A UVA Heart & Vascular Center Initiative

A New Way to Manage Type 2 Diabetes

Posted April 11, 2017

Lose weight and hit the gym! If you’re one of the 29 million Americans with Type 2 diabetes, this is likely the first thing you heard from your doctor upon diagnosis.

Unfortunately, for many of us, dropping pounds and keeping them off isn’t an easy feat. So we rely on pills to manage the condition, which can be costly, inconvenient and may cause unwelcome side effects. For University of Virginia behavioral scientist and medical researcher Daniel Cox, PhD, those options were a last resort.

“From my own personal experience, I knew that losing at least 7 percent of my body weight and keeping it off just wasn’t going to happen, but I didn’t want to have to take medication to keep my glucose under control,” he says. “So I decided to come up with an alternative.”

Together with UVA endocrinologist Anthony McCall, MD, PhD, Cox developed the GEM approach based on personal, clinical and research experience. GEM is a three-pronged disease management strategy that focuses on: Glycemic load, Exercise and Monitoring blood glucose.

“The primary contributor to poor diabetes control, measured by a person’s A1c, is glucose elevation after eating, and if we can diminish this, we can significantly lower patients’ A1c,” says Cox. The most effective ways to lower after-meal glucose, according to Cox, include:

  1. Smart food selection — not calorie cutting; specifically, identifying and replacing high glycemic-load foods (beverages and processed foods high in sugar, carbohydrates and dried fruits) with low glycemic load foods (fresh fruits, vegetables and legumes, unsweetened dairy products, fish and meat)
  2. Reducing sedentary behaviors and increasing moderate, routine physical activity (not necessarily going to the gym)
  3. Monitoring glucose systematically, before and after meals and physical activity; this allows you to immediately see the effect that food choices and routine activity choices have on your glucose levels. It also empowers you, letting you know how to control your glucose.

Monitoring how you eat and assessing how physical activity impacts your glucose levels can be very helpful, with or without medication, adds McCall. “Focusing on your mealtime blood sugars can lead to a substantial decrease in the risk of diabetes complications that are linked to high sugars,” he says.

The results of a feasibility study in 2015 of the researchers’ GEM approach showed significant improvements for those enrolled in the study compared to patients receiving routine care. As a result, Cox and McCall are teaming up with UVA Family Medicine physician John Gazewood, MD, to further investigate their approach with the following study currently enrolling at UVA:

Type 2 Diabetes Study: Continuous Glucose Monitoring

This five-month study will examine the benefits of continuous glucose monitoring and behavioral treatment in the management of Type 2 diabetes. All participants will continue routine care with their primary physician; two-thirds will also use a lifestyle program focusing on continuous glucose monitoring, food choices and changing physical activities. To learn more about the study and find out if you are eligible to participate, visit https://med.virginia.edu/psychiatry/t2dm/, email t2dm@virginia.edu or call 434.243.6520

“So often doctors turn to medication first because they sense that a patient is not going to lose weight and they don’t have the time to closely monitor them — they just can’t stay on top of it,” says Cox. “With this study we hope to show that there is another effective alternative to weight loss.”







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