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Review
. 2025 Mar 25:15598276251325802.
doi: 10.1177/15598276251325802. Online ahead of print.

Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: Implications for Clinicians

Richard M Rosenfeld  1 , Meagan L Grega  2 , Mahima Gulati  3
Affiliations
Review

Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults: Implications for Clinicians

Richard M Rosenfeld et al. Am J Lifestyle Med. .

Abstract

This review is based on a presentation at the 2024 Annual Meeting of the American College of Lifestyle Medicine (ACLM), which showcased ACLM's first clinical practice guideline on Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults. Our goal is to offer pragmatic implications of the guideline for everyday patient care, including case presentations showing how the guideline recommendations (key action statements) can be implemented. The target audience is any clinician or healthcare professional in a community or outpatient healthcare setting involved in managing non-pregnant adults with T2D, prediabetes or a history of gestational diabetes mellitus (GDM). Unique features of the ACLM guideline include placing lifestyle interventions as the foundation of T2D management and prevention, offering strategies for sustained behavior change, and emphasizing all six pillars of lifestyle medicine: plant-predominant nutrition, regular physical activity, restorative sleep, stress reduction, social connectedness, and avoiding risky substances. This review is not intended to substitute for the full guideline, which should be read before doing the recommended actions.

Keywords: behavioral medicine; clinical practice guideline (CPG); evidence-based medicine; gestational diabetes mellitus; health coaching; lifestyle interventions; lifestyle medicine; nutrition; prediabetes; primary care integration; social determinants of health; type 2 diabetes.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Richard M. Rosenfeld has a consulting role as Director of Guidelines and Quality for the American College of Lifestyle Medicine.

Figures

Figure 1.
Figure 1.
Criteria for determining recommendation strength. The recommendation strength for a key action statement is determined by the aggregate evidence grade (Table 3) and the benefit vs. harm relationship (e.g., preponderance vs. balance). For some combinations with a preponderance of benefit or harm the guideline development group can choose between two possibilities (e.g., for evidence grades B, C, and X). Adapted from American Academy of Pediatrics.
Figure 2.
Figure 2.
Flowchart showing the interrelationships of the guideline key action statements (KAS), with the numbering for each KAS corresponding to its order in the text.
Figure 3.
Figure 3.
(a) Handout on advocacy for lifestyle changes in preventing and managing type 2 diabetes in adults, part 1 (b) handout on advocacy for lifestyle changes in preventing and managing type 2 diabetes in adults, part 2.
Figure 4.
Figure 4.
Examples of SMART goals and goals that are not in the SMART framework.
Figure 5.
Figure 5.
Worksheet for shared decision-making in implementing SMART goals for behavior change. The framework applies to all six pillars of lifestyle intervention, namely physical activity, nutrition, sleep, stress management, social connections, and avoidance of risk substances.
Figure 6.
Figure 6.
Move Your Way Physical Activity Guidelines for Americans (PAGA). Note that the guidelines include recommendations for both aerobic and muscle-strengthening activity. Department of Health and Human Services. Office of Disease Prevention and Health Promotion.
Figure 7.
Figure 7.
Person-centered exercise form that can be used by clinicians and healthcare professionals to engage individuals in physical activity by prescribing goals using the FITT framework: frequency, intensity, time and type. Reproduced with permission from the American College of Sports Medicine.
Figure 8.
Figure 8.
Examples of bite-sized activities that individuals can utilize to break up or reduce sedentary time.
Figure 9.
Figure 9.
Tips and guidelines for maintaining good sleep habits for better management of diabetes and prediabetes.
Figure 10.
Figure 10.
Handout for individuals explaining the health risks of ultra-processed foods, why whole-foods are better, and how to increase fiber in the eating plan.
Figure 11.
Figure 11.
Handout for individuals showing how strong relationships can reinforce healthy lifestyle habits.
Figure 12.
Figure 12.
Handout for individuals with suggestions on how to think about and manage stress for better health.
Figure 13.
Figure 13.
NIDA quick screen questionnaire for substance use with directions for coding the responses.
See this image and copyright information in PMC

References

    1. Rosenfeld RM, Grega ML, Karlsen MC, et al. 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. Am J Lifestyle Med. 2025. In press. - PMC - PubMed
    1. Wang H, Akbari-Alavijeh S, Parhar RS, Gaugler R, Hashmi S. Partners in diabetes epidemic: a global perspective. World J Diabetes. 2023;14(10):1463-1477. doi: 10.4239/wjd.v14.i10.1463 - DOI - PMC - PubMed
    1. Lancet . Diabetes: a defining disease of the 21st century. Lancet. 2023;401(10394):2087. doi: 10.1016/S0140-6736(23)01296-5 - DOI - PubMed
    1. Centers for Disease Control and Prevention . National diabetes statistics report. cdc.org. 2023. https://www.cdc.gov/diabetes/php/data-research/index.html. Accessed December 2.
    1. Centers for Disease Control . Leading causes of death. cdc.org. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Updated October 25, 2024. Accessed December 2, 2024.

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