Johannesburg, South Africa – A groundbreaking shift in diabetes treatment is underway, thanks to the American College of Lifestyle Medicine’s (ACLM) newly released clinical practice guideline. For the first time, lifestyle interventions – think diet, exercise, and stress management – are taking centre stage in the fight against type 2 diabetes and prediabetes in adults. This represents a significant move away from solely relying on medication, offering hope for potential remission and improved quality of life for millions across South Africa and beyond.

Why is this a big deal for South Africans? Diabetes is a growing concern in South Africa, with prevalence rates steadily increasing. Factors like changing diets, sedentary lifestyles, and genetic predisposition contribute to the rise. Traditionally, treatment has heavily focused on medication to manage blood sugar levels. However, this new guideline acknowledges the powerful role lifestyle changes can play in not just managing, but potentially reversing the condition.

What are these lifestyle interventions? The ACLM guideline provides detailed recommendations across several key areas:

• Nutrition: Emphasizing whole, unprocessed foods, plant-based diets, and portion control. The guideline supports various dietary approaches, including Mediterranean-style diets and low-carbohydrate plans, tailored to individual needs and preferences.
• Physical Activity: Regular exercise, including both aerobic activities (like walking, swimming, or cycling) and strength training, is crucial. The guideline recommends at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity per week.
• Stress Management: Techniques like mindfulness, yoga, and meditation can help regulate blood sugar levels and improve overall well-being.
• Sleep Hygiene: Adequate and quality sleep is increasingly recognized as vital for metabolic health.

Remission is Possible: The guideline highlights the potential for achieving remission in type 2 diabetes through sustained lifestyle changes. Remission is generally defined as having blood sugar levels within a normal range without the need for medication. While not a cure, remission offers a significant improvement in health outcomes and reduces the risk of long-term complications associated with diabetes, such as heart disease, kidney disease, and nerve damage.

What does this mean for doctors and patients in South Africa? This guideline provides a framework for healthcare professionals to shift their approach to diabetes care. It encourages a more holistic and patient-centered approach, empowering individuals to take control of their health. Patients are encouraged to discuss these lifestyle interventions with their doctors and explore the best strategies for their individual circumstances. It's not about restrictive diets or grueling workouts; it's about making sustainable, positive changes to daily habits.

Looking Ahead: The ACLM guideline is a landmark achievement in diabetes care. It underscores the importance of preventative measures and lifestyle interventions in managing and potentially reversing this chronic condition. With increased awareness and implementation of these recommendations, South Africa can take a significant step towards improving the health and well-being of its citizens affected by diabetes. Further research and local adaptation of these guidelines will be essential to ensure their effectiveness within the South African context.