Spanning nearly 300 pages, the recently released 2023 American Diabetes Association Standards of Medical Care offer a comprehensive overview of diabetes management. Given the significant connection between obesity and diabetes, one of the prominent themes is weight loss. For the approximately 37 million Americans living with diabetes, what other important changes should they consider?
The Importance of Collaborative Lifestyle Changes
According to Dr. David M. Nathan, a Harvard Medical School professor and co-author of the guidelines, this update does not introduce drastic changes. “Much of the lifestyle advice for managing diabetes remains consistent with the common-sense wisdom that our grandparents shared: eat your vegetables, get outside for some exercise, and ensure you’re getting adequate sleep.”
However, there has been a subtle shift toward a more person-centered approach in diabetes care over the past five to ten years. Dr. Nathan, who directs the Diabetes Center and Clinical Research Center at Massachusetts General Hospital, emphasizes the importance of collaboration between patients and physicians.
“This means working together to develop a lifestyle and medication plan that suits your individual needs. Doctors aren’t there to dictate your choices; rather, they are there to support you in making informed decisions to manage your diabetes effectively.”
Five Essential Takeaways for Managing Diabetes
Dr. Nathan highlights five key recommendations from the guidelines that individuals with type 2 diabetes should be aware of (many of these tips are also relevant for those with type 1 diabetes, but it’s advisable for them to consult their doctors for specific guidance):
1) Prioritize Quality Sleep: The link between poor sleep and obesity is well-established, and growing evidence suggests that sleep disturbances are associated with an increased risk of diabetes. “Disrupted sleep patterns can negatively impact blood sugar control,” notes Dr. Nathan. Obstructive sleep apnea—a serious condition that causes repeated interruptions in breathing during sleep—is common among individuals with diabetes, especially those who are obese. Symptoms such as loud snoring, gasps during sleep, and daytime fatigue warrant evaluation. Speak to your doctor about a home-based test for sleep apnea.
2) Avoid Fad Diets: While many trendy diets—like keto, paleo, and intermittent fasting—can facilitate weight loss, most individuals tend to regain weight once they stop adhering to these diets. Dr. Nathan advises adopting a sustainable, healthy eating pattern that you can maintain long-term. Beneficial options include the Mediterranean diet and the DASH diet. For individuals with diabetes, it’s crucial to steer clear of sugary beverages and limit sweets and high-fat foods, while incorporating more high-fiber carbohydrates such as whole-grain bread and brown rice.
3) Exercise Safely: Walking is a great form of exercise for most individuals, but it’s important to start slowly and gradually increase your distance and pace if you haven’t been active. Those with diabetes should pay special attention to wearing well-fitting shoes and regularly inspecting their feet for any redness, blisters, or sores. Diabetes can lead to neuropathy (numbness due to nerve damage), which may impair your ability to feel minor injuries on your feet, potentially leading to more serious complications.
4) Work Towards a Healthier Weight: The tips above can aid in weight loss, but many individuals with obesity may require medications to achieve significant weight loss. Metformin, the most commonly prescribed medication for lowering blood sugar, can help individuals lose an average of about five pounds. While this modest weight reduction can improve diabetes and its associated complications, larger weight losses yield even greater benefits.
Two newer diabetes medications, semaglutide (Ozempic) and tirzepatide (Mounjaro), can assist individuals in losing between 15 to 20 pounds, respectively, and also lower hemoglobin A1c levels by as much as two percentage points (A1c measures average blood sugar over three months). “These once-weekly injectable medications are exciting developments and should be considered as a primary option alongside metformin for those with diabetes and obesity,” says Dr. Nathan. However, due to their high cost (around $1,000 per month before insurance) and the requirement for indefinite use, they may not be suitable for everyone. In comparison, metformin is significantly more affordable at approximately $4 per month.
5) Understand Your Treatment Goals: As before, most individuals with diabetes should strive for an A1c level of 7% or less. Achieving this goal, even without weight loss, significantly reduces the risk of serious complications like vision problems, kidney disease, and neuropathy, according to Dr. Nathan.
Diabetes also increases the risk of heart disease. The target blood pressure should be less than 130/80 mm Hg, and the goal for LDL cholesterol is a 50% reduction (or reaching 70 mg/dL or lower). For individuals with existing heart disease, a lower LDL target of 55 mg/dL is recommended.
“Many of my patients take statins to lower cholesterol, and I often adjust their doses to help them meet lower targets,” adds Dr. Nathan. In some cases, a combination of cholesterol-lowering medications may be necessary to address persistently high LDL levels.