Treating Early Type 2 Diabetes by Reducing Postprandial Glucose Excursions: A Paradigm Shift in Lifestyle Modification

Eligibility Criteria

• 1. Medications that have affected participant's weight (e.g., prednisone) within the last 3 months
• 2. Participation in an exercise program to lose weight since last hemoglobin A1c blood test
• 3. 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
• 4. Conditions that preclude participating in the study (e.g., severe mental disease like manic depressive illness, severe depression, active substance abuse)
• 5. Conditions that preclude increasing physical activity (e.g., severe neuropathy, cardiovascular disease, COPD/emphysema, severe osteoarthritis, stroke)
• 6. 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
• 7. Conditions that restrict diet such as severe gastroparesis, ulcers, or food allergies
• 8. 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
• 9. Currently undergoing treatment for cancer that in the opinion of the PI would preclude participation in the study
• 10. No marked renal impairment (for example eGFR \< 45 mL/min/1.73 meters squared; CKD-3b)
• 11. Currently pregnant or contemplating pregnancy within the next 14 months
• 12. Currently breastfeeding
• 13. Any condition that, in the opinion of the principal investigator, could interfere with the safe and effective completion of the study.