 For people with pre-diabetes, lifestyle modification now considered the cornerstone of diabetes prevention. Diet-wise, that means individuals with pre-diabetes, or diabetes-diabetes, should aim to reduce their intake of excess calorie-saturated fat and trans fat. Too many of us consume a diet with too many of these solid fats, as well as added sugars. Thankfully, the latest dietary guidelines aim to shift consumption towards more plant-based foods. Lifestyle modification is now the foundation of the American Association of Clinical Endocrinology Guidelines, the European Diabetes Association Guidelines, as well as the official standards of care for the American Diabetes Association. Dietary strategies include reduced intake of fat and increased intake of fiber, meaning unrefined plant foods, including whole grains. That's based on research like this. We've known eating lots of whole grains associated with a reduced risk of developing type 2 diabetes. This recent study took it further, demonstrating that whole grain consumption may also protect against pre-diabetes in the first place. To help prevent diabetics from dying, recommendations should focus on the reduction of saturated fat, cholesterol, and trans fat intake, which is basically code for meat and dairy, eggs, and junk food. And increases in omega-3 soluble fiber and aphidosterols, all of which are found packaged in flax seeds, for example, and efficient but still uncommon intervention for pre-diabetes. They found that about two tablespoons of ground flax a day decrease insulin resistance, which is a hallmark of the disease. So if the standards of care for all the major diabetes groups says that lifestyles are preferred treatment for pre-diabetes because it's so safe and highly effective, why don't more doctors do it? Unfortunately, the opportunity to treat this disease naturally is often unrecognized. Only about one in three patients report ever being told about diet or exercise. Possible reasons for not counseling patients include lack of reimbursement, lack of resources, lack of time, lack of skill. We're just not teaching doctors how. The inadequacy of clinical education is a consequence of the failure of healthcare and medical education to adapt to the great transformation of disease from acute to chronic, from broken legs to broken hearts. Chronic disease is now the principal cause of disability, consuming three quarters of our sickness care system. Why has there been little academic response to this rising prevalence of chronic disease? Maybe it's because doctors aren't getting paid to do it. Attempting to change to a rational chronic care model is practically unthinkable in the absence of radically changed compensation. Why haven't reimbursement policies been modified? One crucial reason may be a failure of leadership in medical profession and medical education to recognize and respond to this changing nature of disease patterns. How far behind the times is the medical profession? A report by the Institute of Medicine on Medical Training concluded that the fundamental approach to medical education has not changed since 1910.