Type 2 diabetes (T2D) affects tens of millions of Americans. Lifestyle modifications may prevent T2D in patients with prediabetes and can improve T2D — in some cases even helping patients to achieve remission. Diet and exercise changes are common interventions recommended to patients with diabetes. Additionally, good sleep hygiene practices and mental health support are equally as crucial. As with most long-term medical conditions, a diabetes diagnosis can feel overwhelming, as it often requires complex, lifelong treatment. Adequate sleep and psychosocial support improves a patient's ability and motivation to self-manage the disease.
In today's side-by-side comparison, we compare the latest clinical practice guidelines from the American College of Lifestyle Medicine (ACLM) and the American Diabetes Association (ADA) on lifestyle interventions for T2D and prediabetes in adults. This article is focused on the information in these guidelines related to sleep, psychosocial support, and the use of recreational substances. We encourage you to review the full-text version of the guidelines, for a complete look at the guidelines in their entirety.
Guidelines for Comparison
| Item | 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 | Standards of Care in Diabetes — 2025 |
|---|---|---|
| Authoring Organization | American College of Lifestyle Medicine | American Diabetes Association |
| Publication Date | June 2025 | December 2024 |
| Graded Recommendations | Yes | Yes |
| Links | Summary / Full Text | Summary / Full Text |
Key Takeaways
The ADA’s Standards of Care in diabetes is a comprehensive resource for clinicians. It is a living document with detailed recommendations, updated at least annually to reflect emerging evidence and clinical considerations. In comparison, the guideline from the ACLM is more focused, only offering guidance on lifestyle modifications for prediabetes and T2D.
Sleep
- Both societies recommend screening for sleep disorders and referral to appropriate specialists for further evaluation and management if needed.
- The ADA also adds a recommendation to provide counseling on sleep-promoting routines and habits for people with diabetes.
Psychosocial Support
- ACLM stresses the importance of creating positive connections that can help the patient achieve their goals and optimize glucose management.
- Similar to the ADA the ACLM also recommends that patients with serious mental health conditions be referred to appropriate providers. The ADA takes this a stop further, recommending that these patients have an increased level of support with enhanced monitoring and assistance with diabetes self management.
- The ADA recommends additional monitoring of glycemia, lipids, and weight for patients with diabetes who are taking second-generation atypical antipsychotics.
- When it comes to stress, depression, and anxiety the ACLM recommends cognitive behavior therapy-based interventions. The ADA makes recommendations on when to screen, rescreen, and refer patients with diabetes to a behavioral health specialist for diabetes distress, hypoglycemia fear, anxiety, depression, and disordered eating.
Recreational Substances
- The ACLM and the ADA recommend screening for substance use (tobacco, alcohol, and recreational drugs) and counseling patients on the negative impacts of such use on diabetes.
- The ADA gives more details regarding appropriate counseling depending on the substance being used.
Comparison of Recommendations
| Item | ACLM | ADA |
|---|---|---|
| Sleep | In adults with prediabetes, T2D, or a history of gestational diabetes mellitus (GDM), the clinician or Healthcare provider (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. | Consider screening for sleep health in people with diabetes, including symptoms of sleep disorders, disruptions to sleep due to diabetes symptoms or management needs, and worries about sleep. Refer to sleep medicine specialists and/or qualified behavioral health professionals as indicated. Counsel people with diabetes to practice sleep-promoting routines and habits. |
| Psychosocial Support | 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 (Specific, Measurable, Achievable, Relevant, And Time-Bound) goals and optimize glucose management. 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. | Psychosocial care should be provided to all people with diabetes, with the goal of optimizing health-related quality of life and health outcomes. Such care should be integrated with routine medical care and delivered by trained health care professionals using a collaborative, person-centered, culturally informed approach. Implement screening protocols for psychosocial concerns, including diabetes distress, depression, anxiety, fear of hypoglycemia, and disordered eating behaviors. Screen at least annually or when there is a change in disease, treatment, or life circumstances. When indicated, refer to behavioral health professionals or other trained health care professionals, ideally those with experience in diabetes, for further assessment and treatment for symptoms of diabetes distress, depression, suicidality, anxiety, treatment-related fear of hypoglycemia, disordered eating, and/or cognitive capacities. Such specialized psychosocial care should use age-appropriate standardized and validated tools and treatment approaches. Consider developmental factors and use age-appropriate validated tools for psychosocial screening in people with diabetes. Screen for diabetes distress at least annually in people with diabetes, caregivers, and family members, and repeat screening when treatment goals are not met, at transitional times, and/or in the presence of diabetes complications. Health care professionals can address diabetes distress and may consider referral to a qualified behavioral health professional, ideally one with experience in diabetes, for further assessment and treatment if indicated. Screen people with diabetes for anxiety symptoms. Health care professionals can discuss diabetes-related worries and should consider referral to a qualified behavioral health professional for further assessment and treatment if anxiety symptoms indicate interference with diabetes self-management behaviors or quality of life. Screen people with diabetes at risk for hypoglycemia or fear of hypoglycemia, especially if they have experienced severe and/or frequent hypoglycemic events. Conduct at least annual screening of depressive symptoms in all people with diabetes and more frequently among those with a history of depression. Use age-appropriate, validated depression screening measures, recognizing that further evaluation will be necessary for individuals who have a positive screen. Rescreen for depression at diagnosis of complications or when there are significant changes in medical status. Refer to qualified behavioral health professionals or other trained health care professionals with experience using evidence-based treatment approaches for depression in conjunction with collaborative care with the diabetes treatment team. Screen for disordered or disrupted eating using validated screening measures. In addition, a review of the medical treatment plan is recommended to identify potential treatment-related effects on hunger/caloric intake. Consider reevaluating the treatment plan of people with diabetes who present with symptoms of disordered eating behavior, an eating disorder, or disrupted patterns of eating, in consultation with a qualified professional. Key qualifications include familiarity with diabetes disease physiology, treatments for diabetes and disordered eating behaviors, and weight-related and psychological risk factors for disordered eating behaviors. Provide an increased level of support for people with diabetes and serious mental illness through enhanced monitoring of and assistance with diabetes self-management behaviors. Monitor changes in body weight, glycemia, and lipids in adolescents and adults with diabetes who are prescribed second-generation antipsychotic medications; adjust the treatment plan accordingly, if needed. |
| 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. | Advise adults with diabetes and those at risk for diabetes who consume alcohol to not exceed the recommended daily limits. Advise abstainers to not start drinking alcohol, even in moderation. Educate people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues. The importance of monitoring glucose after drinking alcoholic beverages to reduce hypoglycemia risk should be emphasized. Advise all people with diabetes not to use cigarettes and other tobacco products or e-cigarettes. Ask people with diabetes routinely about the use of cigarettes or other tobacco products. After identification of use, recommend and refer for combination treatment consisting of both tobacco/smoking cessation counseling and pharmacologic therapy. Advise people with type 1 diabetes and those with other forms of diabetes at risk for diabetic ketoacidosis not to use recreational cannabis in any form. |
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