Currently Viewing:
Evidence-Based Diabetes Management March 2017
Differential Weight Loss Effects on Type 2 Diabetes Remission Among Adults
Virender Kumar, PhD; William Encinosa, PhD; Hena Thakur; and Kisha Thakur
From the Editor in Chief: Why WAIT Results Highlight the Value of Lifestyle Intervention
Robert A. Gabbay, MD, PhD, FACP
Currently Reading
Diabetes: An Opportunity to Have a Lasting Impact on Health Through Lifestyle Modification
Hena N. Patel, MD; Andrew M. Freeman, MD, FACC; and Kim A. Williams MD, FACC
Reaching Beyond the Exam Room: How Technology-backed Lifestyle Intervention Is Improving Health Outcomes for Diabetes and Hypertension Management
Andreas Michaelides, PhD, and Ed Pienkosz, MS
A Bundle of Nudges: Healthcare Payment in an Era of Behavioral Science
Mike Payne, MBA, MSci
Managed Care Updates: Medicare and CGM, Omada Health Hires, Council for Diabetes Prevention Officers
AJMC Staff
Payer-Provided Fitness Rewards: Employers Will Look At Evidence
Kenneth Snow, MD, MBA
Making Diabetes Self-Management Education Patient-Centered: Results From a North Carolina Program
Paige Johnson Cartledge, RN, BSN

Diabetes: An Opportunity to Have a Lasting Impact on Health Through Lifestyle Modification

Hena N. Patel, MD; Andrew M. Freeman, MD, FACC; and Kim A. Williams MD, FACC
Three cardiologists, including the 2015-2016 president of the American College of Cardiology, review the evidence in support of lifestyle modification for diabetes management or remission.
  Finally, educating physicians and allied health professionals on the power of lifestyle changes through diet, exercise and physical activity, and mindfulness is a critically underestimated and underfunded approach. Because of minimal nutrition training in medical school and the lack of exposure to lifestyle medicine, many healthcare providers do not counsel, implement, or coach patients to make these changes. Recently, the American College of Cardiology hosted a half-day intensive within its 2016 Annual Scientific Sessions that solely focused on lifestyle modification. Education from leading experts in the realm of lifestyle and nutrition was delivered with an incredibly positive response to a standing room-only audience. The intensive session started with a debate about commonly held nutrition misconceptions and was followed by sessions on the latest in behavioral modification and motivational interviewing, smoking cessation, and scientific evidence around the topics of mindfulness, stress reduction, love, and connection. Overall comments from the audience showed a true desire to learn more about these topics and ways to implement them in common practice.

  In summary, treatment for diabetes and the associated CVD has come a very long way. Behavioral intervention, in the form of lifestyle medicine, is an approach that both minimizes cost and maximizes yield in dealing with both. Now is the time for the medical community, as a whole, to become aware of this approach and review the research that has often been ignored despite excellent results. While implementation is the major barrier, along with patient compliance and uptake, the time and effort required leads to lasting results that are well worth the initial investment.

Hena N. Patel, MD, and Kim A. Williams, MD, FACC, are with the Rush University Medical Center, Division of Cardiology, Chicago. Andrew M. Freeman, MD, FACC, is with the Department of Medicine, Division of Cardiology, National Jewish Health, Denver. Dr Williams served as the 2015-2016 president of the American College of Cardiology.

  1. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383-393. doi: 10.1056/NEJMoa021778.

  2. Grundy S, Benjamin I, Burke G, et al. Diabetes and cardiovascular disease: a statement for healthcare professional from the American Heart Association. Circulation. 1999;101(13):1134-1146. doi:

  3. Haffner S, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229-234.

4. Colhoun H, Betteridge D, Durrington P, et al; CARDS investigators. Primary prevention of cardiovascular disease in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicenter randomized placebo-controlled trial. Lancet. 2004;364(9435):685-696.

  5. Kempner W. Treatment of heart and kidney disease and of hypertensive and arteriosclerotic vascular disease with the rice diet. Ann Intern Med. 1949;31(5):821-856.

  6. Laaksonen DE, Lindström J, Lakka TA, et al; Finnish diabetes prevention study. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes. 2005;54(1):158-165. doi: 10.2337/diabetes.54.1.158.

 7. Lindström J, Peltonen M, Tuomilehto J. Lifestyle strategies for weight control: experience from the Finnish diabetes prevention study. Proc Nutr Soc. 2005;64(1):81-88. doi: ttps:// PNS2004394412.

  8. Fine LJ, Philogene S, Gramling R, Coups EJ, Sinha S. Prevalence of multiple chronic disease risk factors: 2001 National Health Interview Survey. Am J Prev Med. 2004;27(suppl 2):18-24. doi: 10.1016/jamepre.2004.04.017.

  9. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.

  10 American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36(4):1033-1046. doi: 10.2337/dc12-2625.

  11. Tuomilehto J, Schwarz P, Lindström J. Long-term benefits from lifestyle interventions for type 2 diabetes. Diabetes Care. 2011;34(suppl 2):S210-S214. doi: 10.2337/dc11-s222.

  12. American Diabetes Association. Standards of medical care in diabetes—2015. Diabetes Care. 2015;38(1):S1-S89. doi:

  13. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(suppl 1):S120-S143. doi: 10.2337/dc14-S120.

  14. Estruch R, Ros E, Salas-Salvadó J, et al; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet [published correction appears in N Engl J Med.2014;370(9):886]. N Engl J Med. 2013;368(14):1279-1290. doi: 10.1056/NEJMoa1200303.

  15. Fraser GE. Vegetarian diets: what do we know of their effects on common chronic diseases? Am J Clin Nutr. 2009;89(5):1607S-1612S. doi: 10.3945/ajcn.2009.26736K.

  16. van Dam RM, Willett WC, Rimm EB, Stampfer MJ, Hu FB. Dietary fat and meat intake in relation to risk of type 2 diabetes in men. Diabetes Care. 2002;25(3):417-424.

  17. Salmerón J, Manson JE, Stampfer MJ, Colditz GA, Wing AL, Willett WC. Dietary fiber, glycemic load, and risk of non-insulin dependent diabetes in women. JAMA. 1997;277(6):472-477.

  18. Bunner AE, Wells CL, Gonzales J, Agarwal U, Bayat E, Barnard ND. A dietary intervention for chronic diabetic neuropathy pain: a randomized controlled pilot study. Nutr Diabetes. 2015;5:e158. doi: 10.1038/nutd.2015.8

  19. Li Y, Zhou C, Zhou X, Li L. Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis. Atherosclerosis. 2013;229(2):524-530. doi: 10.1016/j.atherosclerosis.2013.04.003.

  20. Paul-Labrador M, Polk D, Dwyer J, et al. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. 2006;166(11):1218-1224. doi: 10.1001/archinte.166.11.1218.

  21. Wing RR, Jeffery RW, Burton LR, Nissinoff KS, Baxter JE. Food provision vs structured meal plans in the behavioral treatment of obesity. Int J Obes Relat Metab Disord. 1996;20(1):56-62.

  22. Jeffery RW, Wing RR, Thorson C, et al. Strengthening behavioral interventions for weight loss: a randomized trial of food provision and monetary incentives. J Consult Clin Psychol. 1993;61(6):1038-1045. doi: 10.1037/0022-006X.61.6.1038.

  23. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. doi: 10.1056/NEJMoa012512.

  24 Tuomilehto J, Lindström J, Eriksson JG, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350. doi: 10.1056/NEJM200105033441801.

  25. Pan X, Li G, Hu Y, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance: the Da Qing IGT and Diabetes Study. Diabetes Care. 1997;20(4):537-544.

  26. Wing RR, Bolin P, Brancati FL, et al; Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154. doi: 10.1056/NEJMoa1212914.

  27. Balducci S, Zanuso S, Nicolucci A, et al; Italian Diabetes Exercise Study (IDES) Investigators. Effect of an intensive exercise intervention strategy on modifiable cardiovascular risk factors in subjects with type 2 diabetes mellitus: a randomized controlled trial: the Italian Diabetes and Exercise Study (IDES).Arch Intern Med. 2010;170(20):1794-1803. doi: 10.1001/archinternmed.2010.380.

  28. Hood KK, Rohan JM, Peterson CM, Drotar D. Interventions with adherence-promoting components in pediatric type 1 diabetes: meta-analysis of their impact on glycemic control. Diabetes Care. 2010;33(7):1658-1664. doi: 10.2337/dc09-2268.

  29. Greaves CJ, Sheppard KE, Abraham C, et al; IMAGE Study Group. Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC Public Health. 2011;11:119. doi: 10.1186/1471-2458-11-119.
Copyright AJMC 2006-2018 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up

Sign In

Not a member? Sign up now!