II. Goals

  1. First priority: Blood Glucose control
  2. Second priority: Weight loss
    1. Do not overemphasize weight loss
    2. Weight loss goal: 10-20 pounds or 10% weight loss
    3. Better Blood Sugar control results in weight gain
    4. DCC Trial found Blood Sugar control more important
    5. Reference
      1. Watts (1990) Arch Intern Med 150(4):803-6 [PubMed]

III. Efficacy

  1. Intensive lifestyle intervention (Look Ahead Study)
    1. Results in up to 5% weight loss and improved glycemic control (or in up to 20%, diabetes remission)
    2. Best outcomes are for early intervention (<2 years of type 2 diabetes)
    3. Gregg (2012) JAMA 308(23): 2489-96 [PubMed]

IV. Management: General Approach

  1. Moderately restrict calories
    1. Improves Blood Sugar control (and secondarily decreases weight)
    2. Eat less often and in smaller portions and substitute more healthy food choices
    3. Weigh or measure food quantity and track accurately
      1. Diet and fitness tracking applications are widely available and easy to use
    4. Limit triggers for eating (e.g. less time around restaurants) and other less healthy behaviors
      1. Establish strategies for specific situations (social, parties, vacations)
    5. Hypocaloric diet more important than weight loss
      1. Wing (1987) Arch Intern Med 147:1749-53 [PubMed]
  2. Adjust Meal Schedule
    1. Break up Caloric Intake
      1. Breakfast: 20%
      2. Lunch: 40%
      3. Dinner: 40%
    2. Intersperse small snacks between meals
      1. Crackers or juice in afternoon and at bedtime
      2. Jenkins (1992) Am J Clin Nutr 55(2): 461-7 [PubMed]
  3. Modify fat intake
    1. Decrease overall fat intake
    2. Avoid saturated fats
    3. Switch to monounsaturated or polyunsaturated fats
      1. Eating nuts and peanut butter reduces NIDDM risk
      2. Jiang (2002) JAMA 288:2554-60 [PubMed]
  4. Increase Physical Activity
    1. See Exercise in Diabetes Mellitus
    2. Track Heart Rate and exertional level
    3. Periodically increase activity throughout the day (e.g. bout of brisk walking)
    4. Walk stairs instead of taking elevators
    5. Goal: 175 minutes weekly Exercise (look-ahead program)

V. Management: Look Ahead Study Protocol (intensive management)

  1. Background
    1. Adapted for Diabetes Mellitus II from the CDC Intensive Diabetes Prevention Program (DPP)
  2. Goals
    1. Weight loss 10% and Exercise 175 minutes per week
  3. Protocols
    1. See general measures above
    2. Look Ahead program recommended commercial meal replacements for breakfast and lunch for the first 6 months
  4. Resources: Look Ahead materials for counselors and patients
    1. https://www.lookaheadtrial.org/publicResources/interventionMaterial.cfm?docCollectionGUID=5f2e0038-831a-4401-9d11-95a38e7c2c49

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