Lifestyle Therapy for Diabetes Mellitus

  • W. Timothy GarveyEmail author
  • Gillian Arathuzik


Lifestyle therapy is the cornerstone of diabetes treatment and is designed to work alone or in concert with any medical therapy to achieve the following treatment goals: (i) control glycemia to prevent microvascular complications, (ii) prevent acute complications and hypoglycemia, (iii) prevent cardiovascular disease events by improving risk factors such as dyslipidemia and hypertension, and (iv) improve functionality and quality of life. Medical nutrition therapy (MNT) and diabetes self-management education and support programs are critically important components of lifestyle therapy in patients with type 2 diabetes mellitus (T2D) and type 1 diabetes mellitus (T1D), and these interventions should be individualized and developed by the health-care team in collaboration with the patient. MNT can be accomplished by any one of several healthy meal plans, which can be selected based on personal and cultural dietary preferences. Lifestyle therapy includes physical activity that optimally encompasses both aerobic and resistance exercises and a reduction in sedentary behavior, and takes into account patients’ preferences and capabilities. While the conventional practice of MNT and lifestyle intervention recognizes the benefits of weight loss, the approach has lacked a concerted approach in optimally using therapeutic options directed at weight loss as a primary treatment goal. This chapter emphasizes a reconfigured approach to lifestyle therapy for T2D designed to achieve and sustain clinically meaningful weight loss as a primary objective. Weight loss can dramatically benefit patients with diabetes who are overweight or obese by enhancing glycemic control concomitant with reduced need for glucose-lowering medications, by improving the cardiovascular disease risk profile, and enhancing quality of life.


Lifestyle therapy Type 2 diabetes Type 1 diabetes Weight loss Medical nutrition therapy 



α-linolenic acid


American Association of Clinical Endocrinologists


American Diabetes Association


American Heart Association


Body Mass Index


Cardiovascular disease


Certified Diabetes Educator


Continuous positive airway pressure


Dietary approaches to stop hypertension


Docosahexaenoic acid


Diabetes self-management education and support




Eicosapentaenoic acid


Extended release


Food and Drug Administration


Glycemic Index


High-density lipoprotein


Impaired fasting glucose


Impaired glucose tolerance


Institute of Medicine


Latent autoimmune diabetes of adults


Laparoscopic adjustable gastric banding


Low-density lipoprotein


Medical nutrition therapy


Oral glucose tolerance tests


Registered dietitian


Sodium/glucose cotransporter-2


Surgical Treatment And Medications Potentially Eradicate Diabetes Efficiently


Type-1 diabetes


Type-2 diabetes


Total daily dose


Very-low-calorie diets


  1. 1.
    Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract. 2009;15:540–59.PubMedCrossRefGoogle Scholar
  2. 2.
    American Diabetes Association. Standards of medical care in diabetes–2015. Diabetes Care. 2015;38 Suppl 1:S20–30.CrossRefGoogle Scholar
  3. 3.
    TRIAD Study Group. Health systems, patients, factors, and quality of care for diabetes: a synthesis of findings from the TRIAD study. Diabetes Care. 2010;33:940–7.CrossRefGoogle Scholar
  4. 4.
    Duncan I, Birkmeyer C, Coughlin S, Li QE, Sherr D, Boren S. Assessing the value of diabetes education. Diabetes Educ. 2009;35:752–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Berikai P, Meyer PM, Kazlauskaite R, Savoy B, Kozik K, Fogelfeld L. Gain in patients’ knowledge of diabetes management targets is associated with better glycemic control. Diabetes Care. 2007;30:1587–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Marrero DG, Ard J, Delamater AM, et al. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report. Diabetes Care. 2013;36:463–70.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care. 2002;25:1159–71.PubMedCrossRefGoogle Scholar
  8. 8.
    Shah M, Kaselitz E, Heisler M. The role of community health workers in diabetes: update on current literature. Curr Diab Rep. 2013;13:163–71.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Haas L, Maryniuk M, Beck J, et al. National standards for diabetes self-management education and support. Diabetes Care. 2013;37 Suppl 1:S144–53.PubMedCentralGoogle Scholar
  10. 10.
    Garvey WT. New tools for weight-loss therapy enable a more robust medical model for obesity treatment: rationale for a complications-centric approach. Endocr Pract. 2013;19:864–74.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    UK Prospective Diabetes Study. 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients, UKPDS Group. Metabolism. 1990;39:905–12.CrossRefGoogle Scholar
  12. 12.
    Bosello O, Armellini F, Zamboni M, et al. The benefits of modest weight loss in type II diabetes. Int J Obes Relat Metab Disord. 1997;21(Suppl 1):S10–3.Google Scholar
  13. 13.
    Norris SL, Zhang X, Avenell A, et al. Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes. Cochrane Database Syst Rev. 2005;CD005270.Google Scholar
  14. 14.
    Henry RR, Chilton R, Garvey WT. New options for the treatment of obesity and type 2 diabetes mellitus (narrative review). J Diabetes Complicat. 2013;27:508–18.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Garber AJ, Abrahamson MJ, Barzilay JI, et al. American association of clinical endocrinologists’ comprehensive diabetes management algorithm 2013 consensus statement—executive summary. Endocr Pract. 2013;19:536–57.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Ogden CL, Carroll MD, Kit BK, et al. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311:806–14.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual medical spending attributable to obesity: payer-and-service-specific estimates. Health Aff. 2009;28:w822–31.CrossRefGoogle Scholar
  18. 18.
    Van Gaal LF, Mentens IL, De Block CE. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444:875–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity. 2014;22:110–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention editor. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta: US Department of Health and Human Services; 2014.Google Scholar
  21. 21.
    American Diabetes Association. Economic costs of diabetes in the US in 2012. Diabetes Care. 2013;36:1033–46.PubMedCentralCrossRefGoogle Scholar
  22. 22.
    American Diabetes Association. Standards of medical care in diabetes–2015. Diabetes Care. 2015;38(Suppl 1):S8–16.CrossRefGoogle Scholar
  23. 23.
    Institute of Medicine editor. The role of nutrition in maintaining health in the nation’s elderly: evaluating coverage of nutrition services for the medicare population. Washington, DC: National Academies Press; 2000.Google Scholar
  24. 24.
    Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013;36:3821–42.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    American Diabetes Association. Standards of medical care in diabetes–2015. Diabetes Care. 2015;38(Suppl 1):S33–40.Google Scholar
  26. 26.
    American Diabetes Association. Standards of medical care in diabetes–2015. Diabetes Care. 2015;38(Suppl 1):S49–57.CrossRefGoogle Scholar
  27. 27.
    Handelsman Y, et al. American association of clinical endocrinologists and american college of endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21(0):1–87.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Franz MJ, Powers MA, Leontos C, et al. The evidence for medical nutrition therapy for type 1 and type 2 diabetes in adults. J Am Diet Assoc. 2010;110:1852–89.PubMedCrossRefGoogle Scholar
  29. 29.
    Camelon KM, Hådell K, Jämsén PT, Ketonen KJ, Kohtamäki HM, Mäkimatilla S, Törmälä ML, Valve RH. The plate model: a visual method of teaching meal planning. DAIS Project Group. Diabetes atherosclerosis intervention study. J Am Diet Assoc. 1998;98(10):1155–8.PubMedCrossRefGoogle Scholar
  30. 30.
    U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary guidelines for Americans 2010.
  31. 31.
    Kirpitch A, Maryniuk M. The 3 R’s of glycemic index: recommendations, research, and the real world. Clin Diabetes. 2011;29:155–9.CrossRefGoogle Scholar
  32. 32.
    Franz MJ. Diabetes mellitus nutrition therapy: beyond the glycemic index. Arch Intern Med. 2012;172:1660–1.PubMedCrossRefGoogle Scholar
  33. 33.
    Jenkins DJ, Kendall CW, Augustin LS, et al. Effect of legumes as part of a low glycemic index diet on glycemic control and cardiovascular risk factors in type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2012;172:1653–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Thomas DE, Elliott EJ. The use of low glycaemic diets in diabetes control. Br J Nutr. 2010;104:797–802.PubMedCrossRefGoogle Scholar
  35. 35.
    Post RE, Mainous AG 3rd, King DE, Simpson KN. Dietary fiber for the treatment of type 2 diabetes mellitus: a meta-analysis. J Am Board Fam Med. 2012;25:16–23.PubMedCrossRefGoogle Scholar
  36. 36.
    Palmer S Fill in the fiber gaps—dietitians offer practical strategies to get clients to meet the daily requirements. Today’s Dietit. 2012;14:40.Google Scholar
  37. 37.
    Riccardi G, Rivellese A, Pacioni D, Genovese S, Mastranzo P, Mancini M. Separate influence of dietary carbohydrate and fibre on the metabolic control in diabetes. Diabetologia. 1984;26:116–21.PubMedCrossRefGoogle Scholar
  38. 38.
    Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effects of high dietary fiber intakes in patients with type 2 diabetes mellitus. N Engl J Med. 2000;342:1392–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Hagander B, Asp N-G, Efendic S, Nilsson-Ehle P, Schersten B. Dietary Fiber decreases fasting blood glucose levels and plasma LDL concentration in noninsulin-dependent diabetes mellitus patients. Am J Clin Nutr. 1988;47:852–8.PubMedGoogle Scholar
  40. 40.
    Anderson JW, Zeigler JA, Deakins DA, Floore TL, Dillon DW, Wood CL, Oeltgen PR, Whitley RJ. Metabolic effects of high-carbohydrate high-fiber diets for insulin-dependent diabetic individuals. Am J Clin Nutr. 1991;54:936–43.PubMedGoogle Scholar
  41. 41.
    Institute of Medicine editor. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press; 2002.Google Scholar
  42. 42.
    Brinkworth GD, Noakes M, Parker B, Foster P, Clifton PM. Long-term effects of advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with type 2 diabetes: one-year follow-up of a randomized trial. Diabetologia. 2004;47:1677–86.PubMedCrossRefGoogle Scholar
  43. 43.
    Parker B, Noakes M, Luscombe N, Clifton P. Effect of a high-protein, high-monounsaturated fat weight loss diet on glycemic control and lipid levels in type 2 diabetes. Diabetes Care. 2002;25:425–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003;78:734–41.PubMedGoogle Scholar
  45. 45.
    Pijls LT, de Vries H, van Eijk JT, Donker AJ. Protein restriction, glomerular filtration rate and albuminuria in patients with type 2 diabetes: a randomized trial. Eur J Clin Nutr. 2002;56:1200–7.PubMedCrossRefGoogle Scholar
  46. 46.
    Meloni C, Tatangelo P, Cipriani S, et al. Adequate protein dietary restriction in diabetic and non-diabetic patients with chronic renal failure. J Ren Nutr. 2004;14:208–13.PubMedCrossRefGoogle Scholar
  47. 47.
    Hansen HP, Tauber-Lassen E, Jensen BR, Parving HH. Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy. Kidney Int. 2002;62:220–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Dussol B, Iovanna C, Raccah D, et al. A randomized trial of low-protein diet in type 1 and in type 2 diabetes mellitus patients with incipient and overt nephropathy. J Ren Nutr. 2005;15:398–406.PubMedCrossRefGoogle Scholar
  49. 49.
    Pan Y, Guo LL, Jin HM. Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials. Am J Clin Nutr. 2008;88:660–6.PubMedGoogle Scholar
  50. 50.
    Wheeler ML, Gibson RG, Fineberg SE, Hackward LL, Fineberg NS. Animal versus plant protein meals in individuals with type 2 diabetes and microalbuminuria. Diabetes Care. 2002;25:1277–82.PubMedCrossRefGoogle Scholar
  51. 51.
    Buse JB, Ginsberg HN, Barkis GL, Clark NG, Costa F, Eckel R, Fonseca V, Gerstein HC, Grundy S, Nesto RW, Pignone MP, Plutzky J, Porte D, Redberg R, Stitzel KF, Stone NJ. Primary prevention of cardiovascular disease in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2007;30:162–72.PubMedCrossRefGoogle Scholar
  52. 52.
  53. 53.
    Brehm BJ, Lattin BL, Summer SS, et al. One-year comparison of a high-monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes. Diabetes Care. 2009;32:215–20.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Schwingshakl L, Strasser B, Hoffmann G. Effects of monounsaturated fatty acids on glycaemic control in patients with abnormal glucose metabolism: a systematic review and meta-analysis. Ann Nutr Metab. 2011;58:290–6.CrossRefGoogle Scholar
  55. 55.
    Itsiopoulos C, Brazionis L, Kaimakamis M, et al. Can the Mediterranean diet lower A1C in type 2 diabetes? Results from a randomized cross-over study. Nutr Metab Cardiovasc Dis. 2011;21:740–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Estruch R, Ros E, Salas-Savado J, et al. PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–90.PubMedCrossRefGoogle Scholar
  57. 57.
    Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010;12:204–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Shai I, Schwarzfuchs D, Henkin Y, et al. Dietary intervention randomized controlled trial (DIRECT) group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2009;359:229–41.CrossRefGoogle Scholar
  59. 59.
    Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, food groups, and eating patterns in the management of diabetes. A systematic review of the literature, 2010. Diabetes Care. 2012;35:434–45.PubMedPubMedCentralCrossRefGoogle Scholar
  60. 60.
  61. 61.
    Azadbakht L, Fard NR, Karimi M, et al. Effects of the dietary approaches to stop hypertension (DASH) eating plan on cardiovascular risk among type 2 diabetic patients: a randomized cross-over clinical trial. Diabetes Care. 2011;34:55–7.PubMedCrossRefGoogle Scholar
  62. 62.
    Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010;12:CD006763.Google Scholar
  63. 63.
    Thomas MC, Moran J, Forsblom C, et al. FinnDiane Study Group. The association between dietary sodium intake, ESRD, and all-cause mortality in patients with type 1 diabetes. Diabetes Care. 2011;34:861–6.PubMedPubMedCentralCrossRefGoogle Scholar
  64. 64.
    Ekinci E, Clarke S, Thomas MC, et al. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011;34:703–9.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Position of the American Dietetic Association. Use of nutritive and nonnutritive sweeteners. J Am Diet Assoc. 2004;104:255–75.CrossRefGoogle Scholar
  66. 66.
    Cooper PL, Wahlquist ML, Simpson RW. Sucrose versus saccharin as an added sweetener in non-insulin dependent diabetes: short and medium-term metabolic effects. Diabetic Med. 1988;5:676–80.PubMedCrossRefGoogle Scholar
  67. 67.
    Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, Pi-Sunyer FX. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003;103:1607–12.PubMedCrossRefGoogle Scholar
  68. 68.
    Gardner C, Wylie-Rosett J, Gidding SS, et al., American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Disease in the Young; American Diabetes Association. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care. 2012;35:1798–808.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Richardson T, Weiss M, Thomas P, Kerr D. Day after the night before: influence of evening alcohol risk of hypoglycemia in patients with type 1 diabetes. Diabetes Care. 2005;28:1801–2.PubMedCrossRefGoogle Scholar
  70. 70.
    Burge MR, Zeise TM, Sobhy TA, Rassam AG, Schade DS. Low-dose ethanol predisposes elderly fasted patients with type 2 diabetes to sulfonylurea-induced low blood glucose. Diabetes Care. 1999;22:2037–43.PubMedCrossRefGoogle Scholar
  71. 71.
    Lowe J, Linjawi S, Mensch M, James K, Attia J. Flexible eating and flexible insulin dosing in patients with diabetes: results of an intensive self-management course. Diabetes Res Clin Pract. 2008;80(3):439–43.PubMedCrossRefGoogle Scholar
  72. 72.
    DANFE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomized controlled trial. Brit Med J. 2002;325(7367):746.CrossRefGoogle Scholar
  73. 73.
    American Association of Diabetes Educators. The art and science of diabetes self-management education desk reference, 2nd ed. Chicago: American Association of Diabetes Educators; 2011.Google Scholar
  74. 74.
    Steinsbekk A, Rygg LØ, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res. 2012;12:213.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Deakin TA, McShane CE, Cade JE, Williams R. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2005;2:CD003417.Google Scholar
  76. 76.
    Guare JC, Wing RR, Grant A. Comparison of obese NIDDM and nondiabetic women: short- and long-term weight loss. Obes Res. 1995;3:329–35.PubMedCrossRefGoogle Scholar
  77. 77.
    Wing RR, Marcus MD, Epstein LH, et al. Type II diabetic subjects lose less weight than their overweight nondiabetic spouses. Diabetes Care. 1987;10:563–6.PubMedCrossRefGoogle Scholar
  78. 78.
    Wing RR, Lang W, Wadden TA, et al. The Look AHEAD Research Group. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481–6.PubMedPubMedCentralCrossRefGoogle Scholar
  79. 79.
    Group TLAR, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170:1566–75.Google Scholar
  80. 80.
    Belalcazar LM, Haffner SM, Lang W, et al. Lifestyle intervention and/or statins for the reduction of C-reactive protein in type 2 diabetes: from the look AHEAD study. Obesity. 2013;21:944–50.PubMedPubMedCentralCrossRefGoogle Scholar
  81. 81.
    Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54.PubMedCrossRefGoogle Scholar
  82. 82.
    Gregg EW, Chen H, Wagenknecht LE, et al. Look AHEAD Research Group. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA. 2012;308:2489–96.PubMedPubMedCentralCrossRefGoogle Scholar
  83. 83.
    Foster GD, Borradaile KE, Sanders MH, et al. Sleep AHEAD Research Group of the Look AHEAD Research Group. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med. 2009;169:1916–26.PubMedCrossRefGoogle Scholar
  84. 84.
    Hollander PA, Elbein SC, Hirsch IB, et al. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study. Diabetes Care. 1998;21:1288–94.PubMedCrossRefGoogle Scholar
  85. 85.
    Kelley DE, Bray GA, Pi-Sunyer FX, et al. Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: a 1-year randomized controlled trial. Diabetes Care. 2002;25:1033–41.PubMedCrossRefGoogle Scholar
  86. 86.
    Garvey WT, Ryan DH, Bohannon NJ, et al. Weight-loss therapy in type 2 diabetes: effects of phentermine and topiramate extended-release. Diabetes Care. 2014;37:3309–16.PubMedCrossRefGoogle Scholar
  87. 87.
    Gadde KM, Allison DB, Ryan DH, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377:1341–52.PubMedCrossRefGoogle Scholar
  88. 88.
    O’Neil PM, Smith SR, Weissman NJ, et al. Randomized placebo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: the BLOOM-DM study. Obesity. 2012;20:1426–36.PubMedCrossRefGoogle Scholar
  89. 89.
    Hollander P, Gupta AK, Plodkowski R, et al. COR-Diabetes Study Group. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parameters in overweight and obese patients with type 2 diabetes. Diabetes Care. 2013;36:4022–9.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Sjöström L, Peltonen M, Jacobson P, et al. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311:2297–304.PubMedCrossRefGoogle Scholar
  91. 91.
    Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370:2002–13.PubMedPubMedCentralCrossRefGoogle Scholar
  92. 92.
    O’Brien PE, Macdonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257:87–94.PubMedCrossRefGoogle Scholar
  93. 93.
    Adams TD, Davidson LE, Litwin SE, et al. Gastrointestinal surgery: cardiovascular risk reduction and improved long-term survival in patients with obesity and diabetes. Curr Atheroscler Rep. 2012;14:606–15.PubMedCrossRefGoogle Scholar
  94. 94.
    Garvey WT, Garber AJ, Mechanick JI, et al., On Behalf Of The AACE Obesity Scientific Committee. American association of clinical endocrinologists and American college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014;20:977–89.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100:342–62.PubMedCrossRefGoogle Scholar
  96. 96.
    Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American association of clinical endocrinologists, the obesity society, and American society for metabolic & bariatric surgery. Endocr Pract. 2013;19:337–72.PubMedPubMedCentralCrossRefGoogle Scholar
  97. 97.
    Barte JC, ter Bogt NC, Bogers RP, et al. Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review. Obes Rev. 2010;11:899–906.PubMedCrossRefGoogle Scholar
  98. 98.
    Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6:707–13.PubMedCrossRefGoogle Scholar
  99. 99.
    Turner-McGrievy GM, Barnard ND, Cohen J, Jenkins DJA, Gloede L, Green AA. Changes in nutrient intake and dietary quality among participants with type 2 diabetes following a lowfat vegan diet or a conventional diabetes diet for 22 weeks. J Am Diet Assoc. 2008;108:1636–45.PubMedCrossRefGoogle Scholar
  100. 100.
    Stern L, Iqbal N, Seshadri P, et al. The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med. 2004;140:778–85.PubMedCrossRefGoogle Scholar
  101. 101.
    Dansinger ML, Gleason JA, Griffith JL, Selker HP, Schaefer EJ. Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA. 2005;293(1):43–53.PubMedCrossRefGoogle Scholar
  102. 102.
    Weinsier RL, Wilson NP, Morgan SL, Cornwell AR, Craig CB. EatRight lose weight: seven simple steps. Birmingham: Oxmoor House; 1997.Google Scholar
  103. 103.
    Greene LF, Malpede CZ, Henson CS, Hubbert KA, Heimburger DC, Ard JD. Weight maintenance 2 years after participation in a weight loss program promoting low-energy density foods. Obesity (Silver Spring). 2006;10:1795–801.CrossRefGoogle Scholar
  104. 104.
    Pi-Sunyer FX. Glycemic index and disease. Am J Clin Nutr. 2002;76:290S–298S.PubMedGoogle Scholar
  105. 105.
    Riccardi G, Rivellese AA. Effects of dietary fiber and carbohydrate on glucose and lipoprotein metabolism in diabetic patients. Diabetes Care. 1991;14:1115–25.PubMedCrossRefGoogle Scholar
  106. 106.
    Kiens B, Richter EA. Types of carbohydrate in an ordinary diet affect insulin action and muscle substrates in humans. Am J Clin Nutr. 1996;63:47–53.PubMedGoogle Scholar
  107. 107.
    Ard JD, Cox TL, Zunker C, Wingo BC, Jefferson WK, Brakhage C. A study of a culturally enhanced EatRight dietary intervention in a predominately African American workplace. J Public Health Manage Pract. 2010;16(6):E1–8.CrossRefGoogle Scholar
  108. 108.
    Harris JA, Benedict FG. A biometric study of basal metabolism in man. Washington, DC: Carnegie Institute of Washington; 1919. (publ. no. 279).Google Scholar
  109. 109.
    Mifflin MD, Jeor ST St, Hill LA, Scott BJ, Daugherty SA, Koh YO. A new predictive equation for resting energy expenditure in healthy individuals. Am J Clin Nutr. 1990;51:251–7.Google Scholar
  110. 110.
    Heymsfield SB, van Mierlo CA, van der Knaap HC, Heo M, Frier HI. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord. 2003;27:537–49.PubMedCrossRefGoogle Scholar
  111. 111.
    Wadden TA, West DS, Neiberg RH, Wing RR, Ryan DH, Johnson KC, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009;17:713–22.PubMedCentralCrossRefGoogle Scholar
  112. 112.
    Finley CE, Barlow CE, Greenway FL, Rock CL, Rolls BJ, Blair SN. Retention rates and weight loss in a commercial weight loss program. Int J Obes (Lond). 2007;31:292–8.CrossRefGoogle Scholar
  113. 113.
    Foster GD, Borradaile KE, Vander Veur SS, et al. The effects of a commercially available weight loss program among obese patients with type 2 diabetes: a randomized study. Postgrad Med. 2009;121:113–8.PubMedCrossRefGoogle Scholar
  114. 114.
    Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013;120:106–13.PubMedCrossRefGoogle Scholar
  115. 115.
    Lara-Castro C, Garvey WT. Diet, insulin resistance, and obesity: zoning in on data for Atkins dieters living in South Beach. J Clin Endocrinol Metab. 2004;89:4197–205.PubMedCrossRefGoogle Scholar
  116. 116.
    de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85.PubMedCrossRefGoogle Scholar
  117. 117.
    Martinez-Gonzalez MA, Bes-Rastrollo M. Dietary patterns, Mediterranean diet, and cardiovascular disease. Curr Opin Lipidol. 2014;25(1):20–6.PubMedCrossRefGoogle Scholar
  118. 118.
    Boulé NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286:1218–27.PubMedCrossRefGoogle Scholar
  119. 119.
    Colberg SR, Riddell MC. Physical activity: regulation of glucose metabolism, clinical management strategies, and weight control. In: Peters AL, Laffel LM, editors. Type1 diabetes sourcebook. Alexandria: American Diabetes Association; 2013.Google Scholar
  120. 120.
    Boulé NG, Kenny GP, Haddad E, Wells GA, Sigal RJ. Meta-analysis of the effect of structured exercise training on cardiorespiratory fitness in type 2 diabetes mellitus. Diabetologia. 2003;46:1071–81.PubMedCrossRefGoogle Scholar
  121. 121.
    Rejeski WJ, Ip EH, Bertoni AG, et al., LookAHEAD Research Group. Lifestyle change and mobility in obese adults with type 2 diabetes. N Engl J Med. 2012;366:1209–17.PubMedPubMedCentralCrossRefGoogle Scholar
  122. 122.
    Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C. Physical activity/exercise and type 2 diabetes. Diabetes Care. 2004;27:2518–39.PubMedCrossRefGoogle Scholar
  123. 123.
    Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304:2253–62.PubMedPubMedCentralCrossRefGoogle Scholar
  124. 124.
    Colberg SR, Sigal RJ, Fernhall B, et al. Exercise and type 2 diabetes: the American college of sports medicine and the American diabetes association: joint position statement executive summary. Diabetes Care. 2010;33:2692–6.PubMedPubMedCentralCrossRefGoogle Scholar
  125. 125.
    Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American college of sports medicine and the American Heart Association. Circulation. 2007;116:1081–93.PubMedCrossRefGoogle Scholar
  126. 126.
    Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41:998–1005.PubMedCrossRefGoogle Scholar
  127. 127.
    Colberg SR. Exercise and diabetes: a clinician’s guide to prescribing physical activity, 1st ed. Alexandria: American Diabetes Association; 2013.Google Scholar
  128. 128.
    Lemaster JW, Reiber GE, Smith DG, Heagerty PJ, Wallace C. Daily weight-bearing activity does not increase the risk of diabetic foot ulcers. Med Sci Sports Exerc. 2003;35:1093–9.PubMedCrossRefGoogle Scholar
  129. 129.
    Spallone V, Ziegler D, Freeman R, et al., Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27:639–53.PubMedCrossRefGoogle Scholar
  130. 130.
    Pop-Busui R, Evans GW, Gerstein HC, et al., Action to control cardiovascular risk in diabetes study group. Effects of cardiac autonomic dysfunction on mortality risk in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care. 2010;33:1578–84.PubMedPubMedCentralCrossRefGoogle Scholar
  131. 131.
    Bax JJ, Young LH, Frye RL, Bonow RO, Steinberg HO, Barrett EJ. Screening for coronary artery disease in patients with diabetes. Diabetes Care. 2007;30:2729–36.PubMedCrossRefGoogle Scholar
  132. 132.
    Chu L, Hamilton J, Riddell MC. Clinical management of the physically active patient with type 1 diabetes. Phys Sports Med. 2011;39:64–77.CrossRefGoogle Scholar
  133. 133.
    Miles JM, Leiter L, Hollander P, et al. Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin. Diabetes Care. 2002;25:1123–8.PubMedCrossRefGoogle Scholar
  134. 134.
    Sjostrom L, Peltonen M, Jacobson P, Sjostrom CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307:56–65.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Nutrition Sciences, University of Alabama at Birmingham, GRECC, Birmingham VA Medical CenterUAB Diabetes Research CenterBirminghamUSA
  2. 2.Addison Gilbert HospitalGloucesterUSA
  3. 3.Lahey Outpatient CenterDanversUSA

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