29th May 2025

Non-Pharmacological Management

Ensuring the required long-term engagement with the health service and compliance with treatment is integral to successfully managing T2DM. Therefore, there is perhaps a greater emphasis placed on the structured education of patients, family members and carers about the disease than many other medical conditions. NICE recommends that courses should be offered to patients at the time of diagnosis with

Upon initial diagnosis of T2DM, patients should be encouraged to adjust their lifestyle to reduce their sugar levels and avoid medication. Changes must be individualised, taking into account factors such as the risk of hypoglycaemia and comorbidities. Generalisable suggested dietary modifications include: 

• Opting for high-fibre, low-glycaemic-index sources of carbohydrates, such as whole grains and vegetables, and avoiding low-fibre, high glycaemic-index sources such as white rice, white bread, potatoes, sugary snacks and drinks. 
• Consuming low-fat dairy products where possible.
• Incorporating a portion of oily fish per week into their diet.
• Reducing their amount of saturated and trans-fatty acids.
• Striving to fit 5 portions of fruit or vegetables into their daily diet.
• Avoidance of products that are specifically marketed towards patients with diabetes.

Newly diagnosed patients should be encouraged to engage in regular physical exercise even if they have a normal body weight. Patients who are overweight should target 5-10% weight loss in the initial 6-month period. All patients should be counselled on the risks of smoking and offered help with smoking cessation. Abstinence from alcohol is not required but heavy use is not advisable and patients should be made aware of the erratic effect binge drinking can have on their blood sugar.

Patients living with T2DM with a BMI of over 35kg/m2 should be considered for bariatric surgery, lower than the usual recommended threshold of 40kg/m2 due to there being good evidence that it improves control of the disease. For patients from Asian, Middle Eastern, Black African or African-Caribbean family backgrounds a lower threshold of 32.5kg/m2 is used for referral for assessment.