- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05766735
Treating Early Type 2 Diabetes by Reducing Postprandial Glucose Excursions: A Paradigm Shift in Lifestyle Modification (GEM)
March 28, 2024 updated by: Chiara Fabris, PhD
A Randomized Control Trial (RCT) with 1:1 randomization of adults newly diagnosed with type 2 diabetes (T2D) to Routine Care (RC) and RC + Glycemic Excursion Minimization (RC+GEM); a program that provides RC in addition to continuous glucose monitors (CGM) within a structured, self-directed, and personalized lifestyle program called GEM.
Our hypothesis is that RC+GEM will: 1) reduce hemoglobin A1c as much or more, 2) require less diabetes medication, 3) cost less, and 4) have more secondary benefits, (e.g.
greater reduction in cardiovascular risk, weight, diabetes distress, depression symptoms), compared to RC alone.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Detailed Description
The proposed study will compare individualized self-administered versions of RC+GEM to RC among patients recently diagnosed with type 2 diabetes.
We hypothesize that, compared to RC alone, RC+GEM will be at least as effective at improving blood glucose control (A1c), and RC+GEM will do so with less reliance on diabetes medication and with greater secondary benefits such as lower risk of cardiovascular disease, more "good" cholesterol (HDL), greater weight loss, a greater sense of empowerment, and fewer diabetes-related expenses.
It is further hypothesized that these benefits will be sustained over 13.5-months of follow-up with no structured maintenance program.
Study Type
Interventional
Enrollment (Estimated)
200
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Corey Rynders, MEd, PhD
- Phone Number: 434-422-2653
- Email: car2r@uvahealth.org
Study Contact Backup
- Name: Chiara Fabris, PhD
- Phone Number: 434-982-6483
- Email: cf9qe@virginia.edu
Study Locations
-
-
Colorado
-
Aurora, Colorado, United States, 80045
- Recruiting
- University of Colorado Department of Family Medicine
-
Contact:
- Tamara K. Oser, MD
- Phone Number: 303-724-2060
- Email: tamara.oser@cuanschutz.edu
-
Contact:
- Britney Prince
- Phone Number: 303-724-8968
- Email: britney.prince@cuanschutz.edu
-
-
Virginia
-
Charlottesville, Virginia, United States, 22903
- Recruiting
- University of Virginia Center for Diabetes Technology
-
Principal Investigator:
- Chiara Fabris, PhD
-
Sub-Investigator:
- Anthony McCall, MD, PhD
-
Sub-Investigator:
- Wen Yu, PhD
-
Sub-Investigator:
- Mark Conaway, PhD
-
Contact:
- Corey Rynders, MEd, PhD
- Phone Number: 434-422-2653
- Email: car2r@uvahealth.org
-
Contact:
- Chiara Fabris, PhD
- Phone Number: 434-982-6483
- Email: cf9qe@virginia.edu
-
Principal Investigator:
- Daniel Cox, PhD
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 80 years (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria
- Clinical diagnosis, based on investigator assessment, of type 2 diabetes diagnosed within the past 12 months
- Age ≥30.0 and ≤80 years old at time of consent
- Hemoglobin A1c = ≥6.5-≤9% (medical record value <6-months is acceptable)
- Access to Smartphone throughout the study
- Diabetes management visit with PCP within six months of screening date
Exclusion Criteria:
- Medications that have affected participant's weight (e.g., prednisone) within the last 3 months
- Participation in an exercise program to lose weight since last hemoglobin A1c blood test
- Currently taking psychotropic medications that raise blood glucose (e.g., atypical antipsychotics) such as clozapine, olanzapine, risperidone, quetiapine, asenapine, arirprazole, brexpiprazole, iloperidone, lurasidone, paliperidone, and ziprasidone
- Conditions that preclude participating in the study (e.g., severe mental disease like manic depressive illness, severe depression, active substance abuse)
- Conditions that preclude increasing physical activity (e.g., severe neuropathy, cardiovascular disease, COPD/emphysema, severe osteoarthritis, stroke)
- Conditions that prevent doing the self-directed GEM program, such as inability to read English, mental health conditions that prevent engagement in treatment, such as active substance abuse, severe depression
- Conditions that restrict diet such as severe gastroparesis, ulcers, or food allergies
- Severe vision impairment that at PI discretion would preclude ability to read the GEM manual or see the information on the CGM or activity tracker
- Currently undergoing treatment for cancer that in the opinion of the PI would preclude participation in the study
- No marked renal impairment (for example eGFR < 45 mL/min/1.73 meters squared; CKD-3b)
- Currently pregnant or contemplating pregnancy within the next 14 months
- Currently breastfeeding
- Any condition that, in the opinion of the principal investigator, could interfere with the safe and effective completion of the study.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Routine Care (RC)
Participants will be actively working with their primary care provider during the study and will attend appointments with their provider as needed.
The study team will monitor their progress at the scheduled Assessment Visits.
The participants should discuss any concerns they have, including side effects or cost, in order to adjust the medication regime with their primary care team.
Their physician/clinician may recommend additional things, like weight loss, exercise programs and/or diabetes education programs.
|
RC participants will meet with their primary care provider to determine the best diabetes medication and proper dose.
The participant will be allowed to change medications, or use a combination of medications, that is best suited for their care during the duration of the study.
The study team will not influence these decisions.
|
Experimental: Routine Care + Glucose Excursion Minimization (RC+GEM)
Participants will actively work with their primary care provider and receive personalized routine care (RC).
In addition, participants will receive GEM, an individualized, person-centered, empowerment program, not a behavior modification program.
GEM provides individuals with personally relevant information to make choices that will help them achieve their diabetes goals.
It focuses on techniques - eating low glycemic load foods, increasing moderate and vigorous exercise, and monitoring blood glucose (BG) to educate individuals about the impact of high glycemic load nutrients and vigorous exercise.
The emphasis is on minimizing glucose excursions by any practical means, e.g., nutrient selection, timing and combinations of nutrient intake, time restricted eating, eating carbohydrates after protein and fat, post prandial physical activity, whatever is personally affirmed by BG feedback.
|
In addition to receiving routine care, participants will receive GEM, a structured, self-directed, and personalized program that will allow participants with pre-diabetes to improve their metabolic status by illustrating the effects of their routine food and physical activity choices on their blood glucose levels and variability.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Hemoglobin A1c at 4.5-months of follow-up
Time Frame: 4.5 months
|
Repeated measures models, using the baseline Hemoglobin A1c, as a covariate, will be used to compare groups with respect to Hemoglobin A1c levels at the 4.5-month assessment.
|
4.5 months
|
Change in Hemoglobin A1c at the 13.5-months of follow-up
Time Frame: 13.5 months
|
Repeated measures models, using the baseline Hemoglobin A1c, as a covariate, will be used to compare groups with respect to Hemoglobin A1c levels at the 13.5-month assessment.
|
13.5 months
|
Change in Metformin at 4.5-months of follow-up
Time Frame: 4.5 months
|
Repeated measures models, using baseline Metformin, as a covariate, will be used to compare groups with respect to Metformin at the 4.5-month assessment.
|
4.5 months
|
Change in Metformin at 13.5-months of follow-up
Time Frame: 13.5 months
|
Repeated measures models, using baseline Metformin, as a covariate, will be used to compare groups with respect to Metformin at the 13.5-month assessment.
|
13.5 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Chiara Fabris, PhD, University of Virginia Center for Diabetes Technology
- Principal Investigator: Daniel J. Cox, PhD, AHPP, University of Virginia Center for Diabetes Technology
- Principal Investigator: Tamara Oser, MD, University of Colorado, Denver
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
August 8, 2023
Primary Completion (Estimated)
January 31, 2027
Study Completion (Estimated)
January 31, 2027
Study Registration Dates
First Submitted
February 10, 2023
First Submitted That Met QC Criteria
March 1, 2023
First Posted (Actual)
March 13, 2023
Study Record Updates
Last Update Posted (Actual)
March 29, 2024
Last Update Submitted That Met QC Criteria
March 28, 2024
Last Verified
March 1, 2024
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 220259
- R01DK129687 (U.S. NIH Grant/Contract)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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