Accepted for/Published in: JMIR Diabetes
Date Submitted: Oct 24, 2021
Date Accepted: Jan 13, 2022
Date Submitted to PubMed: Jan 20, 2022
An Innovative Lifestyle Intervention to Reduce Glucose Excursions with the Use of Continuous Glucose Monitoring to Educate, Motivate, and Activate Adults with Newly Diagnosed Type 2 Diabetes: A Paradigm shift
ABSTRACT
Background:
Type 2 diabetes (T2D) is a growing epidemic in the United States, and new treatments are needed. Glycemic Excursion Minimization (GEM) is an alternative lifestyle treatment option focused on reducing post-nutrient blood glucose (BG) excursions. GEM has been proven to be superior to routine care when delivered face-to-face, and equivalent or superior to conventional weight loss therapy, but it has not been evaluated among patients newly diagnosed with T2D or in a self-administered format.
Objective:
This study aimed to evaluate whether a self-administered version of GEM, augmented with continuous glucose monitoring (CGM), would improve metabolic control while diminishing or delaying the need for diabetes medications in adults recently diagnosed with T2D.
Methods:
GEM was self-administered by 17 adults recently diagnosed with T2D, with the aid of a 4-chapter pocket guide and diary, automated motivational text messaging, and feedback from an activity monitor, and CGM and supplies for the 6-week intervention and the 3-month follow-up. The protocol was supplemented with one telephone call reviewing the use of the technology and one call reviewing the use of the GEM pocket guide and intervention in general.
Results:
At follow-up, 67% of the participants’ diabetes was in remission (HbA1c < 6.5%) and only one participant subsequently initiated diabetes medication. Participants demonstrated a significant reduction of HbA1c (from 8.0% to 6.2%, P < .001). Participants also experienced significant reductions in high glycemic load carbohydrates routinely consumed, CGM readings >140mg/dl, body mass index, diabetes distress, and depressive symptoms. Participants felt that use of the CGM was the most significant single element of the intervention.
Conclusions:
GEM augmented with CGM feedback may be an effective initial intervention for adults newly diagnosed with T2D. A self-administered version of GEM may provide primary care physicians and clinicians with a new tool to help people recently diagnosed with T2D achieve remission independent of medication and without weight loss as the primary focus. Future research is needed with a larger and more diverse sample.
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