelines, Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults. These new guidelines are focused on filling the void that ACLM found in that there were no clinical practice guidelines that focused largely on lifestyle interventions as first-line management of prediabetes and type 2 diabetes.

These new guidelines feature 14 key action statements, six pillars of lifestyle medicine interventions, evidence profiles, quality improvement goals, recommendations, and more.

With 14 key action statements highlighted below, along with their associated recommendation level, we’re providing a brief rundown of these guidelines to help you understand what’s provided within. Refer to the full-text version of the guidelines for the most thorough explanation of these and other recommendations.

14 Key Action Statements of the ACLM Guidelines for Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults:
  1. Advocacy for Lifestyle Interventions: The clinician or HCP should be an advocate for lifestyle interventions as first-line management for prediabetes and T2D, including restorative sleep, stress management, adequate physical activity, positive social connections, a whole-food, plant-predominant eating plan, and avoiding risky substances. (Strong Recommendation)
  2. Assessment of Baseline Lifestyle Habits: The clinician or health care professional should assess the baseline lifestyle habits, in adults with prediabetes, T2D or a history of GDM with regards to the 6 pillars of lifestyle medicine (see Table 2), educate the individual regarding opportunities to improve their lifestyle behaviors, and evaluate the individual’s readiness to change. (Strong Recommendation)
  3. Establishing Priorities for Lifestyle Change: For an adult with prediabetes, T2D, or a history of GDM, the clinician or HCP should establish priorities for lifestyle change with regards to the 6 pillars of lifestyle intervention (see Table 2) through shared decision-making and should discuss the role of using SMART (Specific, Measurable, Achievable, Relevant, And Time-Bound) goals in supporting positive lifestyle change. (Strong Recommendation)
  4. Prescribing Aerobic and Muscle Strength Physical Activity: The clinician or HCP should prescribe physical activity, with an emphasis on aerobic and muscle strength training, by establishing SMART goals and using the FITT (frequency, intensity, time, type) framework for implementation for adults with prediabetes, T2D, or a history of GDM. (Strong Recommendation)
  5. Reducing Sedentary Time: The clinician or HCP should prescribe physical activity to reduce sedentary time, using SMART goals, for adults with prediabetes, T2D, or a history of GDM. (Strong Recommendation)
  6. Identifying Sleep Disorders: In adults with prediabetes, T2D, or a history of GDM, the clinician or HCP should ask about sleep quality, quantity, and patterns, determine if a sleep disorder is present, and refer, as indicated, for further evaluation and management. Sleep disorders associated with prediabetes, (T2D), and a history of GDM include, but are not limited to, obstructive sleep apnea, shift work sleep disorder, chronic insomnia, and short or long sleep duration. (Strong Recommendation)
  7. Prescribing a Nutrition Plan for Prevention: In adults with prediabetes, or a history of GDM, the clinician, HCP, or their designee, should prescribe a nutrition plan using SMART goals that is consistent with the individual’s cultural background and is framed in food-based advice regarding caloric intake, nutrient needs, and the importance of a whole-food, plant-predominant eating plan. (Strong Recommendation)
  8. Prescribing a Nutrition Plan for Treatment: The clinician, HCP, or their designee, should clarify with the person with T2D if their goal is to achieve T2D remission or T2D improvement and should prescribe a nutrition plan using SMART goals that is consistent with the person’s desired outcome(s), cultural background, and is framed in food-based guidance promoting appropriate energy intake, nutrient needs, and the benefits of a whole-food, plant-predominant eating plan. (Strong Recommendation)
  9. Peer/Familial Support and Social Connections: The clinician or HCP should counsel adults with prediabetes, T2D, or a history of GDM regarding the importance of cultivating positive social connections provided by peers, family members, and/or other professionals trained in lifestyle change methods to achieve SMART goals and optimize glucose management. (Strong Recommendation)
  10. Identifying Need for Psychological Interventions: In adults with prediabetes, T2D, or a history of GDM the clinician or HCP should identify or refer to someone who can identify serious mental illness such as severe mood/affective disorders, anxiety disorders, or psychotic disorders. For individuals experiencing stress or symptoms of depression or anxiety, prescribe mindfulness-based, cognitive behavioral therapy (CBT), or CBT-based interventions to improve diabetes clinical outcomes.
  11. Tobacco, Alcohol, and Recreational Drugs: The clinician or HCP should assess adults with T2D for use of tobacco, alcohol, and other recreational drugs and should counsel them on how using these substances can adversely impact management of T2D. (Strong Recommendation)
  12. Achieving Person-Driven, Sustained Positive Behavior Change: For adults with prediabetes, T2D, or a history of GDM, the clinician, HCP, or their designee, should help individuals achieve sustained, person-centered, positive behavior change using evidence-based approaches including, but not limited to, coaching, motivational interviewing, and cognitive behavioral therapy. (Strong Recommendation)
  13. Establishing a Plan for Continuity of Care: For adults with prediabetes, T2D, or a history of GDM, the clinician or HCP should establish a plan for continuity of care that prescribes lifestyle interventions and specifies the frequency of visits, anticipated duration of care, potential need for adjustments of pharmacologic therapy, and expectations regarding the individual’s engagement. (Strong Recommendation)
  14. Adjusting Pharmacologic Therapy: For adults with prediabetes, T2D, or a history of GDM, the clinician or HCP should adjust the type and dosing of an individual’s pharmacologic therapy based on the impact of lifestyle intervention on their medication needs. (Recommendation)

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