Case 1

An obese (BMI = 34 kg/m2) 43-year-old African American woman comes to establish care in your office. She is a “never smoker” who moved from another state about three weeks ago. She tells you that her former primary care doctor just diagnosed her with type 2 diabetes mellitus prior to her move. Her hemoglobin A1c was 7.4% when checked four weeks ago. She is currently not on any medicine for her diabetes and wishes to avoid insulin, if possible. Her blood pressure is 136/78 mm Hg and her lipid profile (also done four weeks ago) is: total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, high-density lipoprotein (HDL) = 49 mg/dL, and low-density lipoprotein (LDL) = 170 mg/dL (calculated 10-year ASCVD risk = 4.3%). You discuss the current treatment goal recommendations endorsed by the American Diabetes Association (ADA) in terms of glycemic control, blood pressure control, and lipid management. She agrees to start any medications that you recommend, but asks you if there is any proof that lifestyle modifications can be effective to treat diabetes, similar to the way the DASH (Dietary Approaches to Stop Hypertension) diet was shown effective to treat hypertension.

Question 1 of 6:

What can you tell her about evidence to support lifestyle modification efforts?

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