Lifestyle Medicine Guidelines for T2D, Prediabetes Are the Result of Remarkable Collaboration Across Specialties

"A lot of groups don’t want to just accept what you’ve done and sign on to it. In contrast, I think we had 10 organizations sign on to this, which is something I’ve never seen before."

In a recent interview with Patient Care,^© Richard Rosenfeld, MD, MPH, MBA, discussed the inclusive process behind the development of a new lifestyle-focused clinical guideline for treating and, where possible, reversing prediabetes and type 2 diabetes (T2D). Rosenfeld, lead author of Lifestyle interventions for treatment and remission of type 2 diabetes and prediabetes in adults: a clinical practice guideline from the American College of Lifestyle Medicine, emphasized the broad stakeholder involvement and consensus-building behind the guideline from the start. Engaging a wide range of national medical organizations across specialties—from endocrinology and primary care to nutrition, sleep medicine, and behavioral health—the experience, Rosenfeld said, was unique, the result being an unprecedented level of endorsement from myriad other organizations, many of which publish their own clinical guidelines on management of T2D. The process reflects a collaborative, noncompetitive model of consensus building toward a shared and optimized outcome. He talks about the process in the short vide above.

The following transcript was lightly edited for style and flow.

Patient Care: How was the ACLM experience working with the numerous other health care professional organizations that participated in the guideline development?

Richard Rosenfeld, MD, MPH, MBA: When we develop a guideline, we start by identifying the stakeholders. And for diabetes, it’s very diverse. We mentioned some of them: endocrinology, obesity medicine, sleep medicine, psychiatry, health and wellness coaches, nutritionists, dietitians, lifestyle medicine, cardiology. There's a whole spectrum of individuals—not to mention the advanced practice providers, nurse practitioners, physician assistants. So there are all these people who have skin in the game, many of whom have developed their own products.

What we do is identify the stakeholders. We reach out to all the national organizations and say, “Here’s what we’re doing. We’d like you to recommend to us 1 or 2 individuals—depending on the entity—who can advocate for your organization’s views on this.” So they’re not coming on as their own person; they’re really coming on as the voice of the organization. By doing that, we try and establish this connection upfront.

We give these entities the opportunity to endorse or support the guideline—which, I will say, having done much of this in the past with other groups, is tough to get. A lot of groups don’t want to just accept what you’ve done and sign on to it. In contrast, I think we had 10 organizations sign on to this, which is something I’ve never seen before.

These are endocrine groups, physician associates, nurse practitioners, pharmacology, obesity medicine, sleep medicine, diabetes education and care specialists, health and wellness coaches, the American Academy of Family Physicians, nutrition and dietetics. This is, in my experience—doing a lot of guideline development over 30 years—almost unheard of, to see this willingness of a broad group to endorse your guideline.

I think it’s largely because we’re noncompetitive. We’re not telling them how to manage diabetes. We’re saying, “For some of the key things in the lifestyle arena, here are some ideas on how to do it best in an evidence-based way that’s likely to give you the tools and help you be successful.” So it’s a nonconfrontational approach.

Richard Rosenfeld, MD, MPH, MBA, is the distinguished professor of otolaryngology, SUNY Downstate Health Sciences University and senior advisor for quality and guidelines for the American Academy of Otolaryngology – Head and Neck Surgery. Rosenfeld is board certified in otolaryngology – head and neck surgery and in lifestyle medicine.