People with diabetes and those at high risk of type 2 diabetes are recommended to exercise for at least 150 minutes a week by heart experts, and the Mediterranean diet is also highlighted as being beneficial.

The European Society of Cardiology (ESC) issued its new guidelines covering diabetes, pre-diabetes and cardiovascular diseases, in collaboration with the European Association for the Study of Diabetes (EASD).

The guidelines recommend people with diabetes to take part in 150 minutes or more of moderate-to-vigorous exercise a per week to benefit their condition. People at high risk of type 2 diabetes can help to reduce their chances of developing type 2 by achieving this level of activity.

The ESC said exercise has been shown to improve blood glucose levels and reduce the risk of cardiovascular complications.

The guidelines followed reviews of dietary interventions and encourage people to “adopt a Mediterranean diet supplemented with olive oil and, or, nuts to lower the risk of cardiovascular events”.

The Mediterranean diet is a flexible way of eating that can support different macronutrient intakes (different amounts of carbohydrate, protein and fat, depending on people’s individual needs) and is based around having natural, whole food in place of highly processed foods.

The guidelines briefly discussed low carb dietary interventions, pointing to a meta-analysis (an analysis of multiple studies) that showed that low and high carbohydrate dietary approaches led to similar weight loss after one-year. The guidelines did not review the differences in blood glucose levels between low and high carbohydrate diets.

The guidance states that lifestyle changes that reduce calorie intake are recommended to help reduce body weight. People with and at risk of diabetes also benefit from quitting smoking and avoiding alcohol, according to the guidelines.

People with diabetes achieve better control with self-monitoring of blood glucose. The guidelines state that both structured self-monitoring of blood glucose and continuous glucose monitoring are “valuable tools” to improve blood glucose control.

Chairperson of the guidelines, Professor Francesco Cosentino, who is also a Professor of cardiology based at Sweden’s Karolinska Institute and Karolinska University Hospital, said: “This indicates that it is no longer appropriate to depend on occasional glucose measures to manage control, particularly in type 1 diabetes. At the same time, flash technology has been developed which uses a small sensor worn on the skin to continuously monitor glucose levels. Similar arguments pertain to home blood pressure monitoring.”

The guidelines also have some advice on statins, suggesting women who have diabetes and are of childbearing age should not take the drug. Caution is advised when considering statins for young people.

Prof Cosentino added: “The emphasis of these guidelines is to provide state of the art information on how to prevent and manage the effects of diabetes on the heart and vasculature, with a focus on new data that has emerged since the 2013 document.”

The guidelines were published on Saturday online by the European Heart Journal.

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