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In Australia, more than 1.3 million people have diabetes, with over 300 new cases diagnosed every day—that is one person every five minutes. It’s our fastest-growing long-term health condition, outpacing even heart disease and cancer. [1]

Aboriginal and Torres Strait Islander peoples face much higher risks: they’re three times more likely to develop type 2 diabetes, 4.3 times more likely to end up in hospital because of it, and four times more likely to die from diabetes-related causes compared to non-Indigenous Australians. Sadly, one in five cases in Aboriginal and Torres Strait Islander communities goes undiagnosed.[1]

In Aotearoa New Zealand, diabetes affects about 4.7% of people (around 228,000), and it’s growing fast—by about 7% per year—with numbers expected to nearly double to over 500,000 by the 2040s.

Māori experience a disproportionate burden, with rates around 2.5 times higher than the national average(7.5%), while Pacific peoples face even higher risk at 15.1%. Māori living with type 2 diabetes also have nearly double the death rates from all causes and heart issues compared to non-Māori, alongside higher rates of hospital stays and serious complications.[2]

Despite this, type 2 diabetes is largely preventable and, in many cases, can be successfully managed—or even put into remission—via comprehensive lifestyle changes, where the key principles of lifestyle medicine work together to improve insulin sensitivity and general metabolic health.[3]

But what exactly causes type 2 diabetes?

Type 2 diabetes is a long-term condition where the body has trouble using insulin properly. Insulin is the hormone produced in the pancreas that helps move glucose from the bloodstream into the body’s cells, where it’s used for energy. Normally, when we eat foods containing carbohydrates—like fruit, vegetables, or grains—they’re broken down into glucose, which travels through the blood and is let into cells by insulin, like a key opening a door lock. In type 2 diabetes, this system doesn’t work as well. The ‘lock’ becomes harder to open—often owing to factors like excess fat in the liver and muscles, low physical activity, and regularly taking in more energy from food than the body needs. Glucose can’t enter the cells, so it builds up in the bloodstream. Over time, this build-up can damage blood vessels, organs and tissues.

In this article we examine the key lifestyle medicine principles, or pillars, and their influence on this chronic condition.

Whole food plant-based nutrition

A whole food plant-based (WFPB) dietary pattern centres on vegetables, fruits, whole grains, legumes, nuts, and seeds, while minimising or excluding animal products and highly processed foods.
Large cohort studies consistently show that plant-based dietary patterns are associated with a significantly lower risk of developing type 2 diabetes.[4] Clinical trials further demonstrate that low-fat plant-based diets can improve HbA1c (a measure of average blood glucose levels over the past 3months), reduce body weight, and enhance insulin sensitivity (allowing your body’s cells to respond to insulin and absorb glucose) in people already living with the condition.[5,6]

Crucially, this approach tackles underlying insulin resistance (where the body’s cells aren’t responding to insulin properly) rather than simply attempting to manage blood glucose levels. High-fibre foods slow glucose absorption and improve satiety, while lower levels of dietary fat—particularly saturated fat—can decrease fat accumulation within muscle and liver cells, a key driver of insulin resistance.[6] In New Zealand, where rising rates of excess body weight are closely linked with increasing diabetes prevalence, this mechanism is particularly relevant.[7]

By improving the body’s ability to regulate glucose effectively, a whole food plant-based approach offers a path not just to management, but to optimum metabolic health— that is, the body’s ability to efficiently convert food into energy, regulate blood glucose, and appropriately store or use nutrients.

Low-Fat vs Low-Carb: Two Approaches to Type 2 Diabetes

Although both approaches can influence blood glucose levels, a whole food plant-based dietary pattern addresses the underlying causes of type 2 diabetes—and can reverse insulin resistance—while also supporting cardiovascular health and long-term well-being.

Physical activity

Physical activity is one of the most effective ways to prevent and manage type 2 diabetes, and its benefits start almost immediately. When you move your muscles, they immediately take in glucose directly from the bloodstream—even without insulin.[10,11,12 Using the ‘lock and key’ analogy above, exercise is so powerful that it’s like kicking open the back door; no key necessary! Even short bouts of movement matter. A 10-minute walk after meals is able to significantly reduce the rise in blood glucose that usually follows eating, with effects lasting for hours.[12]

Over time, regular activity improves insulin sensitivity, reduces fat stored in the liver and muscles, and increases overall metabolic health.[12] People who are more active have a substantially lower risk of developing type 2 diabetes—up to 40% lower than inactive individuals. Even moderate activity, for example brisk walking for an hour a day, can reduce diabetes risk by about 34%.[14,15,16]

You don’t need to be perfect to benefit—small increases in activity, combined with other healthy habits, can meaningfully improve blood glucose control and reduce long-term risk.

Restorative sleep

Good-quality sleep is a fundamental part of type 2 diabetes prevention and management. Research shows that both the amount and quality of sleep affect insulin sensitivity and glucose metabolism, key factors in diabetes risk. Poor sleep additionally disrupts appetite hormones, increasing hunger and preference for high-calorie foods, which can also raise diabetes risk.[17]

Sleeping less than 7 hours per night or experiencing disrupted sleep is linked to higher insulin resistance and impaired glucose tolerance.[17,18] These effects can happen quickly—even a single night of poor sleep reduces the body’s ability to manage blood glucose, and chronic sleep loss over weeks can increase insulin resistance by 15–20%.[19]

Supporting healthy sleep habits—such as a regular sleep routine and limiting evening screen use—can improve insulin sensitivity and help reduce the long-term risk of type 2 diabetes.[20]

Stress management

Chronic stress is a key contributor to the development and progression of type 2 diabetes. Stress triggers the release of cortisol, signalling the liver to release more glucose into the bloodstream. This ‘fight or flight’ response provides energy in case the body needs to run or fight—but for people with prediabetes or type 2 diabetes, it can cause harmful prolonged high blood glucose levels. Over time, this hormonal imbalance may impair the body’s ability to regulate glucose and strain insulin-producing cells.[21]

Stress also drives behaviours that worsen metabolic health, including overeating, reduced physical activity, poor sleep, and alcohol use, creating a cycle that amplifies both emotional distress and blood glucose levels.[22,23]

Reducing stress through exercise, relaxation techniques, better sleep, and healthy eating can break this cycle and improve blood glucose control.

Avoidance of risky substances

Smoking and vaping
Smoking doesn’t just harm your lungs and heart; it also makes it harder for your body to manage blood glucose, increasing inflammation and driving insulin resistance, increasing your risk of type 2 diabetes by up to 50% compared to those who have never smoked. The good news? Quitting gradually reduces your risk, showing that it’s never too late to benefit from stopping.[24,25]

New research points to potential metabolic risks linked to vaping (e-cigarette use). Although evidence is still developing, several international studies have found that people who vape currently have higher odds of prediabetes—even if they’ve never smoked traditional cigarettes. Vaping has been associated with higher insulin resistance in some groups, particularly those who also smoke. Large population studies from Korea found that both smokers and vapers had a higher risk of diabetes, with dual users (those who smoke and vape) showing the highest risk.[26,27]

Alcohol
Alcohol can interfere with the maintenance of safe blood glucose levels. It stops the liver from releasing stored glucose, which can cause low blood glucose— resulting in confusion, slurred speech, drowsiness, or unsteadiness—especially if you take insulin or certain diabetes medications.[28,29] Alcohol is high in calories which can make weight management harder and worsen insulin resistance.[30,31]

It can also reduce judgement, memory, and motivation, making day-to-day diabetes management harder—missed glucose checks, skipped insulin or tablets, or changes to usual meals are common. Heavier drinking is linked to poorer long-term blood glucose control (HbA1c) and inconsistent self-care.

If you want to cut down or quit smoking, vaping, or alcohol, talk with your doctor—they can help you find the right plan for you.

Positive social connections

Social relationships play a powerful role in health and well-being. Strong social connections are associated with improved health outcomes, while social isolation is linked to increased mortality risk.[32] In the context of type 2 diabetes, supportive relationships can improve motivation and help sustain lifestyle changes over time.

Community-based programmes in Aotearoa New Zealand can be especially effective in supporting people with or at risk of type 2 diabetes. For example, Green Prescription (GRx) programmes provide support to help people become more physically active, often through local group activities that build routine and social connection.

Group-based programmes such as diabetes education workshops also create opportunities for peer support, which can improve motivation, accountability, and long-term behaviour change.

Take your next step

Ready to take the next step to prevent, manage or reverse type 2 diabetes, either for yourself or your patients?

Sign up for our Overcoming Diabetes in Clinical Practice course (and refer your patients to the companion course) to get structured guidance, support, and tools you need.