Diabetes mellitus type 2 Life style modification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Life style modification is fundamental for diabetes management and it's a part of therapy. It includes diabetes self-management education (DSME), diabetes self-management support (DSMS), nutrition therapy, physical activity, smoking cessation counseling, and psychosocial care. The overall objectives of DSME and DSMS are to support informed decision making, self-care behaviors, problem solving, and active collaboration with the health care team to improve clinical outcomes, health status, and quality of life in a cost-effective manner.

Life style modification

Nutrition Therapy

• What to eat is a challenging concern for diabetic patients. There is not a one size fits all diet pattern to generalize for all patients and dietary requirements should be individualized for every patient.
• All individuals with diabetes should receive individualized medical nutrition therapy (MNT). MNT delivered by a registered dietitian is associated with A1C decreases of 0.3–1% for people with type 1 diabetes and 0.5–2% for people with type 2 diabetes.
• A balance between carbohydrates, fats and proteins should be individualized. Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load, should be advised over other sources, especially those containing sugars.
• Proteins appear to increase insulin response without increasing plasma glucose concentrations. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia.
• Eating foods rich in long-chain omega-3 fatty acids, such as fatty fish and nuts and seeds is recommended to prevent or treat cardiovascular diseases (CVD).
• Adults with diabetes who drink alcohol should do so in moderation (no more than one drink per day for adult women and no more than two drinks per day for adult men).
• Sodium intake should be restricted to less than 2.3 g/d.
• A cohort study concluded that antioxidant rich diet is related to reduced risk of diabetes type 2 and insulin resistance.

Physical activity

It has been proven that weight loss can delay progression from pre-diabetes to diabetes and is helpful to control hyperglycemia in type 2 diabetes. Losing 5% of initial body weight, has been shown to achieve those goal. The U.S. Department of Health and Human Service's physical activity guidelines for Americans suggest that adults over age 18 years engage in 150 min/week of moderate-intensity or 75 min/week of vigorous-intensity aerobic physical activity, or an equivalent combination of the two.

Smoking cessation

All diabetic patients should be encouraged to quit smoking. For the patient motivated to quit, the addition of pharmacological therapy to counseling is more effective than either treatment alone. Special considerations should include assessment of level of nicotine dependence, which is associated with difficulty in quitting and relapse.

Psychological issues

Emotional well-being is an important part of diabetes care and self-management. Patients should be asked for possible barriers to treatment and self monitoring such as, feeling overwhelmed or stressed by diabetes or other life stressors. Appropriate referral should take into consideration susceptible patients.