Nutrition management and physical activity as treatments for diabetes.

Diabetes is essentially a self-management disease in which patients must learn to integrate blood glucose monitoring with nutrition management and physical activity and, if needed, oral agents or insulin. This almost always requires behavior change. The American Diabetes Association diet is no longer a meaningful prescription, because recommendations are now based on individualized nutrition assessment and treatment goals. Physical activity recommendations, as an adjunct to nutrition management, should also be individualized. Using a team approach, focusing on individualization of nutrition management and physical activity, applying behavior change concepts, and providing frequent follow-up can improve self-management and result in improved metabolic control. Primary care practitioners are in a unique position to oversee this process.