Lifestyle management: ADA recommendations for people with diabetes

These guidelines presented recommendations for lifestyle management in people with diabetes. It was determined that diabetes self-management education and support (DSMES), nutrition therapy, physical activity, stopping smoking, and caring for emotional wellbeing are needed.

Lifestyle management is an important part of care for all people with diabetes. Approaches like DSMES, nutrition therapy, physical activity, stopping smoking, and managing emotional well-being, may all be included. 

The American Diabetes Association (ADA) has published their 2018 guidelines on lifestyle management in diabetes.

All people with diabetes were recommended to participate in DSMES. DSMES gives people with diabetes the skills and knowledge to manage their condition. There are 4 key times when a person’s need for DSMES should be examined. These are when the person is first diagnosed with diabetes, once a year, when new problems (such as other health conditions, emotional factors) occur, and if some aspect of the person’s care is changed. DSMES is associated with better diabetes knowledge and self-care, lower HbA1c (measures average blood glucose over the last 3 months), lower weight, and better quality of life.

It was recommended that all people with diabetes be offered nutrition therapy. A registered dietitian who is familiar with diabetes-specific nutrition therapy should provide this. A variety of eating patterns are acceptable. The prescribed eating pattern should be based on individual preferences and goals. All people with diabetes are recommended to limit refined carbohydrates (like sugary snacks), saturated fats (such as those found in meat and dairy), and salt. Unrefined carbohydrates (such as brown rice) and unsaturated fats should be eaten instead. Reducing the total number of calories can be helpful in overweight and obese people with diabetes. If alcohol is consumed, it should be in moderation. In people with diabetes who take insulin and other drugs, alcohol can increase the risk of hypoglycemia (dangerously low blood glucose).

Both children and adults with diabetes should engage in physical activity. It is recommended that children with diabetes take at least 1 hour of moderate or high intensity aerobic exercise (like running or cycling) every day. They should also do resistance exercise (such as weight lifting) at least 3 days each week. Adults with diabetes are recommended to take at least 150 minutes of moderate or high intensity aerobic exercise each week. They should not be inactive for more than 2 days in a row. They should also do resistance exercise at least twice a week. All adults should reduce the amount of time each day spent sitting for long periods of time. Flexibility and balance training (like yoga) is recommended for older adults with diabetes. Physical activity may cause hypoglycemia in some people taking insulin and other drugs. These individuals may need to eat some extra carbohydrate if blood glucose levels are low before exercising.

People with diabetes are recommended to stop smoking, and not to use other tobacco products or e-cigarettes. Emotional well-being is an important part of care for people with diabetes. It is recommended that emotional needs be met as a part of the care of all people with diabetes. This may include testing for conditions like anxiety or depression.

The ADA concluded that lifestyle management for people with diabetes should include DSMES, nutrition therapy, physical activity, stopping smoking, and caring for emotional needs.

The recommendations in these guidelines are guides only, and may not apply to all patients. They should not replace a physician’s opinion and care.