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Carbohydrates\nStudies examining the optimal amount\nof carbohydrate intake for people with\ndiabetes are inconclusive, although mon-itoring carbohydrate intake is a key strat-\negy in reaching glucose goals in people\nwith type 1 and type 2 diabetes (178,179).\nFor people with type 2 diabetes, low-\ncarbohydrate and v... | [
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carbohydrate and very-low-carbohydrate\neating patterns in particular have been found\nt or e d u c eA 1 Ca n dt h en e e df o ra n t i h y p e r g l y -cemic medications (139,180 –184). System-\natic reviews and meta-analyses of RCTsfound carbohydrate-restricted eating pat-\nterns, particularly those considered low | [
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terns, particularly those considered low\ncarbohydrate ( <26% total energy), were ef-\nfective in reducing A1C in the short term\n(<6 months), with less difference in eating\npatterns beyond 1 year (134,182,185 –187).\nQuestions still remain about the optimal de-gree of carbohydrate restriction and the | [
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long-term effects of those meal patterns onCVD. A systematic review and meta-analysis\nof RCTs investigating the dose-dependent\neffects of carbohydrate restriction foundeach 10% decrease in carbohydrate intake\nhad reductions in levels of A1C, fasting\nplasma glucose, body weight, lipids, andsystolic blood pressure at... | [
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favorable effects diminished and were not\nmaintained at follow-up or at greater than12 months. This systematic review high-\nlights the metabolic complexity of re-\nsponse to dietary intervention in type 2diabetes as well as the need to better un-\nderstand longer-term sustainability and | [
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derstand longer-term sustainability and\nresults (188). Part of the challenge ininterpreting low-carbohydrate research\nhas been due to the wide range of de fini-\ntions for a low-carbohydrate eating plan\n(189,190). Weight reduction was also a\ngoal in many low-carbohydrate studies, | [
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goal in many low-carbohydrate studies,\nwhich further complicates evaluatingthe distinct contribution of the eating\npattern (48,130,134,188). As studies on\nlow-carbohydrate eating plans generallyindicate challenges with long-term sus-\ntainability (180), it is important to reas- | [
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tainability (180), it is important to reas-\nsess and individualize meal plan guidanceregularly for those interested in this ap-\nproach. Health care professionals should\nmaintain consistent medical oversight andrecognize that insulin and other diabetes\nmedications may need to be adjusted to | [
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medications may need to be adjusted to\nprevent hypoglycemia, and blood pressurewill need to be monitored. In addition,\nvery-low-carbohydrate eating plans are\nnot currently recommended for individualswho are pregnant or lactating, children,people who have renal disease, or people | [
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with or at risk for disordered eating, andthese plans should be used with cautionin those taking sodium –glucose cotrans-\nporter 2 inhibitors because of the potential\nrisk of ketoacidosis (191– 193).\nRegardless of the amount of carbohy-\ndrate in the meal plan, focus should be\nplaced on high-quality, nutrient-dense... | [
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placed on high-quality, nutrient-dense car-\nbohydrate sources that are high in fiber\nand minimally processed. The addition of\ndietary fiber modulates composition of\ngut microbiota and increases gut microbialdiversity. Although there is still much to be\nelucidated with the gut microbiome and\nchronic disease, higher-... | [
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chronic disease, higher- fiber diets are ad-\nvantageous (194). Both children and adultswith diabetes are encouraged to minimize\nintake of re fined carbohydrates with\nadded sugars, fat, and sodium and instead\nfocus on carbohydrates from vegetables,legumes, fruits, dairy (milk and yogurt),\nand whole grains. People wit... | [
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and whole grains. People with diabetes\nand those at risk for diabetes are encour-aged to consume a minimum of 14 g of fi-\nber/1,000 kcal, with at least half of grain\nconsumption being whole, intact grains,\naccording to the Dietary Guidelines forAmericans (98). Regular intake of suf ficient\ndietary fiber is associated... | [
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dietary fiber is associated with lower all-\ncause mortality in people with diabetes\n(195,196), and prospective cohort studies\nhave found dietary fiber intake is inversely\nassociated with risk of type 2 diabetes(197– 199). The consumption of sugar-\nsweetened beverages and processed foodproducts with large amounts of ... | [
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grains and added sugars is strongly dis-couraged (98,200,201), as these have the\ncapacity to displace healthier, more nutri-\nent-dense food choices.\nThe literature concerning glycemic in-\ndex and glycemic load in individuals withdiabetes is complex, often with varying\ndefinitions of low- and high-glycemic-\nindex f... | [
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index foods (202,203). The glycemic index\nranks carbohydrate foods on their post-prandial glycemic response, and glycemic\nload takes into account both the glycemic\nindex of foods and the amount of carbohy-drate eaten. Studies have found mixed re-sults regarding the effect of glycemic indexand glycemic load on fastin... | [
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and A1C, with one systematic review find-\ning no signifi cant impact on A1C (204)\nwhile others demonstrated A1C reductions\nof 0.15% (202) to 0.5% (190,205).\nIndividuals with type 1 or type 2 diabe- | [
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Individuals with type 1 or type 2 diabe-\ntes taking insulin at mealtime shouldbe offered comprehensive and ongoingeducation about nutrition content and theneed to couple insulin administration withcarbohydrate intake. For people whosemeal schedule or carbohydrate consump-tion is variable, regular education to in- | [
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crease understanding of the relationship\nbetween carbohydrate intake and insulinneeds is important. In addition, educationon using insulin-to-carbohydrate ratios for\nmeal planning can assist individuals with\neffectively modifying insulin dosing frommeal to meal to improve glycemic man-agement (104,178,206 –208). Stu... | [
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shown that dietary fat and protein can im-pact early and delayed postprandial glyce-mia (209 –212), and it appears to have a\ndose-dependent response (213 –216). Re-\nsults from high-fat, high-protein meal stud-\nies highlight the need for additional insulin | [
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ies highlight the need for additional insulin\nto cover these meals; however, more stud-ies are needed to determine the optimalinsulin dose and delivery strategy. The re-\nsults from these studies also point to indi-\nvidual differences in postprandial glycemicresponse; therefore, a cautious approachto increasing insul... | [
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and/or high-protein mixed meals is recom-\nmended to address delayed hyperglycemiathat may occur after eating (73,217,218). Ifusing an insulin pump, a split bolus feature(part of the bolus delivered immediately,\nthe remainder over a programmed dura- | [
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the remainder over a programmed dura-\ntion of time) may provide better insulincoverage for high-fat and/or high-proteinmixed meals (210,219).\nThe effectiveness of insulin dosing deci-\nsions should be con firmed with a structured\napproach to blood glucose monitoring orCGM to evaluate individual responses andguide ins... | [
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glucose 3 h after eating may help to deter-\nmine if additional insulin adjustments are re-quired (i.e., increasing or stopping bolus)(210,219,220). Adjusting insulin doses to\naccount for high-fat and/or high-protein | [
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account for high-fat and/or high-protein\nmeals requires determination of antici-pated nutrient intake to calculate themealtime dose. Food literacy, numeracy,interest, and capability should be evalu-\nated (73). For individuals on a fixed daily\ninsulin schedule, meal planning should\nemphasize a relatively fixed carbohy... | [
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emphasize a relatively fixed carbohydrate\nconsumption pattern with respect to both\ntime and amount while considering insulin\naction. Attention to resultant hunger andsatiety cues will also help with nutrientmodifications throughout the day (73,221). | [
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Commercially available automated insulindelivery systems still require basic diabetesmanagement skills, including carbohydrateS84 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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counting and understanding of the impact\nof protein and fat on postprandial glucose\nresponse (222).\nProtein\nThere is no evidence that adjusting thedaily level of protein intake (typically1–1.5 g/kg body weight/day or 15 –20% | [
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of total calories) will improve health, andresearch is inconclusive regarding theideal amount of dietary protein to opti-mize either glycemic management orCVD risk (203,223). Therefore, protein in-take goals should be individualized basedon current eating patterns. Some re-search has found successful manage-ment of typ... | [
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has found successful manage-ment of type 2 diabetes with meal plansincluding slightly higher levels of protein(20–30%), which may contribute to in- | [
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creased satiety (224).\nHistorically, low-protein eating plans\nwere advised for individuals with diabetickidney disease (DKD) (with albuminuriaand/or reduced estimated glomerular fil- | [
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tration rate); however, current evidencedoes not suggest that people with DKDneed to restrict protein to less than thegenerally recommended protein intake(73). Reducing the amount of dietaryprotein below the recommended daily al-lowance of 0.8 g/kg is not recommendedbecause it does not alter glycemic meas-ures, cardiov... | [
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does not alter glycemic meas-ures, cardiovascular risk measures, or therate at which glomerular filtration rate de- | [
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clines and may increase risk for malnutri-tion (225 –227).\nStrong evidence suggests higher plant\nprotein intake and replacement of animalprotein with plant protein is associatedwith lower risk of all-cause and cardiovas-cular mortality in the Women ’s Health Ini-\ntiative cohort study (228). A meta-analysisof 13 RCTs... | [
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0.0007617895025759935,
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0.0... |
plant proteins leads to small improve-\nments in A1C and fasting glucose in indi-viduals with type 2 diabetes (229). Plantproteins are lower in saturated fat andsupport planetary health (230).\nFats | [
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0.04619625583291054,
-0.08850061893463135,
-0.09511... |
Fats\nEvidence suggests that there is not an op-timal percentage of calories from fat forpeople with or at risk for diabetes andthat macronutrient distribution should beindividualized according to the individual ’s | [
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eating patterns, preferences, and meta-bolic goals (73). The type of fats con-sumed is more important than totalamount of fat when looking at metabolicgoals and CVD risk, and it is recom-\nmended that the percentage of total calo-ries from saturated fats should be limited(98,129,231 –233). Multiple RCTs including | [
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people with type 2 diabetes have re-\nported that a Mediterranean eating pat-\ntern (95,129,234 –239) can improve both\nglycemic management and blood lipids.The Mediterranean eating pattern is\nbased on the traditional eating habits in\nthe countries bordering the Mediterra-nean Sea. Although eating styles vary bycount... | [
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of common features, including consump-\ntion of fresh fruits and vegetables, wholegrains, beans, and nuts/seeds; olive oil asthe primary fat source; low to moderateamounts of fish, eggs, and poultry; and\nlimited added sugars, sugary beverages,sodium, highly processed foods, re fined\ncarbohydrates, saturated fats, and f... | [
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carbohydrates, saturated fats, and fatty orprocessed meats.\nEvidence does not conclusively support\nrecommending n-3 (eicosapentaenoicacid and docosahexaenoic acid) supple-ments for all people with diabetes for theprevention or treatment of cardiovascular\nevents (73,240,241). In individuals with | [
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events (73,240,241). In individuals with\ntype 2 diabetes, two systematic reviewswith n-3 and n-6 fatty acids concludedthat the dietary supplements did not im-\nprove glycemic management (203,242). In | [
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prove glycemic management (203,242). In\nthe ASCEND (A Study of CardiovascularEvents iN Diabetes) trial, when comparedwith placebo, supplementation with n-3fatty acids at a dose of 1 g/day did not\nlead to cardiovascular bene fiti np e o p l e\nwith diabetes without evidence of CVD | [
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with diabetes without evidence of CVD\n(243). However, results from the Reduc-tion of Cardiovascular Events With Icosa-\npent Ethyl-Intervention Trial (REDUCE-IT)\nfound that supplementation with 4 g/dayof pure eicosapentaenoic acid signi ficantly\nlowered the risk of adverse cardiovascu-\nlar events. This trial of 8,17... | [
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lar events. This trial of 8,179 participants,\nin which over 50% had diabetes, found a5% absolute reduction in cardiovascularevents for individuals with establishedatherosclerotic CVD taking a preexisting\nstatin with residual hypertriglyceridemia\n(135–499 mg/dL [1.52 –5.63 mmol/L])\n(244). See Section 10, “Cardiovasc... | [
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(244). See Section 10, “Cardiovascular\nDisease and Risk Management, ”for\nmore information. People with diabetesshould be advised to follow the guide-lines for the general population for therecommended intakes of saturated fat,\ndietary cholesterol, and trans fat (98).\nTrans fats should be avoided. In addi- | [
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Trans fats should be avoided. In addi-\ntion, as saturated fats are progressivelydecreased in the diet, they should be re-\nplaced with unsaturated fats and notwith re fined carbohydrates (238).\nSodium\nAs for the general population, peoplewith diabetes are advised to limit theirsodium consumption to <2,300 mg/day | [
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0.009159374982118607,
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(73). Restriction to <1,500 mg, even for\nthose with hypertension, is generally notrecommended (245 –247). Sodium rec-\nommendations should take into accountpalatability, availability, affordability, andthe dif ficulty of achieving low-sodium\nrecommendations in a nutritionally ade-quate eating plan (248,249).\nMicronut... | [
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0.04182499647140503,
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Micronutrients and Supplements\nD e s p i t el a c ko fe v i d e n c eo fb e n e fitf r o md i -\netary supplements, consumers continueto take them. Estimates show that up to59% of people with diabetes in the U.S.use supplements (250). Without underly-ing de ficiency, there is no benefi tf r o m | [
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0.03921486437320709,
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herbal or nonherbal (i.e., vitamin or min-eral) supplementation for people with dia-betes (73,251). Federal law in the U.S.broadly de fines dietary supplements as\nhaving one or more dietary ingredients, in-cluding vitamins, minerals, herbs or otherbotanicals, amino acids, enzymes, tissuesfrom organs or glands, or extra... | [
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0.0011919016251340508,
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Routine antioxidant supplementation\n(such as vitamins E and C) is not recom-mended due to lack of evidence of ef fi-\ncacy and concern related to long-termsafety. Based on the 2022 U.S. Preven-tative Services Task Force statement,the harms of b-carotene outweigh the\nbene fits for the prevention of CVD or\ncancer. b-Car... | [
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0.0006188176921568811,
-0.05058... |
cancer. b-Carotene was associated with\nincreased lung cancer and cardiovascu-lar mortality risk (253).\nIn addition, there is insuffi cient evidence\nto support the routine use of herbal sup-plements and micronutrients, such as cin-namon (254), curcumin, vitamin D (255),aloe vera, or chromium, to improve glyce-mia in p... | [
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0.018631258979439735,
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0.02165025658905506,
0.008501238189637661,
-0.0680... |
Although the Vitamin D and Type 2\nDiabetes Study (D2d) prospective RCT andDiabetes Prevention and Active Vitamin D(DPVD) showed no signi ficant bene fito fv i -\ntamin D versus placebo on the progressionto type 2 diabetes in individuals at highrisk (257,258), post hoc analyses andmeta-analyses suggest a potential bene fi... | [
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... |
in speci fic populations (257,259 –261).diabetesjournals.org/care Facilitating Positive Health Behaviors and Well-being S85\n©AmericanDiabetesAssociation | [
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Further research is needed to de fine indi-\nvidual characteristics and clinical indica-\ntors where vitamin D supplementationmay be of bene fit.\nMetformin is associated with vitamin\nB12 de ficiency per a report from the Dia-\nbetes Prevention Program OutcomesStudy (DPPOS), which suggests that peri-odic testing of vitam... | [
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0.01574254408478737,
0.0... |
be considered in people taking metfor-\nmin, particularly in those with anemiaor peripheral neuropathy (262,263) (seeSection 9, “Pharmacologic Approaches\nto Glycemic Treatment ”). Consumers can\nconsult the U.S. Food and Drug Adminis-tration (FDA) Dietary Supplement Ingredi-\nent Directory to locate information about | [
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0.017482789233326912,
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ent Directory to locate information about\ningredients used in dietary supplementsand any action taken by the agency withregard to that ingredient (264).\nFor special populations, including preg-\nnant or lactating individuals, older adults,vegetarians, and people following very-low-calorie or low-carbohydrate diets, a | [
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0.07198984175920486,
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multivitamin may be necessary (265).\nAlcohol\nModerate alcohol intake ingested with\nfood does not have major detrimentaleffects on long-term blood glucose man-agement in people with diabetes. Risksassociated with alcohol consumptioninclude hypoglycemia and/or delayed hy-poglycemia (particularly for those using in- | [
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0.023964757099747658,
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0.008... |
sulin or insulin secretagogue therapies),\nweight gain, and hyperglycemia (for thoseconsuming excessive amounts) (73,256).People with diabetes should be educatedabout these risks and encouraged to mon-itor glucose frequently after drinking alco-hol to minimize such risks. People with\ndiabetes can follow the same guide... | [
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diabetes can follow the same guidelines as\nthose without diabetes consistent with Die-tary Guidelines for Americans, 2020 –2025\n(98). The available evidence does not sup-port recommending alcohol consumptioni np e o p l ew h od on o tc u r r e n t l yd r i n k( 2 6 6 ) .\nTo reduce risk of alcohol-related harms, | [
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0... |
To reduce risk of alcohol-related harms,\nadults can choose not to drink or to drinkin moderation by limiting intake to #2\ndrinks a day for men or #1d r i n kad a yf o r\nwomen (one drink is equal to a12-oz beer, a 5-oz glass of wine, or 1.5 ozof distilled spirits) (266). There is growing\nevidence for psychoeducation... | [
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0.03073839470744133,
0.011379428207874298,
-0.08599413186311722,
0.06859393... |
evidence for psychoeducational interven-\ntions that may increase knowledge aboutalcohol use and diabetes, may enhanceperceived risks, and may reduce alcoholuse among young people with type 1 dia-\nbetes (267).\nNonnutritive Sweeteners\nThe FDA has approved many nonnutritive | [
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0.02977016754448414,
0.07552245259284973,
-0.12391906976699829,
0.009180... |
Nonnutritive Sweeteners\nThe FDA has approved many nonnutritive\nsweeteners (NNS) for consumption by thegeneral public, including people with dia-betes (73,268). However, the safety androle of NNS continue to be sources of con-cern and confusion for the public (269).This confusion has been heightened withthe World Heal... | [
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0.020467795431613922,
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0.013816596940159798,
0.017417622730135918,
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... |
tional recommendation (270) against NNS\nfor weight management, the Cleveland | [
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Clinic study on erythritol and its relation-ship to CVD (271), and the InternationalAgency for Research on Cancer classifyingaspartame as a possible carcinogen to hu-mans (272). It should be noted the sys-tematic analysis that informed the WorldHealth Organization recommendation ex-cluded individuals with diabetes. In ... | [
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ex-cluded individuals with diabetes. In an edito-rial from the Journal of Clinical Investigation , | [
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Nobs and Elinav (273) from the WeizmannInstitute described the impact these recentstudies have had on the public perceptionof safety of NNS: “The burden of proof has | [
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shifted from a need to prove that NNS areunsafe to a necessity of understanding theirpotential scope of effects on humans in or-der to optimize their recommended use bypopulations at risk. ”\nDespite FDA approval and generally rec- | [
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ognized as safe (GRAS) status for NNS, aswell as established acceptable daily intake(ADI), questions remain. Implementationand interpretation of human NNS studiesare inherently challenging. Each of thesweeteners are their own distinct com-pounds with different molecular struc-tures, although they are often consideredto... | [
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although they are often consideredtogether in studies. Issues of duration ofexposure (short or long), different physical | [
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0.0490713... |
forms (packets/powder or in beverages),\ncardiometabolic health of the host, per-sonalized individual response, presence ofother nutrient components, the emergingevidence about the microbiome, and lim-ited RCTs complicate the science (273).\nFor some people with diabetes who are | [
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For some people with diabetes who are\naccustomed to regularly consuming sugar-sweetened products, NNS (containing fewor no calories) may be an acceptable sub-\nstitute for nutritive sweeteners (those | [
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stitute for nutritive sweeteners (those\ncontaining calories, such as sugar, honey,and agave syrup) when consumed in mod-eration (274,275). NNS do not appear tohave a signi ficant effect on glycemic man-\nagement (104,276,277), and they canreduce overall calorie and carbohydrate | [
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intake (104,274) as long as individuals arenot compensating with additional caloriesfrom other food sources (73,278). There is\nmixed evidence from systematic reviews\nand meta-analyses for NNS use with re-gard to weight management, with some\nfinding bene fiti nw e i g h tl o s s( 2 7 9 –281)\nwhile other research sugge... | [
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while other research suggests an associa-\ntion with weight gain (282,283). This may\nbe explained by reverse causality and resid-\nual confounding variables (283). The addi-tion of NNS to eating plans poses nobenefit for weight loss or reduced weight | [
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gain without energy restriction (284). In arecent systematic review and meta-analysisusing low-calorie and no-calorie sweetened\nbeverages as an intended substitute for\nsugar-sweetened beverages, a small im-provement in body weight and cardiome-\ntabolic risk factors was seen without | [
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tabolic risk factors was seen without\nevidence of harm and had a direction ofbenefit similar to that seen with water.\nHealth care professionals should continue\nto recommend water, but people with\noverweight or obesity and diabetes mayalso have a variety of no-calorie or low-\ncalorie sweetened products so that they\... | [
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calorie sweetened products so that they\ndo not feel deprived (285).\nHealth care professionals should con-\ntinue to recommend reductions in sugar\nintake and calories with or without the\nuse of NNS. Assuring people with diabe-tes that NNS have undergone extensive\nsafety evaluation by regulatory agencies | [
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safety evaluation by regulatory agencies\nand are continually monitored can allayunnecessary concern for harm. Healthcare professionals can regularly assess\nindividual use of NNS based on the ac-\nceptable daily intake (amount of a sub-stance considered safe to consume each\nday over a person ’s life) and recommend | [
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day over a person ’s life) and recommend\nmoderation. See the chart from the FDA\non safe levels of sweeteners found at\nfda.gov/food/food-additives-petitions/\naspartame-and-other-sweeteners-food.\nPHYSICAL ACTIVITY\nRecommendations\n5.27 Counsel youth with type 1 dia-\nbetes Cor type 2 diabetes Bto engage\nin 60 min/... | [
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in 60 min/day or more of moderate- or\nvigorous-intensity aerobic activity, with\nvigorous muscle-strengthening and\nbone-strengthening activities at least\n3 days/week.\n5.28 Counsel most adults with type 1\ndiabetes Cand type 2 diabetes Bto en- | [
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diabetes Cand type 2 diabetes Bto en-\ngage in 150 min or more of moderate- toS86 Facilitating Positive Health Behaviors and Well-being Diabetes Care Volume 47, Supplement 1, January 2024\n©AmericanDiabetesAssociation | [
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vigorous-intensity aerobic activity per\nweek, spread over at least 3 days/\nw e e k ,w i t hn om o r et h a n2c o n s e c u -\ntive days without activity. Shorter du-rations (minimum 75 min/week) of\nvigorous-intensity or interval training\nmay be suf ficient for younger and\nmore physically fit individuals.\n5.29 Couns... | [
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5.29 Counsel adults with type 1 diabe-\ntesCand type 2 diabetes Bto engage\nin 2–3 sessions/week of resistance ex-\nercise on nonconsecutive days.\n5.30 Recommend flexibility training\nand balance training 2– 3 times/week\nfor older adults with diabetes. Yoga and\ntai chi may be included based on indi-\nvidual preferenc... | [
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vidual preferences to increase flexibil-\nity, muscular strength, and balance. C\n5.31 For all people with diabetes, eval-\nuate baseline physical activity and time\nspent in sedentary behavior (i.e., quiet\nsitting, lying, and leaning). For people\nwho do not meet activity guidelines,encourage increase in physical acti... | [
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(e.g., walking, yoga, housework, gar-\ndening, swimming, and dancing) above\nbaseline (type 1 diabetes Eand type 2\ndiabetes B). Counsel that prolonged\nsitting should be interrupted every\n30 min for blood glucose bene fits.C\nPhysical activity is a general term that in-\ncludes all movement that increases en-\nergy us... | [
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ergy use and is an important part of the\ndiabetes management plan. Exercise is a\nmore speci fic form of physical activity\nthat is structured and designed to im-prove physical fitness. Both physical activ-\nity and exercise are important. Exercisehas been shown to improve blood glu-\ncose levels, reduce cardiovascular ... | [
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cose levels, reduce cardiovascular risk\nfactors, contribute to weight loss, and\nimprove well-being (286). Physical activ-\nity is as important for those with type 1\ndiabetes as it is for the general popula-\ntion, but its speci fic role in the preven-\ntion of diabetes complications and themanagement of blood glucose... | [
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c l e a ra si ti sf o rt h o s ew i t ht y p e2d i a b e -\ntes. Many individuals with type 2 diabetes\ndo not meet the recommended exercise\nlevel per week (150 min). Objective mea-\nsurement by accelerometer in 871 indi-\nviduals with type 2 diabetes showed that\n44.2%, 42.6%, and 65.1% of White, African | [
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44.2%, 42.6%, and 65.1% of White, African\nAmerican, and Hispanic individuals, respec-tively, met the recommended threshold of\nexercise (287). An RCT in 1,366 individualswith prediabetes combined a physical | [
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activity intervention with text messagingand telephone support, which showedimprovement in daily step count at12 months compared with the control\ngroup. Unfortunately, this was not sus-\ntained at 48 months (288). Another RCT,including 324 individuals with prediabe-tes, showed increased physical activity at\n8 weeks w... | [
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8 weeks with supportive text messages,\nbut by 12 weeks there was no differencebetween groups (289). It is important fordiabetes care management teams to un-\nderstand the diffi c u l t yt h a tm a n yp e o p l e\nhave reaching recommended treatment | [
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have reaching recommended treatment\ngoals and to identify individualized ap-proaches to improve goal achievement,which may need to change over time.\nModerate to high volumes of aerobic | [
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Moderate to high volumes of aerobic\nactivity are associated with substantiallylower cardiovascular and overall mortalityr i s k si nb o t ht y p e1a n dt y p e2d i a b e t e s(290). A prospective observational study\nof adults with type 1 diabetes suggested | [
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of adults with type 1 diabetes suggested\nthat higher amounts of physical activityled to reduced cardiovascular mortalityafter a mean follow-up time of 11.4 years\nfor people with and without chronic kid-\nney disease (291). Additionally, structured\nexercise interventions of at least 8 weeks’duration have been shown t... | [
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by an average of 0.66% in people with\ntype 2 diabetes, even without a signi fi-\ncant change in BMI (292). There are also\nconsiderable data for the health bene fits\n(e.g., increased cardiovascular fitness,\ngreater muscle strength, improved insulin\nsensitivity) of regular exercise for those | [
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sensitivity) of regular exercise for those\nwith type 1 diabetes (293). Exercise train-ing in type 1 diabetes may also improve\nseveral important markers such as triglyc-\neride level, LDL cholesterol, waist circum-\nference, and body mass (294). In adultswith type 2 diabetes, higher levels of exer-\ncise intensity are... | [
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cise intensity are associated with greater\ni m p r o v e m e n t si nA 1 Ca n di nc a r d i o r e s p i r a -toryfitness (295); sustained improvements\nin cardiorespiratory fitness and weight loss\nhave also been associated with a lower risk\nof heart failure (258). Other bene fits in-\nclude slowing the decline in mobil... | [
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clude slowing the decline in mobility among\noverweight people with diabetes (296). TheADA position statement “Physical Activity/\nExercise and Diabetes ”reviews the evi-\ndence for the bene fits of exercise in people\nwith type 1 and type 2 diabetes and offers\nspecifi c recommendations (297). Increased | [
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specifi c recommendations (297). Increased\nphysical activity (soccer training) has alsobeen shown to be bene ficial for improving\noverall fitness in Latino men with obesity,demonstrating feasible methods to increase\nphysical activity in this population (298).\nPhysical activity and exercise should be rec-\nommended and... | [
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0.027440520003437996,
-0.002593260258436203,
-0.04163859412074089,
0.02... |
ommended and prescribed to all individuals\nwho are at risk for or with diabetes as part\nof management of glycemia and overall\nhealth. Speci fic recommendations and pre-\ncautions will vary by the type of diabetes,\nage, activity, and presence of diabetes-\nrelated health complications. Recommen- | [
0.01552031934261322,
0.04071539640426636,
-0.050523798912763596,
0.0334654375910759,
-0.05475880578160286,
-0.011823917739093304,
0.09296441078186035,
0.104239322245121,
-0.0417579710483551,
-0.01530520711094141,
-0.008257819339632988,
0.04914265125989914,
-0.08736378699541092,
-0.03912660... |
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