GEM approach to diabetes management secures $3.5M funds from NIH

04 Sep 2023 --- A new approach to managing Type 2 diabetes, the glycemic excursion minimization (GEM) approach, saw 70% of patients who participated in a trial go into remission. In addition, GEM secured a grant of US$3.5 million from the National Institutes of Health (NHI).

The grant will be used for a large-scale clinical trial testing the “radical” new approach, which healed patients in an earlier study without using weight loss strategies or medication.

“Instead of focusing on reducing weight with diets or medication, we focus on reducing how much blood glucose goes up and stays up after eating and drinking. These blood glucose elevations are what leads to high A1C and cardiovascular risks among adults with type 2 diabetes,” says Dr. Daniel Cox, professor of psychiatry and internal medicine at the UVA School of Medicine. 

Globally, diabetes is one of the leading causes of death and disability. Currently, half a billion people live with the disease, which is expected to more than double by 2050, reaching up to 1.3 billion people, according to a recent study in The Lancet. 

Simple as selective nutrition 
Cox developed the approach, “Glucose Everyday Matters,” or GEM, believing that educating people on better dietary and exercise choices will help them control their blood sugar and possibly alter the general prognosis.  

GEM is an alternative lifestyle treatment option focused on reducing post-nutrient glucose excursions rather than reducing weight. Essentially, it prevents blood sugar spikes by presenting “educated” food and drink selections in combination with physical activity. This speeds up the recovery when blood sugar spikes occur. 

For example, when people eat fruit or a sweet treat, they can compensate for that with an evening stroll to even out their blood sugar.The foundation of the new approach is glycemic excursion minimization, also known as GEM. 

A study from the German Diabetes Center in Düsseldorf revealed a strong association between adding these dietary items and increased life spans for diabetic patients. Whole grains, fiber, fish and n-3 polyunsaturated fatty acids (PUFAs) have the potential to reduce all premature death risk factors in adults with Type 2 diabetes, the researchers flag.

Meanwhile, researchers from the University of Southern Denmark found that a low carbohydrate diet could help diabetes patients achieve better weight loss and glucose control in the short term.

“It’s an exciting time, with new medications and lifestyle interventions to improve the control of diabetes, giving patients many new options. Lifestyle interventions have the advantage of being able to put diabetes in remission. GEM is a one-time, brief six-week intervention that impacts a lifelong lifestyle,” explains Cox.

Positive results were observed using the GEM approach in combination with glucose monitoring in a small trial of 17 adults recently diagnosed with Type 2. The participants were prompted to stay on track with text messages. After three months, 67% were in remission, and one patient needed to go on medication.

Building on an academic premise
The current study will build on prior research to determine at a larger scale if GEM is a safe, effective tool to manage Type 2 diabetes in recently diagnosed people.

The randomized clinical trial will enroll 200 people in Virginia and Colorado, US and assess, over five years, whether GEM helps them control their blood sugar better, reducing their need for medication. 

The trial will also compare the cost of GEM with other options and evaluate whether it has additional benefits, such as weight loss and decreased depression symptoms. The pilot study results have been published in the scientific journal JMIR Diabetes. 

The pilot analyzed whether a self-administered version of GEM augmented with continuous glucose monitoring improves metabolic control, prolonging the need for medication in adults who have been recently diagnosed. 

By Inga de Jong

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