Literature Collection

Objective: Diabetes is a defining disease of the 21st century because of its rising prevalence, association with obesity, and enormous health impact. Abundant evidence shows that lifestyle interventions can delay or prevent type 2 diabetes (T2D) in adults, offer relief, and sometimes achieve complete remission. Despite this empowering message, there are no clinical practice guidelines that focus primarily on lifestyle interventions as first-line management of prediabetes and T2D. Our objective, therefore, is to offer pragmatic, trustworthy, and evidence-based guidance for clinicians in using the 6 pillars of lifestyle medicine-nutrition, physical activity, stress management, sleep, social connectedness, avoidance of risky substances-for managing adults with T2D and in preventing T2D in adults with prediabetes or a history of gestational diabetes mellitus. Methods: We used well-established, peer-reviewed guideline methodology to develop evidence-based key action statements (recommendations) that facilitate quality improvement in clinical practice. The guideline development group included 20 members representing consumers, advanced practice nursing, cardiology, clinical pharmacology, behavioral medicine, endocrinology, family medicine, lifestyle medicine, nutrition and dietetics, health education, health and wellness coaching, sleep medicine, sports medicine, and obesity medicine. Recommendation strength was based on the aggregate evidence supporting a key action statement plus a comparison of associated benefits vs harms/costs. Multiple literature searches, conducted by an information specialist, identified 8 relevant guidelines, 118 relevant systematic reviews, and 112 randomized clinical trials. The guideline underwent extensive internal, external, and public review and comment prior to publication. Results: We developed 14 key action statements and associated evidence profiles, each with a distinct quality improvement goal in the context of lifestyle interventions for T2D. Strong recommendations were made regarding advocacy for lifestyle interventions; assessing baseline lifestyle habits; establishing priorities for lifestyle change; prescribing aerobic and muscle strength physical activity; reducing sedentary time; identifying sleep disorders; prescribing nutrition plans for prevention and treatment; promoting peer/familial support and social connections; counseling regarding tobacco, alcohol, and recreational drugs, and establishing a plan for continuity of care. Recommendations were made regarding identifying the need for psychological interventions and for adjusting (deprescribing) pharmacologic therapy. We include numerous tables and figures to facilitate implementation, a plain-language summary for consumers, and an executive summary for clinicians as separate publications. Conclusions: There is robust research evidence supporting the efficacy of lifestyle interventions in preventing, treating, and achieving remission of T2D in adults. Our multidisciplinary guideline development group successfully synthesized this evidence into 14 key action statements that can be used by clinicians and other healthcare professionals to improve quality of care for adults with, or at-risk for, T2D. Despite the research gaps and implementation challenges we highlight in the guideline we believe strongly that our recommendations have immediate relevance and can help raise awareness and shift the paradigm of T2D management towards optimal use of lifestyle interventions.

This review is based on a presentation at the 2024 Annual Meeting of the American College of Lifestyle Medicine (ACLM), which showcased ACLM's first clinical practice guideline on Lifestyle Interventions for Treatment and Remission of Type 2 Diabetes and Prediabetes in Adults. Our goal is to offer pragmatic implications of the guideline for everyday patient care, including case presentations showing how the guideline recommendations (key action statements) can be implemented. The target audience is any clinician or healthcare professional in a community or outpatient healthcare setting involved in managing non-pregnant adults with T2D, prediabetes or a history of gestational diabetes mellitus (GDM). Unique features of the ACLM guideline include placing lifestyle interventions as the foundation of T2D management and prevention, offering strategies for sustained behavior change, and emphasizing all six pillars of lifestyle medicine: plant-predominant nutrition, regular physical activity, restorative sleep, stress reduction, social connectedness, and avoiding risky substances. This review is not intended to substitute for the full guideline, which should be read before doing the recommended actions.

Mental health in the United States faces a mounting crisis, with rising prevalence, inadequate outcomes from pharmacologic treatments, and compounding social and environmental stressors. Traditional care models often neglect the biopsychosocial factors that shape psychological well-being, underscoring the need for a deeper integration of lifestyle medicine and behavioral health. Lifestyle interventions including nutrition, physical activity, sleep hygiene, stress resilience, social connection, and reduction of harmful substance use are biologically active treatments that influence neuroplasticity, inflammation, circadian rhythms, and emotional regulation. Framing these as first-line, rather than adjunctive, interventions repositions them at the center of mental healthcare. Behavioral health professionals are uniquely positioned to facilitate this shift through therapeutic alliance, motivational interviewing, psychoeducation, and interprofessional collaboration. Clinical integration requires systematic assessment of lifestyle domains, incorporation into psychotherapeutic modalities, and deployment within community and digital platforms to enhance access and adherence. Emerging fields such as lifestyle psychiatry, positive psychology, and community-based health models highlight the promise of synergistic care that addresses meaning, purpose, and connectedness. By embedding lifestyle medicine into behavioral health practice, clinicians can foster resilience, reduce disease burden, and expand the scope of preventive and therapeutic strategies, advancing whole-person care for individuals and communities.

INTRODUCTION: As Novel psychoactive substances (NPS) are conceived to mimic the effects of common illicit drugs, they represent a serious public health challenge due to the spike in intoxications and fatalities that have been linked to their use. This study aims to provide epidemiological data on NPS use in the USA, determining lifetime prevalence of use and defining demographic, socioeconomic, drug use patterns and mental health correlates. METHODS: This study uses secondary data from the US National Survey on Drug Use and Health (NSDUH), which is a large cross-sectional population-based survey carried out annually in the USA. We analysed data from 2007-14 (N = 307,935) using bivariate descriptive analysis and binary logistic regression to calculate prevalence and determine factors underlying NPS consumption. Adjusted odds ratios (OR) with 95% CI's were calculated for a set of selected independent variables. RESULTS AND DISCUSSION: Our analysis NSDUH from 2007-14 highlights an increase in NPS use among adults, especially among white young men aged 18 to 25. Although the level of education of NPS users was relatively higher as compared to non-users, NPS users seemed to have a less wealthy situation. However, socioeconomic vulnerability appeared to be less important than mental health issues as a correlate to NPS use. NPS users seem to have followed a pattern of polysubstance use throughout their life, which involves both traditional illicit drugs and classic synthetic drugs. As NPS use seemed to be more prevalent among people having mental health issues, the rise in their use may have a negative impact on population mental health outcomes. CONCLUSION: Further comparative research on trends in NPS use and potential public health responses would be instrumental for developing appropriate health interventions, including drug checking, education for users and training for healthcare professionals working both within emergency wards and in/outpatient addiction and mental health services.

INTRODUCTION: Chronic constipation (CC) is a common gastrointestinal disorder with limited treatment options. Linaclotide is a potent peptide agonist of the guanylate cyclase-C receptor. This action activates intracellular conversion of guanosine 5-triphosphate to cyclic guanosine monophosphate resulting in the stimulation of intestinal fluid secretion. Linaclotide is a promising new agent for refractory constipation. Areas covered: All published articles regarding the development, clinical efficacy, and safety of linaclotide in treating CC were reviewed. Pharmacodynamics, pharmacokinetics, and metabolism of this secretagogue agent were examined. Clinical studies showed that linaclotide increases the number of spontaneous bowel movements and stool consistency scores. Overall, patients reported relief from abdominal discomfort and severity of constipation. Finally, linaclotide has a good safety profile, with diarrhea being the main side effect. Expert opinion: Linaclotide appears to be a well-tolerated and effective agent for patients with CC, and could be effectively combined with other drugs in patients with refractory constipation. However, data on the efficacy and safety of linaclotide in pediatric patients and in opioid-induced constipation are currently limited and more studies need to be undertaken.

INTRODUCTION: Sexual and reproductive health (SRH) is a critical component of overall well-being, yet individuals with substance use disorder (SUD) often face significant barriers to accessing SRH services-and vice versa. SRH settings offer important opportunities to identify and address SUD needs through screening and referral, whereas SUD treatment settings can serve as key access points for SRH care. The Link Study was developed as a cross-training intervention to strengthen collaboration and care coordination between SRH and SUD providers. METHODS: We designed a curriculum covering core elements of SRH and SUD care, emphasizing person-centered practices, trauma-informed approaches, and evidence-based screening and referral tools. Thirty-five providers from three SRH and SUD site pairs participated. Evaluation included pre- and post-training knowledge surveys, site-level screening and referral data, and provider focus groups. We used confidence intervals to assess changes in quantitative outcomes and conducted thematic analysis of qualitative data. RESULTS: Providers demonstrated consistent increases in self-reported knowledge across key domains. Two of the three SRH and SUD sites showed statistically significant improvements in screening practices. Although referral rates did not change significantly, sites reported meaningful updates to workflows, tools, and policies to support integration. All sites sustained cross-sector provider relationships for at least 6 months post-training. DISCUSSION: The Link Study showed promising gains in provider knowledge, improvements in screening practices, and lasting collaboration across SRH and SUD service sectors. Findings highlight the potential of cross-disciplinary training and technical assistance to build integrated care pathways and strengthen community-based health systems.

OBJECTIVE: To evaluate the impact of a digital platform that connects primary care providers and commercially insured adults to outpatient behavioral health services on behavioral health utilization and total medical costs. STUDY DESIGN: A matched difference-in-differences approach was used to assess the effects of the intervention. Data were obtained from administrative medical claims for commercially insured adults. METHODS: The intervention group consisted of members assigned to 735 practices that adopted the platform, and the comparison group included members from 516 practices that did not. Propensity score matching was employed to balance baseline characteristics, and doubly robust difference-in-differences analysis was applied to estimate the intervention's effects on outpatient behavioral health visits, emergency department (ED) visits, inpatient admissions, and total medical costs over 18 months. RESULTS: The intervention group had a 68% higher likelihood of receiving outpatient behavioral health services. They were 35% less likely to have a behavioral health-related ED visit and 43% less likely to be admitted for behavioral health-related inpatient care. Despite increased outpatient utilization, total medical costs were significantly lower in the intervention group (-$27.63 per member per month at 18 months post intervention). CONCLUSIONS: Connecting commercially insured adults to outpatient behavioral health services via a digital platform improves utilization of behavioral health care while reducing costly emergency and inpatient services. These findings suggest that enhancing access to outpatient behavioral health services can lead to better health outcomes and greater cost efficiency in managed care populations.