The American College of Lifestyle Medicine has published the first clinical practice guideline focusing primarily on lifestyle interventions for diabetes treatment and potential remission of type 2 diabetes and prediabetes in adults. The comprehensive guideline relies on evidence-based lifestyle changes rather than medications alone.
The guideline introduces six core lifestyle pillars forming the treatment foundation — plant-predominant nutrition, physical activity, restorative sleep, stress management, social connectedness, and avoidance of risky substances like tobacco and excessive alcohol. Emphasis is on behavior change strategies, health coaching and readiness assessment as essential for sustainable adoption.
A unique aspect of this approach is its focus on diabetes remission — the possibility of achieving normal blood sugar levels without glucose-lowering medications for at least three months. The guideline provides specific frameworks for healthcare providers to assess patients’ readiness to implement sustainable lifestyle interventions and to safely reduce or deprescribe medications when lifestyle changes prove effective.
The publication addresses a critical health crisis affecting more than 135 million Americans — representing more than half of all United States adults who have either diabetes or prediabetes. These conditions cost the healthcare system approximately $456 billion annually, with diabetes alone accounting for $413 billion and prediabetes adding $43 billion.
The guideline also highlights the importance of addressing social determinants of health and tailoring lifestyle interventions to individual patient contexts to improve equity and effectiveness. It includes more than 25 original informational handouts and practical tools for healthcare providers and patients to facilitate the incorporation of lifestyle interventions into diabetes care.
Richard Rosenfeld, MD, MPH, MBA, director of guidelines and quality, and guideline lead author, emphasized that “the guideline is not meant to replace existing diabetes management strategies, but rather to complement them by providing an evidence-based blueprint for how lifestyle interventions for diabetes can be effectively implemented.”
The guideline has received endorsements from major medical organizations including the American Association of Clinical Endocrinology, American Academy of Sleep Medicine, and Association of Diabetes Care & Education Specialists.