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The Making of Medicine

Managing Diabetes Without Dieting

If you develop type 2 diabetes, you’re likely to be told to lose weight. That’s the usual prescription, because losing those extra pounds can improve insulin sensitivity. But for some folks, including our Dan Cox, PhD, that can seem impossible. Dr. Cox knew it wasn’t going to happen for him, so he came up with an alternative approach, one that could let people with diabetes eat as much as they want.

The new approach aims to use blood glucose monitoring to “educate, activate and motivate.” The idea is that if people appreciate how different foods (and exercise) affect their glucose levels, they can use that knowledge to better manage their diabetes — possibly without the need to take medication. “We’re not trying to change your behavior,” he said. “We are trying to give you choices. It’s up to you.”

With Dr. Cox’s approach, there’s no need to count calories. It’s about being aware of your blood sugar level and managing it through healthy decision-making. He told me about one day when he ate lunch and then checked his blood sugar before and after going for a walk: “I saw my blood glucose had dropped 50 points, and that really encouraged me to repeat this,” he said.

Dr. Cox and his collaborator, Dr. Anthony McCall, are testing three variations of the new approach, including one that uses a high-tech method to monitor blood sugar: Study participants wear a sensor that reports their glucose levels to a smartphone app in real time. They can see immediately how certain foods spike their blood sugar and how exercise can bring it back down. “If it turns out to be better [than existing treatments], this new option, this paradigm shift, should be the first choice,” Cox said. “And if it’s only equal to the existing options, that would give patients a much-needed alternative.”

For more details, check out the study website.

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