The NHS exercise guidelines say people should take 150-175 minutes of moderate aerobic activity across five days a week, plus strength exercises on at least two days a week. People should, at the very least, reduce the time they spend sitting for long periods.16

NHS advice on food and keeping active in diabetes refers people to the Diabetes UK advice on healthy weight. This recommends weight loss of 5-10% through calorie intake reduction where weight is an issue.17,18

Researchers have noted that weight loss interventions appear more effective where there is an elevated glucose level after a meal (ie, ‘glucose intolerance’ where there is more likely to be peripheral insulin resistance), compared to those with a high fasting glucose level, where the liver is producing excess glucose. But a sustained very low calorie diet (VLCD) (800kCal/day or below) can improve fasting glycaemia, even in T2D, due to decreased liver fat content and a corresponding improvement in insulin sensitivity.14,19

However, the modes of action are still not clearly understood, and for people at high risk of developing T2D, a tightly controlled lifestyle intervention may only see a three-year delay in onset.14