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Type 2 diabetes, the most common, must first be managed without medication, in particular through physical activity, and only then through possible pharmaceutical treatment, according to new recommendations from the High Authority for Health (HAS).
“Lifestyle modifications – physical activity, nutrition, fight against a sedentary lifestyle – are a prerequisite for the possible implementation of drug treatment for hyperglycemia and must be maintained over time.“, summarized the HAS in a press release this week.
This “paradigm change”, in the words of the authority which guides health policies in France, only applies to type 2 diabetes.
This, which represents 90% of diabetes, affects older patients, who become less responsive to insulin. More acute, type 1 diabetes, which is due to an insulin deficiency, necessarily requires insulin therapy.
The new HAS recommendations come in a context where public health policies are increasingly emphasizing the benefits of physical activity.
This presents “numerous therapeutic benefits such as improving insulin sensitivity, reducing the risk of progression of diabetes or even cardiovascular complications“, underlines the HAS.
The authority therefore recommends the implementation of a physical activity program, as well as a modification of the diet, both of which are personalized according to the patient.
“If lifestyle changes are not enough, medication is then offered to the patient.“, continues the HAS.
It is therefore a new way of conceiving care, which subordinates the medicinal approach to management through lifestyle, instead of putting them on an equal footing.
If this strategy has a consensus among specialists, because it corresponds to the progression of knowledge in recent years, some nevertheless warn of its difficulties of application.
“Starting physical activity or changing your diet is very difficult“, noted on X (ex-Twitter) the cardiologist Florian Zores, emphasizing “the lack of (therapeutic) offer to supervise, encourage and support these changes“.