At a Glance
- New approach shifts focus from restricting calories and reducing weight to lowering postprandial glucose.
- Past feasibility study showed significant improvements in A1c levels for those enrolled in the study compared to patients receiving routine care.
- New study will examine the benefits of continuous glucose monitoring and behavioral treatment in the management of Type 2 diabetes.
Because obesity is a major risk factor for Type 2 diabetes, recommending that patients diagnosed with the disease lose weight and hit the gym is standard practice. However, as you’re likely well aware, these suggestions often fall on deaf ears; patients just aren’t willing or able to significantly alter their lifestyles.
This is why researchers at University of Virginia Health System — behavioral scientist Daniel Cox, PhD, and endocrinologist Anthony McCall, MD, PhD — have been working on a paradigm shift in the management of Type 2 diabetes. Based on personal, clinical and research experience, they’ve introduced and are examining an innovative approach that shifts the focus from restricting calories and reducing weight to lowering postprandial glucose.
“The primary contributor to glycosylated hemoglobin is postprandial glucose elevation, and if we can diminish this, we can significantly lower patients’ A1c,” says Cox. The most effective ways to lower postprandial glucose, according to Cox, include:
- Smart food selection (not caloric restriction), specifically identifying and replacing high glycemic-load foods like starches with low glycemic load foods, such as fresh fruits, vegetables and legumes, dairy, fish and meat.
- Reducing sedentary behaviors and increasing moderate, routine physical activity (not necessarily going to the gym).
- Monitoring glucose systematically, before and after both meals and physical activity, which allows patients to see the effect that their food choices and routine activity have on their glucose levels and thus motivate them to continue their positive choices.
The results of a feasibility study in 2015 of the researchers’ GEM (Glycemic load, Exercise and Monitoring blood glucose) approach showed significant improvements in A1c levels for those enrolled in the study compared to patients receiving routine care. Cox and McCall have now teamed up to secure both an industry grant and a grant from the National Institutes of Health to further investigate their approach. “We know that diabetes complications are heavily influenced by hyperglycemia. Thus, it makes sense, we believe, to focus on lifestyle changes that can reduce the highest sugars that are often after meals,” says McCall.
The researchers will further investigate their approach with the following study currently enrolling at UVA:
Type 2 Diabetes Study: Continuous Glucose Monitoring (IRB #19313)
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 treating physician; two-thirds will also use a lifestyle program focusing on blood glucose monitoring, food choices and changing physical activities.
“The assumption is correct that glucose monitoring by itself has no value for Type 2 diabetes, but if used systematically, it’s extremely beneficial to a referring provider because he or she can see how the treatment is working. It’s beneficial for the patient because he can learn how his body responds to different foods and activities,” explains Cox. “It’s also motivating to patients to immediately see how they can improve their diabetes.” Learn more about the study and its inclusion criteria.
“So often doctors turn to medication first because they sense that a patient is not going to lose weight and they don’t have ability to closely monitor them — they just can’t stay on top of it,” says Cox. “With these studies we hope to show that there is another effective alternative.”
“Monitoring can be an empty exercise in documentation unless and until the monitoring is tied together with lifestyle that works to lower sugars—that is a main focus of this program.” adds McCall. “Moreover, medication may not be terribly effective in the absence of an understanding and implementation of sensible lifestyle changes.”