ABSTRACT
This study is a qualitative case series of lifestyle medicine practitioners' protocols for medication de-escalation in the context of reduced need for glucose-lowering medications due to lifestyle modifications. Increasing numbers of lifestyle medicine practitioners report achieving reductions in medications among patients with type 2 diabetes, and in some cases remission, but limited data exist on the clinical decision-making process used to determine when and how medications are deprescribed. Practitioners interviewed here provide accounts of their deprescribing protocols. This information can serve as pilot data for other practitioners seeking examples of how deprescribing in the context of lifestyle medicine treatment is conducted.
ABSTRACT
Objective: The objective of this Expert Consensus Statement is to assist clinicians in achieving remission of type 2 diabetes (T2D) in adults using diet as a primary intervention. Evidence-informed statements agreed upon by a multi-disciplinary panel of expert healthcare professionals were used. Methods: Panel members with expertise in diabetes treatment, research, and remission followed an established methodology for developing consensus statements using a modified Delphi process. A search strategist systematically reviewed the literature, and the best available evidence was used to compose statements regarding dietary interventions in adults 18 years and older diagnosed with T2D. Topics with significant practice variation and those that would result in remission of T2D were prioritized. Using an iterative, online process, panel members expressed levels of agreement with the statements, resulting in classification as consensus, near-consensus, or non-consensus based on mean responses and the number of outliers. Results: The expert panel identified 131 candidate consensus statements that focused on addressing the following high-yield topics: (1) definitions and basic concepts; (2) diet and remission of T2D; (3) dietary specifics and types of diets; (4) adjuvant and alternative interventions; (5) support, monitoring, and adherence to therapy; (6) weight loss; and (7) payment and policy. After 4 iterations of the Delphi survey and removal of duplicative statements, 69 statements met the criteria for consensus, 5 were designated as near consensus, and 60 were designated as no consensus. In addition, the consensus was reached on the following key issues: (a) Remission of T2D should be defined as HbA1c <6.5% for at least 3 months with no surgery, devices, or active pharmacologic therapy for the specific purpose of lowering blood glucose; (b) diet as a primary intervention for T2D can achieve remission in many adults with T2D and is related to the intensity of the intervention; and (c) diet as a primary intervention for T2D is most effective in achieving remission when emphasizing whole, plant-based foods with minimal consumption of meat and other animal products. Many additional statements that achieved consensus are highlighted in a tabular presentation in the manuscript and elaborated upon in the discussion section. Conclusion: Expert consensus was achieved for 69 statements pertaining to diet and remission of T2D, dietary specifics and types of diets, adjuvant and alternative interventions, support, monitoring, adherence to therapy, weight loss, and payment and policy. Clinicians can use these statements to improve quality of care, inform policy and protocols, and identify areas of uncertainty.
ABSTRACT
Finding the truth is important. In the field of lifestyle medicine the randomized controlled trial has significant limitations. Physicians and patients need to know the truth about the healthy lifestyle changes and their ability to prevent and reverse disease. To meet this challenge, the American College of Lifestyle Medicine has established a committee of experts (HEaLM), under the leadership of David Katz to create a level of evidence construct for ranking lifestyle medicine evidence that includes evidence from basic science and epidemiologic trials. This tool will be used by the new Expert Lifestyle Medicine Panel to create guidelines and standards of practice.
ABSTRACT
Lifestyle Medicine is still being defined. The ACLM is making significant progress in defining it within the house of medicine. The new American and International Boards of Lifestyle Medicine go a long way in identifying the clinical parameters for this new specialty. The board review course defines the academic corpus in a clear way. Now that Lifestyle Medicine has clear borders it needs to be spread throughout the cultures of the world. People in all walks of life and levels of responsibility need to hear stories of individuals and communities that have their health improved by following the principles of Lietyle Medicine.
ABSTRACT
The effective integration of lifestyle medicine into allopathic practices is an evolving necessity driven by limited resources and escalating costs. Efforts in the Florida Hospital system graduate medical education (GME) department to meet this challenge may be instructive to others. Efforts include the hiring of an experienced dietician with a focus on a whole food plant based diet and a patient engagement tool to identify areas where patients are ready to make change. Billing is done using existing finance structure with the goal of decreasing the overall cost of providing care within a Clinically Integrated Network (CIN) context. Additionally, one GME clinician's experience in clinical lifestyle based intervention identifies and comments on several practical clinical factors for bringing effective behavior change to individual patients: patient readiness, a knowledgeable health care provider, adequate time, as well as the effectiveness of the intervention.
ABSTRACT
Patients are often not aware of the reversibility of chronic lifestyle-related diseases and most physicians are not telling them. The present practice of communicating treatment effectiveness with relative risk reductions does not allow clinicians or patients to evaluate the relative effectiveness of our technotherapies or lifestyle interventions. Clinicians should use the clarity of "number needed to treat," "number needed to harm," and absolute risk in communicating with patients about all available therapies and then empower the patient to make the choices that fit their needs best.
ABSTRACT
The cost of providing medical care is increasing. The driving forces include inherent health care system conflicts of interest and financial incentives for procedures and technology. Effective lifestyle medicine principles are not easily adopted and rewarded in the present environment. Recent moves toward outcomes-based pay systems offer the potential to demonstrate the effectiveness of lifestyle medicine principles while bypassing many of the biases, application delays, and political machinations of the traditional randomized control trial methodology. The American College of Lifestyle Medicine is uniquely positioned to be a leading organization in improving health, enhancing patient experience, and reducing the cost of care.
ABSTRACT
Non-drug therapy should be foundational to our treatment plans. These should be evidence-based. Drug based therapies rely heavily on randomized controlled trials while the evidence many lifestyle interventions relies more heavily on epidemiological studies. Both have weaknesses and strengths. Medicine needs a system for evaluating evidence that recognizes the strengths of both types of studies and includes some common measure such as Number Needed to Treat (NNT) and Number Needed to Harm (NNH).
ABSTRACT
A new president is stepping into leadership at the American College of Lifestyle Medicine (ACLM). Opportunities abound. The fact that both diabetes and heart disease are reversible is a message that is not reaching the majority of the general public. But times are changing and lifestyle treatment is on the cusp of being accepted as the self-evident best treatment for chronic medical conditions. ACLM is poised to be the leader in this area. Our members passion and experience are our richest resources. Each member is encouraged to be involved with the different committees of ACLM. Choices include Conference Planning, Education, Research, practice Models, Publications, Awards, Business Development, Membership Development, Strategic Partnerships, Marketing and Communications.
ABSTRACT
BACKGROUND: There is a growing awareness that lifestyle behavior modifications may reduce weight and the atherogenic dyslipidemia associated with obesity and type 2 diabetes mellitus (T2DM). OBJECTIVE: We pilot the effectiveness of a diabetes educational program combining shared medical appointments (SMAs) with an 8-week DVD-based diabetes education program emphasizing a plant-based diet in lowering weight and lipids in individuals with T2DM. This pilot also employed a nonrandomized convenience sample to explore which of the educational program's target behaviors were associated with the greatest risk factor reduction. DESIGN: Forty-six adult patients with T2DM voluntarily self-selected to enroll in the educational quality improvement initiative run as part of a community clinical practice. Target behaviors measured weekly were (1) days with beans for breakfast, (2) days of exercise, (3) minutes of exercise per day, (4) days with light evening meals, (5) days with no evening meals, (6) days with no red meat, (7) days with plant-based diet, and (8) number of 8-ounce cups of water per day. Biometric measurements were taken at the beginning and end of the 2-month program. These included high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides. Weight was measured weekly. Regression analysis was performed to identify which target behaviors were associated with changes in lipids and weight. RESULTS: There was a statistically significant (F = 2.429; df = 8.21; p < 0.05) decrease in weight (mean -8.9 lbs, or 4.05 kg, or 4.1% body weight, p < 0.01) during the 8-week study period. There was a positive trend in all lipid parameters, but none reached statistical significance with this sample. Exploratory weighted least-squares regression found that weight loss in the study group was most associated with higher water consumption (t = 3.16; p < 0.01), days per week with no evening meal (t = 3.03; p < 0.01), and days per week consuming beans for breakfast (t = 2.06; p = 0.05. CONCLUSIONS: In this pilot study, the DVD-based educational program delivered as part of an SMA was associated with significant weight loss but insignificant lipid changes. Behavior changes most closely associated with weight loss were increasing water consumption, eliminating evening meals, and increasing the consumption of beans for breakfast. These potentially important findings in this small sample suggest the need for a randomized clinical trial with a larger and planned sample.
