Lifestyle therapy for diabetes mellitus

Abstract

Lifestyle therapy is the cornerstone of diabetes treatment and is designed to work alone or in concert with any medical therapy to achieve the following treatment goals: (i) control glycemia to prevent microvascular complications, (ii) prevent acute complications and hypoglycemia, (iii) prevent cardiovascular disease events by improving risk factors such as dyslipidemia and hypertension, and (iv) improve functionality and quality of life. Medical nutrition therapy (MNT) and diabetes self-management education and support programs are critically important components of lifestyle therapy in patients with type 2 diabetes mellitus (T2D) and type 1 diabetes mellitus (T1D), and these interventions should be individualized and developed by the health-care team in collaboration with the patient. MNT can be accomplished by any one of several healthy meal plans, which can be selected based on personal and cultural dietary preferences. Lifestyle therapy includes physical activity that optimally encompasses both aerobic and resistance exercises and a reduction in sedentary behavior, and takes into account patients' preferences and capabilities. While the conventional practice of MNT and lifestyle intervention recognizes the benefits of weight loss, the approach has lacked a concerted approach in optimally using therapeutic options directed at weight loss as a primary treatment goal. This chapter emphasizes a reconfigured approach to lifestyle therapy for T2D designed to achieve and sustain clinically meaningful weight loss as a primary objective. Weight loss can dramatically benefit patients with diabetes who are overweight or obese by enhancing glycemic control concomitant with reduced need for glucose-lowering medications, by improving the cardiovascular disease risk profile, and enhancing quality of life.