New Lifestyle Recommendations for Type 2 Diabetes Released to Endocrinologists
Twitter Summary: New recommendations announced by AACE/ACE w/ first-ever lifestyle therapy section – what they advise for sleep, nutrition, exercise + more!
Who tells doctors what to do? Lots of important organizations that help them organize their work. For example, endocrinologist organizations AACE/ACE recently published an updated version of their strategy recommendations (what they call their “algorithm”) for treating type 2 diabetes.
The most substantial change in the 2016 recommendations is the addition of a new Lifestyle Therapy section. The section provides recommendations for nutrition, physical activity, sleep, behavioral support, and interventions to stop smoking. AACE/ACE offer recommendations for both baseline (moderate) interventions. The recommendations increase in intensity for patients with more severe obesity and obesity-related complications. They are outlined below:
|
Category |
Baseline Interventions |
More Intense Interventions |
|
Nutrition |
Plant-based diet with limited saturated fat and no trans fat Aim to maintain optimal weight Calorie restriction with goal of 5-10% weight reduction if BMI ≥25 |
Structured counseling Meal replacement |
|
Physical Activity |
150 min/week of moderate exertion plus strength training |
Structured program Medical evaluation/supervision for patients with limitations on physical activity |
|
Sleep |
Seven hours per night |
Screening for obstructive sleep apnea |
|
Behavioral Support |
Community engagement Screening for anxiety and depression |
Referral to mental health professional Cognitive behavioral therapy |
|
Smoking Cessation |
No tobacco products |
Structured programs |
We love this Lifestyle Therapy section and think it's a very welcome addition – often the conversation about diabetes focuses too highly on drugs and devices, despite the enormous role of lifestyle and behavior in diabetes management. It is particularly refreshing to see AACE/ACE addressing aspects of lifestyle like sleep and mental health that are not always considered in traditional weight loss programs. Mental health is underfunded in virtually every disease area, and having major organizations raise awareness for mental health needs is crucial.
The document and its accompanying summary are added to the full 2015 clinical practice guidelines published last April. Along with the ADA/EASD position statement, the AACE/ACE algorithm is one of the most widely referenced sets of guidelines for type 2 diabetes management in the US. What do you think?
–ER
