4. Lifestyle Management:Standards of Medical Care in Diabetes—2018

Abstract

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Immediate post-breakfast physical activity improves interstitial postprandial glycemia: a comparison of different activity-meal timings

“…In 2018, the global prevalence of insufficient physical activity was 27.5% [22]. Disease risks of inactivity are undeniable [7], and the increasing global prevalence of inactivity is not only alarming, but the health consequences of poor glucose control are preventable with current public guidelines [2,44]. However, public guidelines are often vague and not specific enough for the public to use.…”

“…Conclusion A low-to moderate-intensity physical activity that raises energy expenditure above resting levels is best implemented immediately after breakfast to elicit the best postprandial glucose control. This finding should prompt an update to current physical activity guidelines [2,20,44]. Given the distinct influence of activity-meal timing on blood glucose control following breakfast, the large inter-individual heterogeneity in the therapeutic effect of exercise (reviewed in [38] and the lack of improvement in blood glucose control in some long-term exercise studies [9,14,26,42]) highlights the importance of considering exercise-meal timing in the experimental design of clinical trials.…”

“…Physical inactivity is associated with poor blood glucose control and increased incidence of type 2 diabetes and cardiovascular disease [5,17,18,25,32]. Adults are advised to accumulate ≥ 150 min/week of moderate-intensity activity [2,20,44]. These activity guidelines are also included in diabetes prevention strategies [2].…”

“…Adults are advised to accumulate ≥ 150 min/week of moderate-intensity activity [2,20,44]. These activity guidelines are also included in diabetes prevention strategies [2]. Type 2 diabetes is characterized by elevated HbA1c that increases the risk of cardiovascularrelated mortality.…”

Teaching patients with type 2 diabetes to self-administer insulin

“…From 2012 to 2016 there was a reduction in the prescription of sulfonylurea agents. 2 As a result, for many people with T2DM, insulin is the first treatment that is associated with a risk of hypoglycaemia. Nevertheless, the initiation of insulin should always be preceded by education or revision on the management of hypoglycaemia.…”