Practical methods for utilizing ACLM’s medical follow guideline on life-style interventions to deal with and stop kind 2 diabetes

In this weblog submit, CPG guideline co-author Dr. Meagan Grega affords a step-by-step instance of how clinicians can use the rule of thumb within the examination room to implement life-style interventions for kind 2 diabetes, supporting sufferers in bettering their long-term well being.

By Meagan L. Grega, MD, FACLM, DipABLM, DipABFM 

August 14, 2025

Type 2 diabetes (T2D) and prediabetes are alarmingly widespread within the United States, with over half of the grownup inhabitants assembly the diagnostic standards for one of many two conditions. In 2019, there have been 38.2 million doctor workplace visits for T2D, with diabetes of any kind documented in 14.2% of all outpatient encounters. The annual price for diabetes reached $413 billion in 2022, accounting for 25% of all healthcare {dollars} spent.    

In response to the rising price and healthcare burden of managing metabolic dysfunction, the American College of Lifestyle Medicine (ACLM) chosen the therapy and prevention of kind 2 diabetes and prediabetes in adults by life-style interventions as the main target of its first Clinical Practice Guideline (CPG). This CPG will not be a complete abstract of the right way to diagnose or handle prediabetes or T2D, and it isn’t supposed to interchange different pointers. Instead, it focuses explicitly on evidence-based life-style change interventions as the muse of prevention and therapy of prediabetes and T2D. The purpose of the CPG is to equip healthcare professionals with a sturdy suite of instruments and sources which can be straight relevant to the sufferers they take care of daily.  The crucial subsequent step is figuring out the right way to translate this guideline into motion within the examination room. 

Assessing baseline life-style habits

To discover this subject additional, we’ll study a real-world medical state of affairs—one which displays the kinds of sufferers many healthcare professionals generally encounter.   

Envision a feminine affected person, age 62, with a historical past of hypertension, hyperlipidemia, weight problems and osteoarthritis, who presents to your workplace to debate her current labs. She has had mildly elevated fasting blood glucose for a number of years, however now her labs are vital for a HbA1c of seven.5.  She is understandably involved about her new analysis of T2D and asks what you advocate as subsequent steps in her therapy plan. How can the Key Action Statements (KAS) outlined within the CPG assist your shared decision-making with this affected person?   

KAS 1 (Advocacy for Lifestyle Interventions), KAS 2 (Assessment of Baseline Lifestyle Habits), and KAS 3 (Establishing Priorities for Lifestyle Change) are glorious first steps within the dialogue.   

Highlighting the influence of wholesome life-style behaviors within the therapy of T2D, together with a whole-food, plant-predominant consuming sample, common bodily exercise, prioritizing restorative sleep, wholesome stress administration methods, nurturing connectedness, and avoidance of dangerous substances, is a strong counseling instrument. Patients are sometimes acquainted with the usage of drugs to handle diabetes, however will not be conscious of the spectacular outcomes that may be achieved by optimizing wholesome life-style behaviors. When a healthcare skilled actively promotes the significance of life-style change, it might probably have a long-lasting influence. Consider utilizing Figure 3 from the CPG as a useful affected person handout to information your dialogue. 

Assessing a affected person’s present life-style habits offers a helpful baseline and helps future discussions about habits change targets. There are a number of screening instruments to contemplate in Table 8.  Exploring the affected person’s readiness to alter is one other important element previous to creation of particular habits change targets. Figures 4, 5, 6 are useful affected person handouts to make the most of at this stage. 

Engaging in shared decision-making concerning the affected person’s targets and priorities is a crucial step within the course of. Using a “coach approach” to information the affected person within the creation of SMART targets (Specific, Measurable, Achievable, Relevant and Time-Bound) is an efficient technique for selling affected person autonomy, and sustainable change. Figures 7, 8 and 9 are useful affected person handouts to make the most of throughout this course of. 

Crafting a way of life habits change plan

OK – you’ve advocated for the significance of wholesome life-style adjustments within the administration of T2D, assessed your affected person’s baseline life-style habits, explored their readiness to alter, and launched the idea of SMART targets. What subsequent?  KAS 4 (Prescribing Aerobic and Muscle Strengthening Physical Activity), KAS 5 (Reducing Sedentary Time), KAS 7 (Prescribing a Nutrition Plan for Prevention), KAS 8 (Prescribing a Nutrition Plan for Treatment), and KAS 11 (Tobacco, Alcohol, and Recreational Drugs) are useful subjects to discover as you proceed to craft a administration plan. 

Achieving ample bodily exercise and lowering sedentary time have a big influence on blood glucose ranges, along with bettering cardiorespiratory health, sleep high quality, cognitive operate, and psychological well being. Figures 11 and 14, 15 and 16 are affected person handouts to assist information the dialogue, whereas Table 9 offers useful bodily exercise sources particularly geared in direction of people with motion limitations. 

The elements of optimum diet are sometimes an space of confusion for sufferers. In addition to referral to a dietitian, clinicians are inspired to supply counseling on the advantages of a whole-food, plant-predominant consuming sample. An efficient training technique entails highlighting the consensus suggestions of a number of skilled medical societies to observe a low-sodium, high-potassium dietary sample that features consumption of ample servings of fruits, greens, complete grains, and legumes (whereas limiting quantities of saturated fats, purple meat and processed purple meat, processed meals containing added sugars, sodium and refined grains, and sugar-sweetened drinks) as the popular dietary method for supporting cardiometabolic well being. Figures 18, 19, 20, and 21 and Tables 11-13 are glorious sources to information shared decision-making in crafting diet SMART targets. 

Alcohol, tobacco, and leisure drug use can negatively influence the administration of T2D.  Figures 26 and 27 are helpful screening instruments to make the most of for affected person evaluation and counseling in regard to dangerous substance publicity.   

Other life-style habits to handle

Through motivational interviewing and shared decision-making, your affected person has created SMART targets for bodily exercise, sedentary time, diet, and publicity to dangerous substances.  What different life-style habits can be useful to research? KAS 6 (Identifying Sleep Disorders), KAS 9 (Peer/Familial Support and Social Connections), KAS 10 (Identifying Need for Psychological Interventions), and KAS 12 (Achieving Person-Driven, Sustained Positive Behavior Change) are the following areas to contemplate.  Check out Figure 17 (Lifestyle Sleep Health), Figure 22 (Relationships and Better Health), Figure 23 (Diabetes and Depression), Figure 24 (Managing Stress), and Table 21 (Practical Tips and Techniques Used in Behavior Change-Centered Interventions) for helpful instruments to information your method. 

Additional concerns within the long-term administration of kind 2 diabetes embody KAS 13 (Establishing a Plan for Continuity of Care) and KAS 14 (Adjusting Pharmacologic Therapy).  Longitudinal relationships with a supportive workforce are the key sauce of profitable habits change. Figure 29 offers a instrument for sufferers to facilitate efficient communication with their healthcare workforce. Deprescribing is one other essential space to guage in sufferers who’re efficiently making life-style adjustments whereas on diabetes drugs. Figures 30 and 31 present a structured framework for reducing or discontinuing glucose-lowering drugs within the context of life-style interventions. 

Supporting sufferers within the therapy, remission, and prevention of diabetes is a journey. This CPG offers a roadmap to observe for encouraging habits change as a foundational element of the medical therapy plan.  

About the creator

Meagan L. Grega, MD, FACLM, DipABLM, DipABFM, is the co-founder and chief medical officer of Kellyn Foundation (www.kellyn.org), a 501(c)3 non-profit devoted to creating the wholesome selection the simple selection. Through the “Healthy Neighborhood Immersion Strategy,” Kellyn offers school-based wholesome life-style training and “garden as a classroom” applications; helps entry to nutrient-dense produce by way of the Eat Real Food Mobile Market; engages contributors in hands-on, plant-based cooking courses in group settings and affords intensive therapeutic life-style change interventions for households, employers, and group teams.  She is a graduate of Bucknell University with a BS in biochemistry/cell biology and earned her MD from the University of Pennsylvania Medical School.