Lifestyle Medicine and Type 2 Diabetes in Viet Nam: Prevention, Treatment and the Evidence on Remission

Lifestyle Medicine and Type 2 Diabetes in Viet Nam: Prevention, Treatment and the Evidence on Remission

Last reviewed: September 2026

Type 2 diabetes is often described as a chronic disease requiring long-term management. That remains true for many people, but research over the past several decades has also changed what we understand to be possible.

Lifestyle interventions can substantially reduce the risk of developing type 2 diabetes among people at high risk, improve glucose control and other cardiometabolic risk factors after diabetes has developed, and, in some people, contribute to type 2 diabetes remission. In 2025, the American College of Lifestyle Medicine published a comprehensive clinical practice guideline specifically addressing lifestyle interventions for adults with type 2 diabetes, prediabetes and a history of gestational diabetes. The American Diabetes Association's 2026 Standards of Care likewise continue to place healthy behaviors, diabetes self-management support and social determinants of health within comprehensive diabetes management.

None of this means that type 2 diabetes can simply be “reversed” through willpower, that medication is unnecessary or that remission should be the goal for every person. It means something more clinically useful: lifestyle intervention deserves to be treated as a serious component of evidence-based diabetes care rather than as generic advice added at the end of a consultation.

For Viet Nam, where diabetes and other noncommunicable diseases represent a growing long-term health challenge, that distinction matters.

Why type 2 diabetes matters for Viet Nam

Estimates of diabetes burden in Viet Nam vary according to age range, diagnostic definition and methodology. The International Diabetes Federation's 2025 Diabetes Atlas estimated that approximately 2.5 million adults aged 20 to 79 years were living with diabetes in Viet Nam in 2024, with an estimated 37.8% undiagnosed.

Viet Nam's 2021 national STEPS survey provides a different but complementary picture. Among adults aged 18 to 69 years, 7.1% had raised fasting blood glucose or were currently taking glucose-lowering medication, compared with 4.1% in 2015. These two estimates should not be treated as directly interchangeable because they use different populations and methods, but both point to a substantial metabolic disease burden.

More than 95% of people with diabetes globally have type 2 diabetes, according to the World Health Organization's September 2026 update. Type 2 diabetes develops through a complex interaction among insulin resistance, progressive loss of adequate insulin secretion, genetics, ageing and environmental and behavioral influences.

Body size alone is also an inadequate way to identify who may be at risk. The American Diabetes Association's 2026 Standards use a lower body mass index threshold for risk-based screening among people of Asian ancestry. Testing should be considered at any age in adults with overweight or obesity and at least one additional risk factor, using a body mass index threshold of 23 kg/m² for people of Asian ancestry rather than 25 kg/m². For people who do not otherwise meet risk-based criteria, screening begins at age 35.

The practical lesson for Viet Nam is simple: diabetes risk should not be judged only by whether a person appears visibly overweight.

Prevention is one of the strongest areas of evidence

Among people at high risk, type 2 diabetes can often be delayed and in many cases prevented.

One of the landmark studies was the United States Diabetes Prevention Program. Its intensive lifestyle intervention reduced the incidence of type 2 diabetes by 58% over approximately three years among adults at high risk. Follow-up has shown that the benefit persisted over time, with diabetes incidence still reduced by 24% after 21 years compared with the original placebo group.

The intervention was much more than advice to “eat better and exercise.” It used a structured curriculum involving nutrition, physical activity, self-monitoring, problem solving and ongoing behavioral support. The original goals included approximately 7% weight loss and at least 150 minutes of moderate-intensity physical activity each week.

The 2026 American Diabetes Association Standards now recommend that adults with overweight or obesity who are at high risk of type 2 diabetes be referred to a diabetes prevention program targeting at least 5–7% reduction in initial body weight through a healthy reduced-calorie eating pattern and at least 150 minutes per week of moderate-intensity physical activity. Evidence-based eating patterns and appropriately designed technology-assisted programs may also support prevention.

Not everyone with prediabetes will progress to diabetes, and not everyone needs the same intervention. The important point is that prevention can be structured, measurable and evidence-based rather than limited to a warning that someone should “watch their sugar.”

Once type 2 diabetes develops, lifestyle remains part of treatment

Lifestyle intervention remains relevant after diabetes has been diagnosed.

The 2025 American College of Lifestyle Medicine guideline recommends assessing baseline lifestyle habits, establishing priorities through shared decision-making, supporting appropriate nutrition and physical activity, reducing prolonged sedentary behavior, identifying sleep-related problems, addressing risky substances and incorporating stress management, positive social connection and behavior-change support into care.

This is also consistent with Vietnamese clinical guidance. The Ministry of Health's Decision No. 5481/QĐ-BYT, as amended by Decision No. 1353/QĐ-BYT, provides national guidance for diagnosis and treatment of type 2 diabetes. It includes assessment of eating patterns, physical activity, work, health literacy, psychological needs, financial difficulties and social support, and it identifies lifestyle intervention as part of treatment.

The Vietnamese guidance also makes an important practical point: nutrition should be individualized according to health status, treatment, eating habits and local customs, while physical activity should be selected so that it can be maintained over time.

Nutrition, physical activity and behavior change are therefore not merely “wellness” activities for a person living with diabetes. They can directly influence glucose control, cardiovascular risk factors, body composition, functional capacity and treatment requirements.

That still does not mean “lifestyle instead of medicine.”

Lifestyle Medicine and medication are not opposing approaches

An unhelpful debate sometimes frames diabetes care as a choice between Lifestyle Medicine and medication. Modern evidence-based diabetes care does not support that opposition.

The American College of Lifestyle Medicine guideline advocates lifestyle interventions as foundational in the management of prediabetes and type 2 diabetes. At the same time, the American Diabetes Association's 2026 Standards state that pharmacotherapy should generally begin when type 2 diabetes is diagnosed, unless contraindications or other clinical circumstances justify a different approach. Medication selection should be person-centered and consider glucose goals, cardiovascular and kidney disease, weight, hypoglycemia risk, adverse effects, treatment burden and patient preferences.

These recommendations can coexist.

A person with recently diagnosed diabetes, mild hyperglycemia and no major complications has different needs from someone presenting with severe hyperglycemia, chronic kidney disease, heart failure or established atherosclerotic cardiovascular disease. Several modern diabetes medications provide cardiovascular, kidney or weight-related benefits beyond glucose lowering. Delaying an indicated treatment simply to “try lifestyle first” may therefore be inappropriate in some patients.

The clinically useful question is not, “Lifestyle Medicine or medication?” It is, “How should lifestyle interventions, medications and other evidence-based treatments be combined for this particular person?”

Nutrition matters, but there is no single diabetes diet

Nutrition is one of the most important components of diabetes management, but it is also an area in which oversimplification is common.

There is no single universal eating pattern that every person with type 2 diabetes must follow. Contemporary diabetes guidance emphasizes individualized medical nutrition therapy that considers metabolic goals, usual eating patterns, preferences, culture, resources and treatment needs. For diabetes prevention, the 2026 American Diabetes Association Standards cite evidence for patterns including Mediterranean-style and lower-carbohydrate approaches, while continuing to emphasize overall food quality and sustainable energy balance.

The American College of Lifestyle Medicine guideline places particular emphasis on a whole-food, plant-predominant eating pattern, while also calling for plans to be appropriate to the individual's culture, nutrient needs, energy requirements and desired clinical outcomes.

The practical message is more important than forcing every patient into a dietary label. Eating patterns that improve overall food quality, emphasize minimally processed foods, support appropriate energy intake and produce sustainable metabolic improvement can be useful.

For people in Viet Nam, this usually means working with foods that are actually eaten at home, at work and in the community. Treatment should not require people to abandon Vietnamese food culture or adopt a foreign “diabetes diet.” Depending on the person, clinically relevant changes may involve the amount and type of staple foods, vegetables, legumes, protein sources, cooking methods, beverages, snacks and highly processed foods.

Vietnamese Ministry of Health guidance itself states that nutrition should be simple, not unnecessarily expensive and appropriate to local customs, while being individualized to the patient's health status and treatment.

A diet that looks ideal on paper but cannot be maintained in the patient's real cultural and economic environment is unlikely to become effective long-term treatment.

Physical activity does much more than burn calories

Exercise is often described mainly as a method of losing weight, but its value in diabetes care is broader.

Regular physical activity can improve insulin sensitivity, glucose metabolism, cardiovascular health, functional capacity and weight management. Both contemporary international guidance and Vietnamese clinical guidance support aerobic activity, resistance or muscle-strengthening activity, and reducing prolonged sedentary time.

Vietnamese guidance recommends forms of activity that patients can maintain over time and identifies walking as a practical, low-cost option. It includes a general target of 150 minutes of physical activity per week and recommends resistance exercise two to three times weekly where appropriate. It also emphasizes breaking up prolonged sitting.

An exercise plan still has to be individualized. Cardiovascular disease, neuropathy, foot problems, proliferative retinopathy, frailty, musculoskeletal conditions and hypoglycemia risk may change what is safe. People using insulin or medicines that stimulate insulin secretion may require particular attention to glucose around exercise.

For this reason, “exercise more” is not a sufficient clinical prescription. The relevant questions are what kind of activity is appropriate, how much is safe, what the patient can realistically sustain and how progress will be monitored.

Sleep, stress and social connection also belong in diabetes care

Glucose management does not happen independently of the rest of a person's life.

The 2025 Lifestyle Medicine guideline extends diabetes care beyond nutrition and physical activity to include restorative sleep, stress management, positive social connection, avoidance of risky substances and sustained behavior change.

That does not mean that every elevated glucose result should be attributed to stress or poor sleep. It means that clinically relevant sleep disturbance, psychological distress and social circumstances should not be ignored simply because they do not appear on a laboratory report.

Obstructive sleep apnea, chronic sleep deprivation, depression, anxiety, difficult working conditions, caregiving burden and social isolation can all complicate diabetes self-management. Identifying these factors may substantially change what a realistic treatment plan looks like.

Lifestyle Medicine is strongest when behavior change is treated as a clinical process, not as a test of whether a patient has enough discipline.

Weight loss can be important, but diabetes care should not become weight-centered care

For people with type 2 diabetes who also have overweight or obesity, intentional weight loss can substantially improve glucose control. Greater sustained weight loss is also one of the strongest predictors of remission.

Weight, however, is not the whole disease.

People can develop type 2 diabetes without conventional obesity, and international screening recommendations recognize increased diabetes risk at lower body mass index thresholds among people of Asian ancestry.

Even where weight loss is appropriate, important treatment outcomes also include glucose control, blood pressure, lipids, cardiovascular and kidney risk, physical function, nutrition quality, psychological wellbeing, smoking status and quality of life.

A patient who does not lose a large amount of weight may still achieve substantial health benefits through improved eating patterns, increased physical activity, smoking cessation, adequate sleep and appropriate medication.

Successful diabetes care should therefore not be reduced to a number on a scale.

What does type 2 diabetes remission actually mean?

The word remission needs to be used carefully.

An international expert group convened by the American Diabetes Association, with participation from the European Association for the Study of Diabetes, Diabetes UK, the Endocrine Society and the Diabetes Surgery Summit, proposed a standardized definition in 2021.

Under usual circumstances, type 2 diabetes remission is defined as a glycated hemoglobin level below 6.5% that persists for at least three months in the absence of usual glucose-lowering pharmacotherapy. Where glycated hemoglobin is not a reliable measure of chronic glucose control, specified glucose-based alternatives can be considered.

For remission achieved through lifestyle intervention, timing also matters. The consensus notes that the effect of a lifestyle intervention may take longer to stabilize, so assessment should allow sufficient time after the intervention begins and at least three months after withdrawal of glucose-lowering medication.

Remission is deliberately not the same as cure.

Glucose may later return to the diabetes range. The underlying susceptibility to diabetes may remain, and ageing, weight regain, illness, declining pancreatic beta-cell function or other factors can lead to recurrence.

People in remission therefore still require follow-up. The consensus recommends at least annual assessment to determine whether remission persists, together with the routine monitoring recommended for potential diabetes complications.

This distinction is important in public communication. Saying that some people with type 2 diabetes can achieve remission is supported by evidence. Promising a permanent “natural cure” is not.

What does the evidence on remission actually show?

Remission is not theoretical. Clinical trials have demonstrated that it can occur, particularly when substantial and sustained weight loss is achieved relatively early after diagnosis.

The Diabetes Remission Clinical Trial, better known as DiRECT, is one of the best-known examples. Its structured weight-management program achieved remission in approximately 46% of participants in the intervention group at one year and 36% at two years.

Longer-term results illustrate why remission should not be described as an easy or permanent outcome. After the original two-year trial, eligible intervention participants were offered lower-intensity support for another three years. Among the 85 extension participants with five-year data, 11, or 13%, were in remission at year five. Because participation and denominators changed over time, this 13% should not be interpreted as directly equivalent to the original one-year and two-year percentages.

The extension study also found that only 26% of those who had been in remission at year two remained in remission at year five. Sustaining weight loss over time was a major challenge.

These findings should not be converted into a promise that a certain percentage of all people with type 2 diabetes will achieve remission. DiRECT enrolled a selected population, used a structured intervention and provided ongoing professional support.

The broader lesson is more useful: greater and more sustained weight loss is associated with a higher probability of remission, and remission tends to be more achievable earlier in the disease course.

Remission should be an opportunity, not a guarantee

For some adults, particularly those with relatively recent type 2 diabetes who can safely undertake an intensive intervention, remission may be a reasonable treatment objective.

For others, it may be unlikely, inappropriate or simply not what matters most to them.

Duration of diabetes, residual pancreatic beta-cell function, comorbidities, frailty, ability to sustain substantial weight loss and other clinical factors can all influence the probability and desirability of remission. Continuing to require medication should never be presented as personal failure.

The Lifestyle Medicine guideline therefore recommends discussing whether the patient wishes to pursue clinical improvement or remission and aligning the intensity of lifestyle intervention with the person's goals and clinical circumstances.

A person who substantially improves glucose control, cardiovascular risk, physical function and quality of life has achieved meaningful clinical benefit even if the formal remission threshold is never reached.

Remission is one possible outcome. It is not the only definition of successful diabetes treatment.

Medication safety becomes especially important when lifestyle interventions work

Substantial lifestyle change can sometimes improve glucose rapidly. For a person receiving insulin, sulfonylureas or another therapy associated with hypoglycemia, that improvement can create a safety issue if medication is not reassessed.

Major changes in energy intake, carbohydrate intake, weight and physical activity may alter medication requirements. Both Lifestyle Medicine guidance and conventional diabetes care therefore require clinical monitoring as treatment changes.

This should never be interpreted as permission for patients to discontinue medication themselves.

Medication adjustment and deprescribing are clinical decisions. In Viet Nam, medical examination and treatment remain regulated under the Law on Medical Examination and Treatment, currently consolidated in Document No. 26/VBHN-VPQH dated February 26, 2026.

The practical implication is almost the opposite of what some “natural treatment” messaging suggests: when an intensive lifestyle intervention is working and medication needs may be changing, closer professional monitoring may become more important, not less.

Remission does not remove cardiovascular, kidney or complication risk overnight

Diabetes care is about much more than blood glucose.

Blood pressure, lipid levels, kidney function, cardiovascular disease, smoking, retinal health, foot health and other complications still require attention. Even when glucose improves dramatically, previous exposure to diabetes and existing cardiovascular or kidney disease do not simply disappear.

The international remission consensus therefore recommends continued monitoring for diabetes complications even when remission has been achieved.

This is especially important in the era of diabetes medications that provide cardiovascular or kidney protection. A patient with excellent glucose control may still have a clinical indication for particular pharmacologic therapy because of chronic kidney disease, heart failure or cardiovascular risk.

The goal of Lifestyle Medicine should be better comprehensive care, not simply getting every patient “off medication.”

Prevention and treatment need to fit the patient's real environment

Lifestyle intervention is sometimes discussed as if everyone has equal access to healthy food, time for exercise, adequate sleep, safe places for activity and healthcare. In reality, those opportunities vary considerably.

Work schedules, income, food affordability, health literacy, family responsibilities, geography, primary care capacity and social support can all influence whether a recommendation is feasible. This is why modern Lifestyle Medicine increasingly incorporates social determinants of health and emphasizes culturally relevant, patient-centered care.

For Viet Nam, an intervention designed for a highly resourced urban patient cannot simply be copied into every setting. Food environments, local healthcare capacity, household structures, transportation, digital access and availability of specialized professionals differ across communities.

The Vietnamese health system is also moving more noncommunicable disease care closer to communities. In September 2026, the World Health Organization reported continued expansion of community-based management of hypertension and diabetes. Its established hypertension-control model currently screens around 10 million people each year and provides treatment to more than 2 million, while this broader primary-care approach is being used to strengthen management of hypertension, diabetes and other noncommunicable diseases closer to where people live.

That distinction is important: the 10 million screening and two million treatment figures refer specifically to the hypertension-control model, not to the number of people screened or treated for diabetes.

Viet Nam's legal framework is also placing greater emphasis on prevention and community management

The legal environment has changed since July 2026.

The Law on Disease Prevention No. 114/2025/QH15, effective July 1, 2026, expressly covers the prevention and control of noncommunicable diseases. It identifies unhealthy behavior and lifestyle, metabolic abnormalities and environmental factors among risk factors for noncommunicable disease. It also provides for early detection, counseling, monitoring, preventive treatment for people at risk, and community management and complication prevention for people already living with noncommunicable diseases.

The law does not create a separate legal category of “Lifestyle Medicine,” nor does it change the professional licensing rules governing clinical diabetes care. It does, however, strengthen the national legal context for prevention, early identification of risk and community-based management of chronic disease.

Vietnamese clinical diabetes care remains governed by the applicable healthcare laws and professional guidance. The Ministry of Health's diabetes guideline under Decision No. 5481/QĐ-BYT of December 30, 2020, as amended by Decision No. 1353/QĐ-BYT of February 23, 2021, remains an important national clinical reference. A Ministry of Health nutrition-prevention guideline issued in 2026 continues to refer to Decision 5481 for diabetes-specific nutrition guidance.

What should good Lifestyle Medicine for type 2 diabetes look like?

It should begin with accurate diagnosis and comprehensive assessment, not simply with a diet plan.

The clinical team needs to understand glucose control, medication use, cardiovascular and kidney risk, complications, nutrition, physical activity, sleep, tobacco and alcohol exposure, psychological health, social circumstances and the patient's priorities. Lifestyle interventions can then be incorporated into a broader treatment plan, with involvement from nurses, clinical nutrition professionals, clinical psychologists and other appropriately qualified healthcare professionals when their expertise is needed.

Progress should be measured. Depending on the individual, relevant outcomes may include glycated hemoglobin, glucose patterns, blood pressure, lipid levels, body weight or waist measures, medication requirements, physical capacity, sleep, nutrition-related behaviors, smoking status, quality of life and patient-reported goals.

Follow-up matters because type 2 diabetes is not managed through a one-time intervention. A plan that works for three months may not remain practical three years later. Weight regain, relapse in health behaviors or difficulty maintaining treatment should prompt reassessment and support rather than blame.

This is where Lifestyle Medicine can add meaningful structure to diabetes care. It is not a competing medical system. It is a way of ensuring that lifestyle, behavior and the patient's everyday environment receive the clinical attention they deserve.

What does this mean for Viet Nam?

Viet Nam does not need to choose between modern diabetes medicine and Lifestyle Medicine. A stronger approach is to integrate both.

Contemporary pharmacotherapy has transformed diabetes management, particularly for people with significant hyperglycemia, obesity, chronic kidney disease, heart failure or cardiovascular disease. At the same time, medication cannot provide physical activity, restorative sleep, nutritious food, tobacco cessation, supportive social relationships or sustainable behavior change.

Vietnamese Ministry of Health guidance already recognizes lifestyle intervention as part of diabetes treatment. International evidence now provides an even stronger framework for structured diabetes prevention, intensive lifestyle treatment and, for selected patients, remission.

The opportunity is therefore not to import an alternative model that sits outside mainstream medicine. It is to strengthen existing diabetes care by integrating systematic lifestyle assessment, clinical nutrition, appropriate physical activity, behavior-change support, multidisciplinary care and ongoing outcome measurement into prevention, primary care and long-term disease management.

For one person, success may mean preventing diabetes altogether. For another, it may mean lower glycated hemoglobin, better cardiovascular risk, improved physical function or reduced treatment burden. For a selected group, remission may be possible.

All of these can be meaningful clinical outcomes.

Remission changes what is possible, but not the principles of good care

Perhaps the most important change in our understanding of type 2 diabetes is that disease progression is not always inevitable. Some people can prevent or substantially delay type 2 diabetes. Some people with established disease can achieve major metabolic improvement, and some can reach remission.

That evidence should raise the quality of care, not the level of unrealistic promises.

Type 2 diabetes remains a serious chronic disease. Remission is not a cure. Medication remains important for many patients. Screening and monitoring for complications remain necessary. Lifestyle interventions need to be individualized, culturally relevant and delivered safely. People who do not achieve remission have not failed.

The strongest message from the current evidence is therefore not that Lifestyle Medicine replaces diabetes treatment.

It is that lifestyle intervention is itself an important part of evidence-based diabetes treatment and, in some people, when delivered with sufficient intensity, clinical monitoring and sustained support, it can alter the course of type 2 diabetes more profoundly than was once thought possible.

For Viet Nam, bringing that understanding into prevention, primary healthcare and long-term diabetes management could contribute to a more proactive and patient-centered response to one of the country's major chronic disease challenges.

References

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2. American Diabetes Association Professional Practice Committee for Diabetes. Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).

3. American Diabetes Association Professional Practice Committee for Diabetes. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S50–S60. doi:10.2337/dc26-S003.

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5. Riddle MC, Cefalu WT, Evans PH, et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care. 2021;44(10):2438–2444.

6. Lean MEJ, Leslie WS, Barnes AC, et al. 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK: an extension study. Lancet Diabetes & Endocrinology. 2024.

7. International Diabetes Federation. IDF Diabetes Atlas, 11th Edition. 2025. Country data: Viet Nam.

8. Ministry of Health of Viet Nam and World Health Organization. National Survey on the Risk Factors of Noncommunicable Diseases in Viet Nam, 2021.

9. World Health Organization. Diabetes: Questions and Answers. September 1, 2026.

10. World Health Organization Viet Nam. Strengthened grassroots health care brings NCD services to 10 million in Viet Nam. September 8, 2026.

11. Ministry of Health of Viet Nam. Decision No. 5481/QĐ-BYT on the Professional Guideline for Diagnosis and Treatment of Type 2 Diabetes, December 30, 2020, as amended by Decision No. 1353/QĐ-BYT, February 23, 2021.

12. National Assembly of Viet Nam. Law on Disease Prevention No. 114/2025/QH15, dated December 10, 2025, effective July 1, 2026.

13. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, Law on Medical Examination and Treatment, dated February 26, 2026.

This article is intended for professional education and general information. It does not provide individualized medical advice and should not be used to start, stop or change diabetes medication. Diagnosis, treatment, medication adjustment and assessment of diabetes remission should be undertaken by appropriately qualified healthcare professionals based on the individual's clinical circumstances and applicable Vietnamese law.

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