Vaccine Recommendations

People with type 2 diabetes are at higher risk of influenza and its complications. It is therefore widely recommended they, as well as their family members and care-givers, be vaccinated against the flu every year.⁹ In addition to the seasonal flu vaccine, older people with type 2 diabetes should consult with their healthcare provider about the potential benefits of pneumococcal vaccines (PCV13 and PPSV23).¹⁰

Weight Management

Overweight and obesity are closely linked to insulin resistance and type 2 diabetes. In fact, excess body fat appears to be key trigger of systemic inflammation leading to insulin resistance.^{11, 12} Weight loss, while difficult to achieve, can reverse insulin resistance, prevent prediabetes from progressing, and improve insulin sensitivity and glucose metabolism in people with type 2 diabetes.¹³ Therefore, healthy weight management is an important goal in a type 2 diabetes treatment plan.

Exercise

Exercise helps decrease body fat and improve insulin sensitivity, promotes metabolic, cardiovascular, and musculoskeletal fitness, and improves mental health and quality of life.^{14, 15} People who exercise are less likely to develop type 2 diabetes, and physical training, especially when it progresses in intensity and amount, improves glycemic control in people with type 2 diabetes.¹⁶ In the short term, however, exercise can induce low blood sugar (hypoglycemia) in people with diabetes taking blood sugarlowering medications, or even occasionally increased blood sugar.¹⁷ Therefore, people with diabetes should consult with a qualified exercise specialist before starting an intensive exercise program. Current research also highlights the harm of prolonged sitting, and a meta-analysis of studies found breaking up prolonged periods of sitting with short bouts of physical activity has a moderate impact on glucose, insulin, and triglyceride levels.^{18, 19}

Alcohol

Drinking light to moderate amounts of alcohol has been associated with lower risk of type 2 diabetes in multiple studies and meta-analyses; however, according to a large meta-analysis that included 38 studies with a combined total of more than 1.9 million subjects, it appears to be more protective for women than men, and may not be protective in people of Asian descent.^{20, 21} For people with type 2 diabetes, light to moderate intake of alcohol appears to be safe and is not correlated with glycemic control.²² Emerging evidence from a controlled clinical trial, in which 224 people with well-controlled type 2 diabetes were assigned to drink one 150 ml glass (5 ounces, or one serving) of red wine, white wine, or water daily for two years, adds to the evidence that this level of wine consumption is safe in this population; furthermore, red wine in particular appeared to have a positive impact on cardiovascular risk in this study.^{23, 24} Nevertheless, high alcohol consumption offers no protections and increases the risks of cardiovascular disease and death from all causes in people with and without type 2 diabetes.²⁵ It is also important to note that drinking alcohol may increase the risk of hypoglycemia, especially in those taking blood glucose-lowering medications.^{26, 27}

Smoking

Smokers are also more likely to develop diabetes, and people with type 2 diabetes who smoke are at higher risk for kidney damage, heart disease, and other diabetes-related problems.^{28, 29} Because electronic cigarettes also appear to pose cardiovascular and possibly other health hazards, people with type 2 diabetes who don’t smoke should not start vaping, and those who do smoke should talk with their healthcare provider to develop an individualized plan for smoking cessation.³⁰

Blood Glucose Monitoring

Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, the benefits of SMBG in people with type 2 diabetes who are not being treated with insulin are less clear. Supporters posit the use of SMBG may help people with type 2 diabetes set and achieve their glycemic goals by making it easy for them to see how factors such as food choices and physical activity influence blood glucose levels. Two meta-analyses of clinical trials provide some clarity: they both found people with type 2 diabetes who used SMBG for up to six months were more effective at reducing HbA1c (a marker of long-term blood glucose control) compared to those who didn’t use SMBG, but after one year, the difference was gone.^{31, 32} This suggests SMBG may be especially useful as a short-term educational tool for those newly diagnosed or with poor glycemic control, but may not be useful as a long-term disease management strategy.

While traditional SMBG devices can only detect glucose levels at isolated points in time, new continuous glucose monitoring devices provide information about short-term fluctuations in glucose levels (glycemic variability). Continuous glucose monitoring devices are inserted under the skin and left in place for periods ranging from a few days to a few weeks. This technology is frequently used by insulin-treated type 1 and type 2 diabetes patients and can be integrated with insulin release from automatic insulin pumps to optimize glucose stability. The potential value of monitoring glycemic variability in people with non-insulin-treated type 2 diabetes is still being explored.^{33, 34}