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. 2025 Jun 10;19(2 Suppl):10S-131S.
doi: 10.1177/15598276251325488. eCollection 2025 Jul.

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

Richard M Rosenfeld  1 , Meagan L Grega  2 , Micaela C Karlsen  3 , Abd Moain Abu Dabrh  4 , R Nisha Aurora  5 , Jonathan P Bonnet  6 , Lori Donnell  7 , Stephanie L Fitzpatrick  8 , Beth Frates  9 , Elizabeth A Joy  10 , Jane F Kapustin  11 , Dawn R Noe  12 , Gunadhar Panigrahi  13   14 , Arun Ram  15 , Lianna S Levine Reisner  16 , Willy Marcos Valencia  17 , Lorraine J Weatherspoon  18 , Jonathan M Weber  19 , Kara L Staffier  3 , Mahima Gulati  20
Affiliations

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

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

Abstract

Objective: Diabetes is a defining disease of the 21st century because of its rising prevalence, association with obesity, and enormous health impact. Abundant evidence shows that lifestyle interventions can delay or prevent type 2 diabetes (T2D) in adults, offer relief, and sometimes achieve complete remission. Despite this empowering message, there are no clinical practice guidelines that focus primarily on lifestyle interventions as first-line management of prediabetes and T2D. Our objective, therefore, is to offer pragmatic, trustworthy, and evidence-based guidance for clinicians in using the 6 pillars of lifestyle medicine-nutrition, physical activity, stress management, sleep, social connectedness, avoidance of risky substances-for managing adults with T2D and in preventing T2D in adults with prediabetes or a history of gestational diabetes mellitus. Methods: We used well-established, peer-reviewed guideline methodology to develop evidence-based key action statements (recommendations) that facilitate quality improvement in clinical practice. The guideline development group included 20 members representing consumers, advanced practice nursing, cardiology, clinical pharmacology, behavioral medicine, endocrinology, family medicine, lifestyle medicine, nutrition and dietetics, health education, health and wellness coaching, sleep medicine, sports medicine, and obesity medicine. Recommendation strength was based on the aggregate evidence supporting a key action statement plus a comparison of associated benefits vs harms/costs. Multiple literature searches, conducted by an information specialist, identified 8 relevant guidelines, 118 relevant systematic reviews, and 112 randomized clinical trials. The guideline underwent extensive internal, external, and public review and comment prior to publication. Results: We developed 14 key action statements and associated evidence profiles, each with a distinct quality improvement goal in the context of lifestyle interventions for T2D. Strong recommendations were made regarding advocacy for lifestyle interventions; assessing baseline lifestyle habits; establishing priorities for lifestyle change; prescribing aerobic and muscle strength physical activity; reducing sedentary time; identifying sleep disorders; prescribing nutrition plans for prevention and treatment; promoting peer/familial support and social connections; counseling regarding tobacco, alcohol, and recreational drugs, and establishing a plan for continuity of care. Recommendations were made regarding identifying the need for psychological interventions and for adjusting (deprescribing) pharmacologic therapy. We include numerous tables and figures to facilitate implementation, a plain-language summary for consumers, and an executive summary for clinicians as separate publications. Conclusions: There is robust research evidence supporting the efficacy of lifestyle interventions in preventing, treating, and achieving remission of T2D in adults. Our multidisciplinary guideline development group successfully synthesized this evidence into 14 key action statements that can be used by clinicians and other healthcare professionals to improve quality of care for adults with, or at-risk for, T2D. Despite the research gaps and implementation challenges we highlight in the guideline we believe strongly that our recommendations have immediate relevance and can help raise awareness and shift the paradigm of T2D management towards optimal use of lifestyle interventions.

Keywords: behavioral medicine; clinical practice guideline; 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 ACLM funded the development of this guideline in full, including meeting and travel expenses. Members of the GDG declared perceived conflicts of interest from the past 2 years, and these conflicts were shared across the group. Conflicts of interest included financial relationships, personal experiences, work/employment situation, and any previously established “stake” in a topic.103 It was determined that individuals with potential conflicts could remain in the GDG if the following criteria were met: (1) they reminded the panel of potential conflicts before discussion related to their conflict, (2) they recused themselves from discussions related to their conflict if requested by the panel, and (3) they agreed not to discuss the guideline in any way with industry prior to publication.104 Conflicts were reviewed at the start of each conference call and in-person meeting with the same process followed for perceived conflicts as described above. All conflicts are disclosed at the end of this document.Richard M. Rosenfeld: Non-Financial—Director of Guidelines & Quality, ACLM; Chief Medical Officer, ABLM. Jonathan P. Bonnet: Published 2 editions of the Lifestyle Medicine Handbook and the Medical Fitness Bible. Co-lead of the ACLM’s Board Review Course. Serves on the American Board of Lifestyle Medicine. Recipient of multiple research grants from the Ardmore Institute of Health in conducting Teaching Kitchen research at Emory University. Jane F. Kapustin: Consulting Fee—Speaker for Sanofi/Provention Bio (Type 1 D prevention) National and regional speaker for NP and other medical associations. Micaela C. Karlsen: salaried employee—American College of Lifestyle Medicine. Dawn R. Noe: Consulting Fee—Speaker for Lifescan Diabetes, Diabetes Advisor for Medtronic; Salary—private practice nutrition coaching business. Kara L. Staffier: salaried employee—American College of Lifestyle Medicine.

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