Sec­tion 5. Fa­cil­i­tat­ing Pos­i­tive Health Be­hav­iors and Well-​be­ing to Im­prove Health Out­comes

(https:/​/​doi.org/​10.2337/​dc23-​S005)

The ti­tle has been changed from “Fa­cil­i­tat­ing Be­hav­ior Change and Well-​be­ing to Im­prove Health Out­comes” to be in­clu­sive of strength-​based lan­guage.

Rec­om­men­da­tion 5.8 was added to the “Di­a­betes Self-​Man­age­ment Ed­u­ca­tion and Sup­port” sub­sec­tion to ad­dress so­cial de­ter­mi­nants of health in guid­ing de­sign and de­liv­ery of di­a­betes self-​man­age­ment ed­u­ca­tion and sup­port (DSMES). Ad­di­tion­al in­for­ma­tion was also added sup­port­ing use of tele­health de­liv­ery of care and oth­er dig­i­tal health so­lu­tions to de­liv­er DSMES.

Screen­ing for food in­se­cu­ri­ty by any mem­bers of the health care team was added to the nu­tri­tion sec­tion.

A sec­tion on in­ter­mit­tent fast­ing and time-​re­strict­ed eat­ing was in­clud­ed in the “Eat­ing Pat­terns and Meal Plan­ning” sub­sec­tion.

Em­pha­sis was placed on sup­port­ing larg­er weight loss­es (up to 15%) based on efficacy and ac­cess of new­er med­i­ca­tions.

Lan­guage was added to Rec­om­men­da­tion 5.23 about the harms of β-​carotene sup­ple­men­ta­tion based on the U.S. Pre­ven­ta­tive Ser­vices Task Force re­port.

The new sub­sec­tion “Sup­port­ing Pos­i­tive Health Be­hav­iors” was added, in­clud­ing the ad­di­tion of Rec­om­men­da­tion 5.37, which en­cour­ages use of be­hav­ioral strate­gies by mem­bers of the di­a­betes care team, with the goal to sup­port di­a­betes self-​man­age­ment and en­gage­ment in health be­hav­iors to pro­mote op­ti­mal di­a­betes health out­comes.

The “Psy­choso­cial Is­sues” sub­sec­tion was re­named “Psy­choso­cial Care” to high­light the rec­om­men­da­tion­s’ em­pha­sis on pro­vid­ing ap­pro­pri­ate psy­choso­cial sup­port to peo­ple with di­a­betes as part of or in con­junc­tion with stan­dard di­a­betes care.

The “Psy­choso­cial Care” sub­sec­tion in­cludes a new Rec­om­men­da­tion 5.55 to screen for sleep health in peo­ple with di-​ abetes and make re­fer­rals to sleep medicine and/​or qualified be­hav­ioral health pro­fes­sion­al as in­di­cat­ed.

Oth­er rec­om­men­da­tions in this sub­sec­tion were re­vised to spec­i­fy the roles of di­a­betes care pro­fes­sion­als as well as qualified men­tal/​be­hav­ioral health pro­fes­sion­als to pro­vide psy­choso­cial care, to spec­i­fy top­ics for psy­choso­cial screen­ing, treat­ment, and re­fer­rals when in­di­cat­ed, and to in­clude care­givers and fam­i­ly mem­bers of peo­ple with di­a­betes. De­tails were added about re­sources for de­vel­op­ing psy­choso­cial screen­ing pro­to­cols and about in­ter­ven­tion. Across the specific psy­choso­cial do­mains (e.g., di­a­betes dis­tress, anx­i­ety), de­tails were added about data sup­port­ing in­ter­ven­tion and care ap­proach­es to sup­port psy­choso­cial and be­hav­ioral out­comes in peo­ple with di­a­betes and their fam­i­ly mem­bers.