THE ROLE OF LIFESTYLE MEDICINE IN TYPE 2 DIABETES: A COMPREHENSIVE REVIEW
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a progressive metabolic disorder strongly linked to modifiable lifestyle factors. Lifestyle medicine provides a multidomain, evidence-based framework for prevention and management of T2DM and its complications.
Objective: This narrative review synthesizes evidence on six lifestyle medicine domains—diet, physical activity, sleep, smoking cessation, stress management, and social support—in improving glycemic control, insulin sensitivity, and overall health in adults with T2DM.
Methods: A PubMed search was conducted using keywords including “type 2 diabetes,” “lifestyle medicine,” “diet,” “physical activity,” “sleep,” “smoking cessation,” “stress,” “mindfulness,” and “social support.” Peer-reviewed English-language studies were prioritized, emphasizing systematic reviews, meta-analyses, randomized controlled trials, and large cohort studies. Relevant guidelines and professional society reports were also reviewed.
Results: Carbohydrate-restricted, low-glycemic-index, and Mediterranean diets reduced HbA1c by 0.7–1.8% and fasting glucose by up to 1.3 mmol/L. Aerobic plus resistance training improved HbA1c (~0.7%), HOMA-IR, and VO₂ peak. Optimal sleep (7–8 h) correlated with better glycemic control, while short or long durations worsened HbA1c by 0.2–0.3%. Smoking impaired insulin sensitivity and β-cell function, whereas cessation reduced cardiovascular risk. Stress reduction and mindfulness programs lowered HbA1c by ~0.3% and improved mental health. Social interventions, including structured education and peer support, decreased HbA1c by ~0.25% and reduced isolation-related risks.
Conclusion: Lifestyle medicine offers synergistic, non-pharmacological strategies that enhance glycemic control, slow T2DM progression, and improve quality of life. Incorporating these interventions into routine practice is crucial for comprehensive diabetes care.
References
Goyal, R., Singhal, M., & Jialal, I. (2025). Type 2 diabetes. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513253/
Galicia-Garcia, U., Benito-Vicente, A., Jebari, S., Larrea-Sebal, A., Siddiqi, H., Uribe, K. B., … Martín, C. (2020). Pathophysiology of type 2 diabetes mellitus. International Journal of Molecular Sciences, 21(17), 6275. https://doi.org/10.3390/ijms21176275
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., … Gabbay, R. A., on behalf of the American Diabetes Association. (2023). Classification and diagnosis of diabetes: Standards of care in diabetes-2023. Diabetes Care, 46(Suppl. 1), S19–S40. https://doi.org/10.2337/dc23-S002
He, K. J., Wang, H., Xu, J., Gong, G., Liu, X., & Guan, H. (2024). Global burden of type 2 diabetes mellitus from 1990 to 2021, with projections of prevalence to 2044: A systematic analysis across SDI levels for the global burden of disease study 2021. Frontiers in Endocrinology, 15, 1501690. https://doi.org/10.3389/fendo.2024.1501690
Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature Reviews Endocrinology, 14(2), 88–98. https://doi.org/10.1038/nrendo.2017.151
Yeh, B. I., & Kong, I. D. (2013). The advent of lifestyle medicine. Journal of Lifestyle Medicine, 3(1), 1–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390753/
Lippman, D., Stump, M., Veazey, E., Guimarães, S. T., Rosenfeld, R., Kelly, J. H., … Katz, D. L. (2024). Foundations of lifestyle medicine and its evolution. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 8(1), 97–111. https://doi.org/10.1016/j.mayocpiqo.2023.11.004
John, N. A., John, J., Tarnikanti, M., Kalpana, M., Kamble, P., Singhal, A., … Vamishidhar, I. S. (2023). Implications of lifestyle medicine in medical practice. Journal of Family Medicine and Primary Care, 12(2), 208–212. https://doi.org/10.4103/jfmpc.jfmpc_1587_22
Manore, M. M. (2005). Exercise and the Institute of Medicine recommendations for nutrition. Current Sports Medicine Reports, 4(4), 193–198. https://doi.org/10.1097/01.csmr.0000306206.72186.00
Oh, R., Gilani, B., & Uppaluri, K. R. (2025). Low-carbohydrate diet. In StatPearls. StatPearls Publishing.
Masood, W., Annamaraju, P., Khan Suheb, M. Z., & Uppaluri, K. R. (2025). Ketogenic diet. In StatPearls. StatPearls Publishing.
Bhandari, P., & Sapra, A. (2025). Low fat diet. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553097/
Kiani, A. K., Medori, M. C., Bonetti, G., Aquilanti, B., Velluti, V., Matera, G., … Bertelli, M. (2022). Modern vision of the Mediterranean diet. Journal of Preventive Medicine and Hygiene, 63(2 Suppl 3), E36–E43. https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2745
Guasch-Ferré, M., & Willett, W. C. (2021). The Mediterranean diet and health: A comprehensive overview. Journal of Internal Medicine, 290(3), 549–566. https://doi.org/10.1111/joim.13333
Ni, C., Jia, Q., Ding, G., Wu, X., & Yang, M. (2022). Low-glycemic index diets as an intervention in metabolic diseases: A systematic review and meta-analysis. Nutrients, 14(2), 307. https://doi.org/10.3390/nu14020307
Brand-Miller, J., Hayne, S., Petocz, P., & Colagiuri, S. (2003). Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care, 26(8), 2261–2267. https://doi.org/10.2337/diacare.26.8.2261
Baroni, L. (2015). Vegetarianism in food-based dietary guidelines. International Journal of Nutrition, 1(2), 48–73. https://doi.org/10.14302/issn.2379-7835.ijn-14-588
Clifton, P. M., & Keogh, J. (2007). Metabolic effects of high-protein diets. Current Atherosclerosis Reports, 9(6), 472–478. https://doi.org/10.1007/s11883-007-0063-y
Jing, T., Zhang, S., Bai, M., Chen, Z., Gao, S., Li, S., & Zhang, J. (2023). Effect of dietary approaches on glycemic control in patients with type 2 diabetes: A systematic review with network meta-analysis of randomized trials. Nutrients, 15(14), 3156. https://doi.org/10.3390/nu15143156
Okely, A. D., Kontsevaya, A., Ng, J., & Abdeta, C. (2021). 2020 WHO guidelines on physical activity and sedentary behavior. Sports Medicine and Health Science, 3(2), 115–118. https://doi.org/10.1016/j.smhs.2021.05.001
World Health Organization. (2010). Global recommendations on physical activity for health (Appendix 5, Glossary). https://www.ncbi.nlm.nih.gov/books/NBK305048/
Lee, M., & Carroll, T. J. (2007). Cross education: Possible mechanisms for the contralateral effects of unilateral resistance training. Sports Medicine, 37(1), 1–14. https://doi.org/10.2165/00007256-200737010-00001
Kanaley, J. A., Colberg, S. R., Corcoran, M. H., Malin, S. K., Rodriguez, N. R., Crespo, C. J., … Zierath, J. R. (2022). Exercise/physical activity in individuals with type 2 diabetes: A consensus statement from the American College of Sports Medicine. Medicine & Science in Sports & Exercise, 54(2), 353–368. https://doi.org/10.1249/MSS.0000000000002800
European Society of Cardiology. (2025). Physical exercise. https://www.escardio.org/Education/ESC-Prevention-of-CVD-Programme/Treatment-goals/Risk-factor-control/physical-exercise
Grace, A., Chan, E., Giallauria, F., Graham, P. L., & Smart, N. A. (2017). Clinical outcomes and glycaemic responses to different aerobic exercise training intensities in type II diabetes: A systematic review and meta-analysis. Cardiovascular Diabetology, 16, 37. https://doi.org/10.1186/s12933-017-0518-6
Gallardo-Gómez, D., Salazar-Martínez, E., Alfonso-Rosa, R. M., Ramos-Munell, J., Del Pozo-Cruz, J., Del Pozo Cruz, B., & Álvarez-Barbosa, F. (2024). Optimal dose and type of physical activity to improve glycemic control in people diagnosed with type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 47(2), 295–303. https://doi.org/10.2337/dc23-0800
Lee, S. W. H., Ng, K. Y., & Chin, W. K. (2017). The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and meta-analysis. Sleep Medicine Reviews, 31, 91–101. https://doi.org/10.1016/j.smrv.2016.02.001
Liu, H., Zhu, H., Lu, Q., Ye, W., Huang, T., Li, Y., … Ji, L. (2025). Sleep features and the risk of type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of Medicine, 57(1), 2447422. https://doi.org/10.1080/07853890.2024.2447422
Darraj, A. (2023). The link between sleeping and type 2 diabetes: A systematic review. Cureus, 15(11), e48228. https://doi.org/10.7759/cureus.48228
Roderick, P., Turner, V., Readshaw, A., Dogar, O., & Siddiqi, K. (2019). The global prevalence of tobacco use in type 2 diabetes mellitus patients: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 154, 52–65. https://doi.org/10.1016/j.diabres.2019.05.035
Maddatu, J., Anderson-Baucum, E., & Evans-Molina, C. (2017). Smoking and the risk of type 2 diabetes. Translational Research, 184, 101–107. https://doi.org/10.1016/j.trsl.2017.02.004
Pan, A., Wang, Y., Talaei, M., & Hu, F. B. (2015). Relation of smoking with total mortality and cardiovascular events among patients with diabetes mellitus: A meta-analysis and systematic review. Circulation, 132(19), 1795–1804. https://doi.org/10.1161/CIRCULATIONAHA.115.017926
Martin, A., La Rosa, G. R. M., Rice, H., Bertuzzi, A., Witkowski, M., Anastasi, E., … Polosa, R. (2025). Pharmacological interventions for smoking cessation in type 2 diabetes: A systematic review with meta-analysis and GRADE evaluation. Diabetes Research and Clinical Practice, 224, 112202. https://doi.org/10.1016/j.diabres.2025.112202
Lisco, G., Giagulli, V. A., De Pergola, G., Guastamacchia, E., Jirillo, E., Vitale, E., & Triggiani, V. (2024). Chronic stress as a risk factor for type 2 diabetes: Endocrine, metabolic, and immune implications. Endocrine, Metabolic & Immune Disorders Drug Targets, 24(3), 321–332. https://doi.org/10.2174/1871530323666230803095118
Virk, J., Li, J., Vestergaard, M., Obel, C., Kristensen, J. K., & Olsen, J. (2012). Prenatal exposure to bereavement and type-2 diabetes: A Danish longitudinal population-based study. PLoS ONE, 7(8), e43508. https://doi.org/10.1371/journal.pone.0043508
Nikkhah Ravari, O., Mousavi, S. Z., & Babak, A. (2020). Evaluation of the effects of 12 weeks mindfulness-based stress reduction on glycemic control and mental health indices in women with diabetes mellitus type 2. Advances in Biomedical Research, 9, 61. https://doi.org/10.4103/abr.abr_133_20
Hamasaki, H. (2023). The effects of mindfulness on glycemic control in people with diabetes: An overview of systematic reviews and meta-analyses. Medicines, 10(9), 53. https://doi.org/10.3390/medicines10090053
Ezzatvar, Y., Caballero, Ó., Duclos-Bastias, D., Yáñez-Sepúlveda, R., & García-Hermoso, A. (2025). Loneliness and social isolation as risk factors for type 2 diabetes onset: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 223, 112124. https://doi.org/10.1016/j.diabres.2025.112124
Duan, X., Wei, Y., Ge, Y., Bo, Y., Wang, X., & Zhu, Y. (2025). Association of social isolation and loneliness with all-cause and cause-specific mortality among individuals with type 2 diabetes: A prospective study in UK Biobank. Journal of Epidemiology and Community Health, 79(7), 498–505. https://doi.org/10.1136/jech-2024-222775
Spencer-Bonilla, G., Ponce, O. J., Rodriguez-Gutierrez, R., Alvarez-Villalobos, N., Erwin, P. J., Larrea-Mantilla, L., … Montori, V. M. (2017). A systematic review and meta-analysis of trials of social network interventions in type 2 diabetes. BMJ Open, 7(8), e016506. https://doi.org/10.1136/bmjopen-2017-016506
Views:
33
Downloads:
9
Copyright (c) 2025 Wojciech Gąska, Julia Głowacka, Mathias Spitaleri, Filip Kieloch, Dawid Sewruk, Oskar Sienkiel, Agnieszka Fitas, Wiktor Gąska, Karol Kanon, Karolina Dębek-Kalinowska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
