The Use of Continuous Glucose Monitoring Integrated with an Innovative Lifestyle Intervention to Educate, Motivate, and Activate Adults with Newly Diagnosed Type 2 Diabetes: Pilot Study (Preprint)

Abstract

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.

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.

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.

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.

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.