Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the american diabetes association (ADA) and the european association for the study of diabetes (EASD)

Participating in leisure-time activity and avoiding extended sedentary periods may help prevent type 2 diabetes in those at risk and may aid glycemic control in people with diabetes.

“Participating in leisure-time activity and avoiding extended sedentary periods may help prevent T2D for those at risk959,960 and may also aid in glycemic control for those with DM.961–964”

Carbohydrate restricted nutrition therapy results in improved glycemia, most cardiovascular risk markers and reduced need for medication, as recognized by professional society guidelines.

“It is well recognized among professional society guidelines that carbohydrate restricted nutrition therapy results in improved glycemia, most cardiovascular risk markers and reduced need for medication [11][12][13][14], yet current evidence is limited to two-years of follow-up [8,15,16,17,18].”

Sustained adherence to carbohydrate restriction is considered challenging.

“Nonetheless, sustained adherence to carbohydrate restriction is considered challenging (27, 28)”

The goal for clinical management of type 2 diabetes is to achieve and maintain tight control of HbA1c and systolic blood pressure.

“Due to the association of HbA1c and systolic blood pressure with diabetes complications and mortality,4951 the goal for clinical management of T2D is to achieve and maintain tight control of HbA1c and systolic blood pressure.52”

Exercise helps preserve muscle mass and sustain weight loss.

“However, long-term weight maintenance is more successful when exercise is included, as stopping GLP-1 therapy alone often leads to weight regain, while exercise helps preserve muscle mass and sustain weight loss.”

GLP-1 receptor agonists are highly effective for weight loss and improving metabolic and cardiovascular health, often surpassing the results of lifestyle interventions alone such as exercise and diet modification.

“Recent literature shows that GLP-1 receptor agonists are highly effective for weight loss and improving metabolic and cardiovascular health, often surpassing the results of lifestyle interventions alone, such as exercise and diet modification.”

GLP-1RAs can induce substantial weight loss (often 10-15% or more).

“GLP-1RAs, including liraglutide and semaglutide, can induce substantial weight loss (often 10–15% or more), improve cardiometabolic risk factors, including histological damage associated with metabolic dysfunction–associated steatohepatitis (MASH) (3), and reduce major adverse cardiovascular events in both diabetic and non-diabetic populations (1, 4–12).”

GLP-1RAs reduce major adverse cardiovascular events in both diabetic and non-diabetic populations.

“GLP-1RAs, including liraglutide and semaglutide, can induce substantial weight loss (often 10–15% or more), improve cardiometabolic risk factors, including histological damage associated with metabolic dysfunction–associated steatohepatitis (MASH) (3), and reduce major adverse cardiovascular events in both diabetic and non-diabetic populations (1, 4–12).”

Exercise and lifestyle interventions remain foundational for obesity and metabolic disease management, offering broad health benefits, but are often limited by adherence and modest long-term weight loss.

“Exercise and lifestyle interventions remain foundational for obesity and metabolic disease management, offering broad health benefits, but are often limited by adherence and modest long-term weight loss (11, 16, 18).”

Exercise, particularly resistance training, is crucial for preserving lean mass and functional health, especially during weight loss.

“Exercise, particularly resistance training, is crucial for preserving lean mass and functional health, especially during weight loss (11, 17, 18).”

Long-term adherence to lifestyle interventions is challenging, and weight loss is often modest and difficult to sustain.

“However, long-term adherence is challenging, and weight loss is often modest and difficult to sustain due to physiological (11, 16, 18, 19).”

Lifestyle interventions, including exercise and dietary modification, remain the cornerstone of obesity and diabetes management, with proven benefits for weight loss, glycemic control, cardiovascular health, and quality of life.

“Lifestyle interventions, including exercise and dietary modification, remain the cornerstone of obesity and diabetes management, with proven benefits for weight loss, glycemic control, cardiovascular health, and quality of life (11, 16, 18, 30).”

Exercise and lifestyle interventions, while generally less potent for weight loss, provide unique and irreplaceable health benefits - preserving skeletal muscle, improving cardiorespiratory fitness, enhancing psychological well-being, and lowering chronic disease risk.

“Exercise and lifestyle interventions, while generally less potent for weight loss, provide unique and irreplaceable health benefits – preserving skeletal muscle, improving cardiorespiratory fitness, enhancing psychological well-being, and lowering chronic disease risk (11, 16, 18, 19).”

Adequate management of diabetes is highly complex and challenging, necessitating a multimodal therapeutic approach to control the condition and prevent associated microvascular and cardiovascular complications.

“Adequate management of diabetes is highly complex and challenging, necessitating a multimodal therapeutic approach to effectively control the condition and prevent associated microvascular and cardiovascular complications [3-5].”

GLP-1 receptor agonists have demonstrated cardiovascular benefits among people with diabetes and established ASCVD and those at higher ASCVD risk.

“GLP-1 receptor agonists have demonstrated cardiovascular benefits among people with diabetes and established atherosclerotic cardiovascular disease (ASCVD) and those at higher ASCVD risk, and newer trials are expanding our understanding of their benefits in other populations (109).”

GLP-1 RAs have demonstrated cardiovascular benefits among people with diabetes and established ASCVD and those at higher ASCVD risk.

“GLP-1 RAs have demonstrated cardiovascular benefits among people with diabetes and established atherosclerotic cardiovascular disease (ASCVD) and those at higher ASCVD risk, and newer trials are expanding our understanding of their benefits in other populations (122).”

Lifestyle modification remains essential for holistic health and may mitigate some pharmacotherapy risks.

“Yet, enthusiasm for GLP-1RAs should not eclipse the foundational role of lifestyle modification, which remains essential for holistic health and may mitigate some pharmacotherapy risks (11, 18, 20).”

Routine self-monitoring of blood glucose is considered of limited additional clinical benefit while adding to burden and cost for adults with non-insulin-treated type 2 diabetes.

“Routine self-monitoring of blood glucose (SMBG) is considered “of limited additional clinical benefit while adding to burden and cost” (8).”

Diabetes is directly influenced by various lifestyle factors, and lifestyle modifications are the cornerstones of nonpharmacological management of T2DM.

“Given that diabetes is directly influenced by various lifestyle factors, lifestyle modifications, including dietary changes, weight management, increased physical activity, smoking cessation, and psychological support, are the cornerstones of nonpharmacological management of the condition [4,6-10].”

DPP-4 inhibitors do not reduce or increase major adverse cardiovascular outcomes.

“DPP-4 inhibitors do not reduce or increase major adverse cardiovascular outcomes (109).”

In people with established ASCVD, SGLT2 inhibitors have shown cardiovascular benefits.

“In those with established ASCVD, these agents have shown cardiovascular benefits (109).”

SGLT2 inhibitors have shown cardiovascular benefits in those with established ASCVD.

“In those with established ASCVD, these agents have shown cardiovascular benefits (122).”

In people with established ASCVD, SGLT2 inhibitors have shown cardiovascular benefits.

“In those with established ASCVD, these agents have shown cardiovascular benefits”

Nutrition therapy plays an integral role in overall diabetes management.

“Nutrition therapy plays an integral role in overall diabetes management, and each person with diabetes should be actively engaged in education, self-management, and treatment planning with the health care team, including the collaborative development of an individualized eating plan (70,94).”

After medication is initiated, nutrition therapy continues to be an important component.

“However, after medication is initiated, nutrition therapy continues to be an important component, and RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan (70,94).”