Develop a Personal Plan Based on Evidence

Evidence-based plan

Health care teams and patients should collaboratively develop an evidence-based plan. Patients’ goals and plans will vary. See Create a personal plan. As a starting point, health care teams should discuss the following goals and strategies that proved successful in the NIH-sponsored DPP research study:

Weight loss of 5 to 7 percent of body weight

• Explain weight loss in pounds of weight loss or a goal weight by a particular date—usually 3 to 4 months. Assist the patient to make a very specific goal for weight loss.
• Ask the patient to identify specific action steps they can take to reach that goal and help patients create a timeline with short-term goals (weight loss per week) and accountability (daily or weekly weigh-ins).

Moderate physical activity

• Help patients develop a plan for physical activity. One option is to walk 5 days a week for 30 minutes a day. Recognize that many patients will need to set a smaller initial goal. Consider offering a walking plan for beginners.
• Patients should also be encouraged to decrease sedentary behavior or time spent sitting.

Reduction in daily fat and calorie intake

• The table below outlines the fat and calorie goals used in the DPP. Resources like those in Your Game Plan to Prevent Type 2 Diabetes can help the patient translate these goals into changes in the foods they are already eating.

Recommended fat and calorie goals based on initial weight:

Tracking progress

• Encourage patients to record daily fat and calorie intake and physical activity using tools like USDA's ChooseMyPlate.
• To increase patients’ accountability to reach their weight goal, ask patients to weigh in at home once daily or weekly and to record these weights in a diary or log.
• Arrange a short-term follow-up visit to review the food, activity, and weight logs and discuss whether the plan should change. Scheduling another visit creates a deadline for action. This can motivate patients to stick with the plan.

Metformin therapy

• Consider the addition of metformin to lifestyle therapy for some patients who prefer both treatments, who are not making progress toward their weight loss goals using lifestyle changes, or for certain patient groups who do almost as well preventing their diabetes when they are taking metformin as they do when offered lifestyle interventions. These groups include women with prediabetes and a history of gestational diabetes and younger persons with prediabetes who have a BMI above 35.¹

Create a personal plan

The plan for diabetes prevention should be primarily created with the patient and family, with the advice and support of the physician and other members of the health care team, using a patient-centered approach. Because a patient’s actions not only reflect individual characteristics, but also the patient’s environment at home, at work, and in the community, all of these factors should be considered in a lifestyle intervention plan.² Generally, the changes the patient is making will be beneficial for the whole family, and family involvement and support may increase the patient’s likelihood of meeting goals.

Health care teams can start by assessing prior weight loss efforts for what worked or didn’t work and why. Then they can help patients identify specific behaviors that may need to be modified to lose weight and prevent type 2 diabetes. Suggested behavior changes will vary among patients. Some examples include packing appropriate shoes for a lunchtime walk, preparing breakfast at home instead of eating out, or drinking water instead of sugary drinks like juices, regular soda, energy drinks, or sports drinks. It should be acknowledged that achieving long-term goals, such as walking 30 minutes daily, is done by meeting a series of short-term goals, such as walking 10 minutes a day to start.

Any plan should incorporate education and ongoing support. Plans for follow-up (e.g., specifying how often, meeting in-person or by email/phone) should be established to assess progress and modify behaviors further, if needed. Health care teams can help patients identify programs or individuals who will be supportive of their lifestyle changes.

To implement an effective lifestyle intervention, some health care professionals will need to improve their counseling skills to effectively help patients. See Support your patients with behavior change strategies for tools and resources to improve your counseling skills.

References