Authors: Winston Wang, MD – Lori Roust, MD – Holly Geyer, MD
Managing your diet and exercise
A combination of a balanced, nutrient-dense diet and regular physical activity is essential for managing diabetes effectively. These lifestyle modifications should be tailored to individual preferences and medical conditions.
For dietary changes, sustainable eating plans that consider the amount and timing of carbohydrate intake to manage glycemia, insulin sensitivity, body weight, and cardiovascular disease risk are important. A healthy eating plan should include fruits, vegetables, whole grains, lean proteins, and low-fat dairy, while being low in saturated and trans fats, cholesterol, salt, and added sugars. Carbohydrate restriction can reduce body weight and improve glycemia, with popular diets such as low carbohydrate, Mediterranean, and vegan diets being frequently followed for diabetes management.
Aerobic exercise, resistance training, or a combination of both are also recommended to improve glucose regulation, insulin sensitivity, and cardiovascular fitness. The ADA suggests at least 150 minutes per week of moderate-intensity aerobic exercise or 75 minutes per week of vigorous-intensity exercise, combined with resistance training involving major muscle groups 2-3 days per week.
Role of medications
Medications play a crucial role in the management of diabetes. The primary goal of treatment is to achieve and maintain control of blood sugar, thereby reducing the risk of both microvascular and macrovascular complications.
Insulin therapy remains a cornerstone for patients in type 1 diabetes, those with significant hyperglycemia, or when oral agents and non-insulin injectables are insufficient. Though it is effective, it requires frequent monitoring with regular glucose checks.
Early cases of type 2 diabetes are often treated with metformin due to its efficacy, safety profile, and cost.
Second-line treatments for type 2 diabetes are chosen based on individual patient characteristics, including other existing conditions and risk factors. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) such as empagliflozin and dapagliflozin, and glucagon-like peptide-1 receptor agonists (GLP-1 RA) such as semaglutide and tirzepatide are often prioritized. SGLT-2 inhibitors are particularly beneficial for patients with heart failure or chronic kidney disease, while GLP-1 RAs are preferred for those needing weight loss or with a high risk of coronary artery disease or stroke. However, combination therapy is frequently necessary as diabetes progresses.
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