{"id":3740,"date":"2025-04-08T11:44:22","date_gmt":"2025-04-08T15:44:22","guid":{"rendered":"https:\/\/med.virginia.edu\/diabetes-technology\/?p=3740"},"modified":"2025-04-08T11:46:43","modified_gmt":"2025-04-08T15:46:43","slug":"a-hidden-gem-a-lifestyle-intervention-for-type-2-diabetes","status":"publish","type":"post","link":"https:\/\/med.virginia.edu\/diabetes-technology\/2025\/04\/08\/a-hidden-gem-a-lifestyle-intervention-for-type-2-diabetes\/","title":{"rendered":"A Hidden GEM: A Lifestyle Intervention for Type 2 Diabetes"},"content":{"rendered":"<p><strong>diaTribe: April 8, 2025<\/strong> &#8211; Lifestyle interventions for managing type 2 diabetes often revolve around weight loss, especially with the rise of GLP-1 medications like\u00a0Ozempic. While losing weight can improve diabetes management and overall health, making it the main goal can feel overwhelming and lead to changes that are difficult to keep up in the long term without medicine.<\/p>\n<p>Enter glycemic excursion minimization (GEM), a lifestyle intervention that shifts the focus from\u00a0weight loss\u00a0to optimizing blood sugar after meals. GEM is a sustainable and effective option for adults with type 2 diabetes not taking insulin.<\/p>\n<p><strong>Key article takeaways:<\/strong><\/p>\n<ul>\n<li dir=\"ltr\">Glycemic excursion minimization, or GEM, is a sustainable lifestyle intervention for people with type 2 diabetes that focuses on reducing blood sugar fluctuations after meals rather than weight loss.<\/li>\n<li dir=\"ltr\">GEM significantly improves A1C levels, reduces diabetes distress, and even leads to diabetes remission in some participants.<\/li>\n<li dir=\"ltr\">Combining GEM with a continuous glucose monitor improves blood sugar management by providing immediate feedback on the effects of food and activity choices.<\/li>\n<\/ul>\n<h2 dir=\"ltr\">How does it work?<\/h2>\n<p>After eating a meal and consuming carbs, blood sugar levels spike and then gradually fall as glucose is absorbed by muscles, fat, and other tissues in a process called blood glucose (BG) recovery.<\/p>\n<p>In people with diabetes, this\u00a0initial spike\u00a0is higher and the recovery takes longer because the body\u2019s ability to efficiently process glucose is impaired, leading to prolonged levels of high blood sugar.<\/p>\n<p>Fluctuations in blood glucose levels, particularly after meals, are known as \u201cglycemic excursions,\u201d and GEM aims to minimize these fluctuations. With GEM, the goal is to lower the initial blood glucose rise by choosing lower-carbohydrate foods, and to speed up the recovery period by increasing physical activity after meals, explained Chiara Fabris, Assistant Professor at the University of Virginia, during the 2025 Advanced Technologies and Treatments for Diabetes (ATTD) conference.<\/p>\n<div id=\"attachment_3742\" style=\"width: 1034px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-3742\" class=\"wp-image-3742 size-large\" src=\"https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed-1024x395.png\" alt=\"Dr. Chaira Fabris presenting at a scientific conference (ATTD)\" width=\"1024\" height=\"395\" srcset=\"https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed-1024x395.png 1024w, https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed-300x116.png 300w, https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed-768x296.png 768w, https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed-1536x592.png 1536w, https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed-519x200.png 519w, https:\/\/med.virginia.edu\/diabetes-technology\/wp-content\/uploads\/sites\/265\/2025\/04\/unnamed.png 1600w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><p id=\"caption-attachment-3742\" class=\"wp-caption-text\">Dr. Chiara Fabris presenting at ATTD.<\/p><\/div>\n<p>\u201cThis can be achieved if we combine the GEM intervention with the use of a continuous glucose monitor (CGM), because the CGM provides immediate feedback on the effect of food and activity choices on glycemic control,\u201d she said.<\/p>\n<p>Fabris described GEM as an empowerment program that educates individuals with type 2 diabetes to make more informed food and physical activity choices, with the support of a\u00a0CGM.<\/p>\n<p>The intervention lasts about 1.5 months, and includes a guide with exercises and homework, personalized texts reminding users about food and activity choices, and prompts to complete daily diaries. It is split into the following four units:<\/p>\n<ul>\n<li dir=\"ltr\">Unit 1 (4 days) educates GEM users about the effects of their routine food and activity choices on their blood sugar response with the assistance of a CGM.<\/li>\n<li dir=\"ltr\">Unit 2 (2 weeks) works on reducing the initial blood sugar spike after meals by limiting and\/or replacing foods with a high carb content.<\/li>\n<li dir=\"ltr\">Unit 3 (2 weeks) focuses on increasing mild and moderate physical activity, especially after eating, to speed up the blood sugar recovery period.<\/li>\n<li dir=\"ltr\">Unit 4 (1 week) helps to manage relapses by continuing to educate and motivate users on optimizing their food and exercise choices.<\/li>\n<\/ul>\n<p>Experts have\u00a0identified\u00a0specific high-carb (or high \u201cglycemic load\u201d) foods that can be reduced or replaced with options that are less likely to spike blood sugar. They also recommend the mantra, \u201csit less, step more\u201d to encourage blood sugar uptake after meals, helping to prevent prolonged high blood sugar levels.<\/p>\n<h2 dir=\"ltr\">What does the research say?<\/h2>\n<p>GEM proved to be superior in a\u00a0<a href=\"https:\/\/drc.bmj.com\/content\/9\/2\/e002403#sec-26\"><u>study<\/u><\/a>\u00a0comparing the long-term effects of GEM and traditional weight loss methods in people with type 2 diabetes. While both interventions reduced body mass index, GEM also improved A1C, cholesterol levels, and enhanced diabetes knowledge and empowerment.<\/p>\n<p>Another\u00a0<a href=\"https:\/\/diabetes.jmir.org\/2022\/1\/e34465\"><u>study<\/u><\/a>\u00a0found that individuals with type 2 diabetes who used the GEM intervention saw an average A1C reduction of 1.8%, with two-thirds achieving diabetes remission (A1C less than 6.5%). Participants also reported improvements in diabetes distress, diabetes empowerment and depressive symptoms. They also felt that use of the CGM was the most significant single element of the intervention. The researcher who conducted the study says that his own type 2 diabetes has been in remission for 15 years using the GEM approach.<\/p>\n<p>A clinical trial has also\u00a0<a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7566397\/#s9\"><u>shown<\/u><\/a>\u00a0that participants who used CGM with the GEM intervention had reductions in carbohydrate consumption and the need for diabetes medication, with significant improvements in A1C, diabetes knowledge, and quality of life.<\/p>\n<p>A clinical trial is\u00a0<a href=\"https:\/\/clinicaltrials.gov\/study\/NCT05766735\"><u>currently recruiting<\/u><\/a>\u00a0in Colorado and Virginia to see if individuals with recently-diagnosed type 2 diabetes are able to experience the same benefits with GEM.<\/p>\n<h2 dir=\"ltr\">The bottom line<\/h2>\n<p>GEM is an empowerment program designed to educate people with diabetes on how carbohydrates and physical activity affect post-meal blood sugar levels. By enabling individuals to make informed choices without the restrictions of traditional weight loss programs, GEM offers an effective and sustainable treatment option for people with type 2 diabetes not taking insulin.<\/p>\n<h3>diaTribe Authors<\/h3>\n<p><a href=\"https:\/\/diatribe.org\/author\/anna-vidovszky\">Anna Vidovszky<\/a><\/p>\n<p><a href=\"https:\/\/diatribe.org\/reviewers\/charles-m-alexander\">Charles M. Alexander, MD, FACP, FACE<\/a><\/p>\n<p><a class=\"button\" href=\"https:\/\/diatribe.org\/diabetes-management\/hidden-gem-lifestyle-intervention-type-2-diabetes?omhide=true&amp;utm_source=diaTribe&amp;utm_campaign=5153674791-EMAIL_CAMPAIGN_2025_03_31_10_14_COPY_02&amp;utm_medium=email&amp;utm_term=0_22467a8528-1cf14ddb25-150363809\">diaTribe Article<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>diaTribe: April 8, 2025 &#8211; Lifestyle interventions for managing type 2 diabetes often revolve around weight loss, especially with the rise of GLP-1 medications like\u00a0Ozempic. While losing weight can improve diabetes management and overall health, making it the main goal can feel overwhelming and lead to changes that are difficult to keep up in the [&hellip;]<\/p>\n","protected":false},"author":1866,"featured_media":3742,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[18],"tags":[],"class_list":["post-3740","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cdt-news-articles"],"acf":false,"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>A Hidden GEM: A Lifestyle Intervention for Type 2 Diabetes - Center for Diabetes Technology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/med.virginia.edu\/diabetes-technology\/2025\/04\/08\/a-hidden-gem-a-lifestyle-intervention-for-type-2-diabetes\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A Hidden GEM: A Lifestyle Intervention for Type 2 Diabetes - Center for Diabetes Technology\" \/>\n<meta property=\"og:description\" content=\"diaTribe: April 8, 2025 &#8211; Lifestyle interventions for managing type 2 diabetes often revolve around weight loss, especially with the rise of GLP-1 medications like\u00a0Ozempic. 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