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ADA: Lifestyle management key to treating patients with diabetes
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In this year’s Standards of Medical Care, the American Diabetes Association emphasizes that lifestyle management is the key to treating patients with diabetes, according to a review article published in Osteopathic Family Physician.
“The cornerstone of treatment of patients with diabetes is lifestyle management. In the vast landscape of advice on diet and exercise, it is important to give evidence-based recommendations on lifestyle management to our patients with diabetes,” Kim Pfotenhauer, DO, assistant professor of medicine in the primary care department at Touro University College of Osteopathic Medicine, told Healio Family Medicine. “This year, the ADA’s Standards of Medical Care featured a more robust section on lifestyle management. This information was compiled to be an easy reference for the osteopathic family physician with the latest recommendations.”
In their article, Pfotenhauer and colleagues reviewed the most important lifestyle recommendations by the ADA to help family physicians provide their patients with the best diabetes care. The Standards of Care now groups lifestyle management into a new section that focuses on:
•physical activity;
•nutrition therapy;
•smoking cessation counselling;
•psychosocial care;
•diabetes self-management education; and
•diabetes self-management support.
The ADA recommends that patients with diabetes take part in aerobic, resistance, flexibility and balance exercises. Aerobic exercises can improve cardiorespiratory function and insulin sensitivity; resistance training can increase muscle mass and strength; flexibility exercises will help increase range of motion around the joints; and balance exercises may decrease the risk for falls among older adults with diabetes.
Patients with type 2 diabetes should reduce their sedentary behavior, as increases risk for mortality and morbidity, the researchers wrote. Younger patients with type 1 diabetes may also see benefits from physical activity, including decreased mortality and possible blood glucose stability. For youth with type 2 diabetes, ADA recommends a minimum of 1 hour per day of moderate-to-high physical activity 3 days per week.
The researchers wrote that people with diabetes should receive individualized medical nutrition therapy, preferably from a registered dietician. Diets should feature healthy eating patterns containing nutritious foods, as seen in Mediterranean, the Dietary Approaches to Stop Hypertension (DASH) and plant-based diets. Carbohydrates higher in fiber and lower in glycemic load should be emphasized and sugar-sweetened beverages should be avoided to control weight and decrease the risk for CVD and fatty liver.
Prior research has demonstrated that smoking cessation was associated with substantial CVD benefit in patients with type 2 diabetes. In their updated recommendations, ADA advises that physicians assess the patient for diabetes distress and other psychosocial issues, according to the Pfotenhauer.
“Type 2 diabetes affects all aspects of a person's life. At times this can become overwhelming leading to decreased self-management,” Pfotenhauer said. “Recognizing these times of distress and treating appropriately can bring a patient back into control and improve or prevent complications.”
National standards advise that patients with diabetes participate in diabetes self-management education to gain knowledge on how to care for their diabetes and diabetes self-management support to learn how to implement these strategies long-term. Diabetes self-management education can improve diabetes knowledge, self-care behaviors, quality of life and healthy coping, and lower weight, health care costs and A1C.
“There is not one strategy that is more important than others. Treating every aspect of the patients' lifestyle is important for improving disease management,” Pfotenhauer said. “As an osteopathic family physician, creating a long-term relationship gives us the benefit of sharing lifestyle management strategies at times when the patient is ready and able to listen to make life long improvements in health.” – by Savannah Demko
Disclosures: Pfotenhauer reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.