American College of Lifestyle Medicine

Proclamation

Whereas in the United States, type 2 diabetes is present in more than 10% of adults over 18, and more than 25% of those over 65, affecting over 30 million people1;

Whereas it is predicted that for children born in the United States after the year 2000, as many as 40% will develop type 2 diabetes, with even higher estimates for African American, Hispanic, and Native American children2,3;  

Whereas published evidence reveals the world-wide epidemic of type 2 diabetes is approaching half a billion people4, and is common where people have been encouraged to adopt a diet of highly processed and predominantly animal-based foods5,6;

Whereas type 2 diabetes is one of the top risk factors for heart disease7,8 and a leading cause of blindness1, amputation9,10, painful neuropathy11, and kidney failure12 leading to dialysis and renal transplantation;

Whereas most current treatments of type 2 diabetes assume it to be an irreversible chronic illness13 which will require ever-increasing levels of medical intervention14;

Whereas the cost of insulin has tripled in the last decade in the U.S.15;

Whereas diabetes results in $237 billion in direct medical costs per year in the United States, with 43% of those costs due to diabetes medications16

Whereas genetics may make type 2 diabetes more likely17,18, the disease is largely a result of diet and lifestyle choices19,20, thus changes in behavior can prevent it from ever occurring21,22; and even reverse it once it has occurred23-25;

Whereas many people with type 2 diabetes may be able to reduce or eliminate their medications if they are successfully treated with inexpensive low-tech lifestyle measures26-28;

Whereas evidence-based lifestyle therapies such as a whole food, plant-based diet and physical activity are far safer and more cost effective than drugs for control of diabetes27,29; and

Whereas most people with type 2 diabetes report never being told14,30,31 their disease may be prevented, arrested, and even reversed23-25 with a predominantly whole food, plant-based diet32-34 and other lifestyle interventions35-37;


Now therefore be it known that the

President and Board of Directors of the American College of Lifestyle Medicine

do hereby declare the following

TYPE 2 DIABETES BILL OF RIGHTS

 

You have the right to be fully informed about all treatment options for type 2 diabetes before consenting to treatment.  

You have the right to be given accurate, complete, and unbiased information about type 2 diabetes, pre-diabetes, and insulin resistance, including the benefits of treatment with a predominantly whole food, plant-based diet and other Lifestyle Medicine interventions such as physical activity, sleep hygiene, and stress management.

You have the right to know the full effects of all medications prescribed to you, including the side effects that can accelerate and exacerbate the underlying causes of type 2 diabetes.

You have the right to know that certain foods increase your risk of developing type 2 diabetes.

You have the right to have your type 2 diabetes medications reduced or eliminated, if you undergo lifestyle therapies that successfully treat the underlying causes of your condition.

You have the right to work with doctors and health care professionals who understand the links between lifestyle choices and Type 2 Diabetes, and who are equipped with the knowledge and strategies to treat and reverse disease through therapeutic lifestyle change.

You have the right to ongoing education on whole food, plant-based nutrition, meal planning, and culinary skills.

You have the right to know that the same diet and lifestyle changes that can prevent, arrest and, often reverse type 2 diabetes may do the same for other chronic conditions—coronary artery disease, obesity, high cholesterol, high blood pressure, arthritis, even some cancers and autoimmune conditions—leading to the best chance of overall good health. 


References

  1. Centers for Disease Control and Prevention. National Diabetes Statistics Report A, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.
  2. Gregg EW, Zhuo X, Cheng YJ, Albright AL, Narayan KM, Thompson TJ. Trends in lifetime risk and years of life lost due to diabetes in the USA, 1985-2011: a modelling study. Lancet Diabetes Endocrinol. 2014;2(11):867-874.
  3. Turin TC, Saad N, Jun M, et al. Lifetime risk of diabetes among First Nations and non-First Nations people. CMAJ. 2016;188(16):1147-1153.
  4. Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract. 2019;157:107843.
  5. Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences. 2017;11(2):65-71.
  6. Talaei M, Wang Y-L, Yuan J-M, Pan A, Koh W-P. Meat, Dietary Heme Iron, and Risk of Type 2 Diabetes Mellitus: The Singapore Chinese Health Study. Am J Epidemiol. 2017;186(7):824-833.
  7. Association AH. Cardiovascular Disease and Diabetes. American Heart Association. https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease--diabetes. Published 2015. Updated 30 August 2015. Accessed 11 May, 2020.
  8. Raghavan S, Vassy JL, Ho Y-L, et al. Diabetes Mellitus-Related All-Cause and Cardiovascular Mortality in a National Cohort of Adults. Journal of the American Heart Association. 2019;8(4):e011295.
  9. Geiss LS, Li Y, Hora I, Albright A, Rolka D, Gregg EW. Resurgence of Diabetes-Related Nontraumatic Lower-Extremity Amputation in the Young and Middle-Aged Adult U.S. Population. Diabetes Care. 2019;42(1):50-54.
  10. Li Y, Burrows NR, Gregg EW, Albright A, Geiss LS. Declining rates of hospitalization for nontraumatic lower-extremity amputation in the diabetic population aged 40 years or older: U.S., 1988-2008. Diabetes Care. 2012;35(2):273-277.
  11. Tavee J, Zhou L. Small fiber neuropathy: A burning problem. Cleveland Clinic journal of medicine. 2009;76(5):297-305.
  12. Prevention CfDCa. National Diabetes Statistics Report, 2020. Atlanta, GA2020.
  13. Gregg EW, Chen H, Wagenknecht LE, et al. Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes. Jama. 2012;308(23):2489-2496.
  14. Steven S, Lim EL, Taylor R. Population response to information on reversibility of Type 2 diabetes. Diabetic Medicine. 2013;30(4):e135-e138.
  15. Gillett R, Gal S. One chart reveals how the cost of insulin has skyrocketed in the US, even though nothing about it has changed. Business Insider. https://www.businessinsider.com/insulin-price-increased-last-decade-chart-2019-9. Published 2019. Updated 18 Sept 2019. Accessed 13 May, 2020.
  16. American Diabetes A. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-928.
  17. Association AD. 2. Classification and Diagnosis of Diabetes. Diabetes Care. 2016;39 Suppl 1:S13-22.
  18. Kahn S, Cooper ME, Del Prato S. Pathophysiology and treatment of type 2 diabetes: perspectives on the past, present, and future. Lancet. 2014;383(9922):1068-1083.
  19. Organization WH. Global Report on Diabetes. Geneva, Switzerland: World Health Organization;2016.
  20. Ley SH, Ardisson Korat AV, Sun Q, et al. Contribution of the Nurses' Health Studies to Uncovering Risk Factors for Type 2 Diabetes: Diet, Lifestyle, Biomarkers, and Genetics. Am J Public Health. 2016;106(9):1624-1630.
  21. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
  22. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.
  23. McInnes N, Smith A, Otto R, et al. Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial. J Clin Endocrinol Metab. 2017;102(5):1596-1605.
  24. Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-551.
  25. Mottalib A, Sakr M, Shehabeldin M, Hamdy O. Diabetes Remission after Nonsurgical Intensive Lifestyle Intervention in Obese Patients with Type 2 Diabetes. J Diabetes Res. 2015;2015:468704.
  26. Barnard N, Cohen J, Jenkins D, Turner-Mcgrievy G. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals With Type 2 Diabetes. Diabetes Care. 2006;29(8):1777-1783.
  27. Herman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142(5):323-332.
  28. Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The lancet Diabetes & endocrinology. 2019;7(5):344-355.
  29. Group DPPR. Within-Trial Cost-Effectiveness of Lifestyle Intervention or Metformin for the Primary Prevention of Type 2 Diabetes. Diabetes Care. 2003;26(9):2518.
  30. Karve A, Hayward RA. Prevalence, diagnosis, and treatment of impaired fasting glucose and impaired glucose tolerance in nondiabetic U.S. adults. Diabetes Care. 2010;33(11):2355-2359.
  31. Lee V, McKay T, Ardern CI. Awareness and Perception of Plant-Based Diets for the Treatment and Management of Type 2 Diabetes in a Community Education Clinic: A Pilot Study. Journal of Nutrition and Metabolism. 2015;2015:236234.
  32. Association AD. Eating doesn’t have to be boring. American Diabetes Association. Nutrition Web site. https://www.diabetes.org/nutrition. Published n.d. Accessed 11 May, 2020.
  33. McMacken M, Shah S. A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of geriatric cardiology : JGC. 2017;14(5):342-354.
  34. Barnard ND, Katcher HI, Jenkins DJ, Cohen J, Turner-McGrievy G. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009;67(5):255-263.
  35. Eikenberg JD, Davy BM. Prediabetes: a prevalent and treatable, but often unrecognized, clinical condition. J Acad Nutr Diet. 2013;113(2):213-218.
  36. Association AD. 3. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S32-S36.
  37. Pischke CR, Marlin RO, Weidner G, Chi C, Ornish D. The Role of Lifestyle in Secondary Prevention of Coronary Heart Disease in Patients With Type 2 Diabetes. Canadian Journal of Diabetes. 2006;30(2):1-7.

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