From the Guidelines
Lifestyle changes, including a healthy diet and regular physical activity, are essential for managing prediabetes and preventing progression to type 2 diabetes, with the most recent and highest quality evidence supporting an intensive lifestyle behavior change program to achieve and maintain a weight reduction of at least 7% of initial body weight and increase moderate-intensity physical activity to at least 150 min/week 1.
Key Recommendations
- The most effective approach combines regular physical activity with dietary modifications and weight loss, aiming for at least 150 minutes of moderate-intensity exercise weekly, such as brisk walking, swimming, or cycling, spread across most days of the week.
- Dietary changes should focus on reducing refined carbohydrates and added sugars while increasing fiber intake through vegetables, fruits, whole grains, and legumes, with portion control being essential, as is limiting processed foods and saturated fats.
- For those who are overweight, losing just 5-7% of body weight can significantly reduce diabetes risk, as supported by the Diabetes Prevention Program (DPP) and other studies 1.
- Additionally, stress management techniques like meditation or yoga, adequate sleep (7-8 hours nightly), and avoiding tobacco products complement these efforts.
- Regular blood glucose monitoring and medical follow-ups every 3-6 months help track progress, with the goal of improving insulin sensitivity, reducing inflammation, and enhancing glucose metabolism, addressing the underlying physiological issues in prediabetes and potentially reversing the condition without medication.
Implementation
- Health care professionals are encouraged to promote a DPP-style program, including its focus on physical activity, to all individuals who have been identified to be at an increased risk of type 2 diabetes, with certified technology-assisted diabetes prevention programs being considered based on individual preference 1.
- Breaking up prolonged sedentary time may also be encouraged, as it is associated with moderately lower postprandial glucose levels, and resistance training can be included in the physical activity plan designed to prevent diabetes 1.
- The preventive effects of physical activity appear to extend to the prevention of gestational diabetes mellitus (GDM), highlighting the importance of a comprehensive approach to diabetes prevention 1.
From the Research
Lifestyle Changes in Prediabetes
Lifestyle changes play a crucial role in managing prediabetes, with the primary goal of preventing the progression to type 2 diabetes. The key lifestyle modifications include:
- Weight loss: Achieving and maintaining a healthy weight through a combination of diet and exercise 2, 3, 4
- Increased physical activity: Engaging in at least 150 minutes of moderate-intensity physical activity per week 2, 3
- Calorie restriction: Reducing daily calorie intake to promote weight loss and improve insulin sensitivity 2
- Self-monitoring: Regularly monitoring blood glucose levels and other health metrics to track progress and make adjustments as needed 2
- Motivational support: Receiving support and guidance from healthcare professionals, family, and friends to maintain motivation and adherence to lifestyle changes 2
Benefits of Lifestyle Changes
The benefits of lifestyle changes in prediabetes include:
- Reduced risk of progressing to type 2 diabetes: Lifestyle modifications have been shown to decrease the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 2
- Improved cardiovascular risk factors: Lifestyle changes can help reduce the risk of cardiovascular disease, kidney disease, and mortality 3, 5, 6
- Cost-effectiveness: Investing in lifestyle modification programs can have a substantial return on investment, with estimated cost savings of up to $7000 per year compared to treating diabetes 4
- Increased remission rates: Lifestyle modification has been shown to increase the percentage of diabetics in remission, with a significant reduction in diabetes risk 6
Comparison to Pharmacological Interventions
While pharmacological interventions, such as metformin, can also be effective in preventing the progression to type 2 diabetes, lifestyle modifications have been shown to have a larger benefit 2, 3. Metformin has been found to decrease the risk of diabetes by 3.2 cases per 100 person-years during 3 years, although it is most effective for specific populations, such as women with prior gestational diabetes and individuals younger than 60 years with a body mass index of 35 or greater 2.