Fast Five Quiz: Glycemic Control in Type 2 Diabetes

Romesh Khardori, MD, PhD


February 21, 2023

Lifestyle changes, including physical activity and nutrition management, should be the foundation of any type 2 diabetes program. The European Society of Cardiology and the American Diabetes Association both recommend moderate to vigorous physical activity for at least 150 minutes per week for the prevention and control of type 2 diabetes. Medical nutritional therapy also plays an important role in the management, and patients with type 2 diabetes should be actively involved in the development of a personalized meal plan. Common key factors among the eating patterns include emphasizing non-starchy vegetables, minimizing the intake of added sugars and refined grains, and choosing whole foods over highly processed foods to the extent possible. Intensive lifestyle intervention may result in diabetic remission and normoglycemia, with potential long-term benefits for health and well-being.

The role of low-carbohydrate diets in type 2 diabetes remains unclear. A meta-analysis of 10 randomized controlled trials revealed that the glucose-lowering effects of low- and high-carbohydrate diets are similar at 1 year or later, with no significant effect on weight or low-density lipoprotein cholesterol levels. However, among diets that have been researched in the setting of type 2 diabetes, reducing overall carbohydrate intake has shown the most evidence for improving glycemia.

Metformin is the preferred first-line pharmacologic agent, but lifestyle changes are essential for the prevention and management of type 2 diabetes. Several other antihyperglycemic agents are also approved for patients with type 2 diabetes in combination with proper diet and exercise. When the addition of oral or injectable agents has failed to lower the A1c level to target, insulin is an appropriate treatment option.

Learn more about lifestyle changes in type 2 diabetes.


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