Evidence-base - International Diabetes Federation

Comprehensive care
LS C 1 Advice on lifestyle management will in general be as
for Recommended care.
LS C 2 Intensive personal counselling might be offered on
a regular basis with a health-care professional
specifically trained in the principles of nutrition, to
facilitate maintenance of lifestyle modifications and
support weight reduction or weight maintenance.
LS C 3 Aerobic and resistance training sessions might be
available, with individualised testing and education by
exercise specialists, and continued support from them.
Rationale
People with type 2 diabetes often have lifestyles (eating and physical activity
habits) which contribute to their problem. It is essential they receive help soon
after diagnosis to consider how they may modify lifestyle in ways which enable
them to take control of their blood glucose, blood lipid and blood pressure, even
if they also require pharmacotherapy (see Chapter 9: Glucose control therapy).
Evidence-base
Evidence supports the effectiveness of nutrition therapy and physical activity
in the prevention and management of type 2 diabetes [1-4] . This is reflected
in the Canadian [5] , UK NICE [6] and Australian guidelines [7] as well as the
ADA standards of medical care [2,8,9] . Lifestyle modification can be difficult to
achieve and maintain [6] . Most lifestyle intervention studies have been shortterm,
however this is being addressed by the Look AHEAD study [10] . Other
considerations include a lack of knowledge about the ongoing contribution of
lifestyle measures once medication has been introduced, or what kind of support
is required on a continuing basis. The UKPDS initial nutrition intervention
was very effective in lowering blood glucose after diagnosis and some people
were then able to maintain target glucose control for many years by nutrition
modifications alone [11,12] .
RCTs and outcomes studies of medical nutrition therapy (MNT) in the
management of type 2 diabetes have reported improved glycaemic outcomes
(HbA 1c decreases of ~1.0-2.0% / 11-22 mmol/mol; range: -0.5-2.6% /
-6.5-29 mmol/mol, depending on the duration of diabetes) and level of glycaemic
control [1] . MNT in these studies was provided by dietitians (nutritionists) as
MNT only or as MNT in combination with diabetes self-management training.
Interventions included reduced energy intake and/or reduced carbohydrate/
fat intake, carbohydrate counting, and basic nutrition and healthy food choices
for improved glycaemic control. Central to these interventions are multiple
encounters to provide education initially and on a continued basis [5,9,13-19] .
Cardioprotective nutrition therapy (saturated and trans fats less than 7% of
daily energy, dietary cholesterol less than 200 mg daily, and a daily fat intake of
25-35%) can reduce total cholesterol by 7-21%, low density lipoprotein (LDL)cholesterol
by 7-22%, and triglycerides by 11-31% [20] . Energy from saturated or
trans fatty acids may be replaced by energy from unsaturated fatty acids. If a
reduced energy intake is a goal, reduction rather than replacement of saturated
5 LIFESTYLE MANAGEMENT
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