New options for controlling type 2 diabetes

Nearly 40% of patients diagnosed with type 2 diabetes imperil their health by stopping their medication within the first year, UVA Health diabetes experts note in a new paper highlighting a growing array of treatment options.

The pragmatic new paper urges doctors to consider not just traditional diabetes medicines but emerging alternatives that patients may be more likely to stick with long-term. “Prescribing a medication or making lifestyle recommendations that a patient is not willing or able to follow for any reason is not likely to lead to improvements in diabetes outcomes,” the authors note in the paper. “The best treatment is one that is easy to implement and sustainable for the patient.”

It is critical, the paper argues, for doctors to work collaboratively with patients, rather than simply telling them what to do. By making patients partners in the decision-making process – and by listening carefully to their preferences and lifestyle needs – doctors will increase the chances the patients will stick with their treatment plan and, ultimately, better control their blood sugar. And that will translate into long-term benefits for their health, says UVA diabetes expert Daniel J. Cox, PhD, one of the paper’s authors and part of UVA’s Center for Diabetes Technology.

“Patients and significant others being personally engaged in whatever approach taken is critical,” said Cox, who has developed an innovative lifestyle-intervention program that is among the options described in the paper. “Nothing works if it is not followed consistently, while most approaches will have some benefits if followed consistently for the duration of diabetes – a lifetime.”

Options for Controlling Diabetes

In addition to traditional diabetes-management drugs such as Metformin, doctors should consider providing appropriate patients with a continuous glucose monitor, which is a sensor taped to the skin that displays change in blood sugar on a smart phone, Cox and his collaborators suggest. The authors note that manufacturers have started to offer lower cost, over-the-counter options available without prescription for patients who may face insurance barriers.

Drugs known as “GLP-1 receptor agonists” such as Ozempic have also taken off among patients with diabetes in recent years, most likely because of their weight-loss benefits, the authors write. Dropping pounds often helps better control blood sugar.

But medicines and weight loss are not the only path to better blood-sugar control, the researchers note. Cox has developed what he calls a “less demanding” lifestyle intervention called GEM (Glucose Everyday Matters) that aims to prevent blood-sugar spikes through informed eating choices and well-timed exercise. In one study, two-thirds of participants put their diabetes into remission using the approach. Cox himself has used GEM to put his diabetes in remission for the past 15 years.

The new paper includes a detailed list of foods people using the program can reduce or replace, such as sugary drinks and dried fruits, to better control their blood sugar. But the GEM program isn’t just about giving up sweets and high-carb foods. Instead, it emphasizes understanding the effects of different foods on an individual’s blood-sugar levels, making smart eating choices and getting extra physical activity to bring blood sugar down – to “sit less, step more,” Cox says.

“Not only does GEM help control one’s diabetes, but it is a lifestyle that promotes general health and vigor, while reducing risks of a variety of other chronic disease,” he said.

Cox is conducting a large clinical trial testing the GEM program with people diagnosed with type 2 diabetes within the last 24 months. thanks to a $3.5 million grant from the National Institutes of Health. For more information on the trial, call 434-422-2653.

About the Article

The overview paper has been published in the Family Medicine and Community Health medical journal. The article is open access, meaning it is free to read. It was written by Tamara K. Oser, Catherine Varney, Anthony L. McCall and Cox. Cox disclosed that he has received Advisory Board Consulting fees from Dexcom and Abbott Diabetes (through the American Diabetes Association). A full list of the authors’ disclosure is included in the paper.

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