title: Glycemic load, exercise, and monitoring blood glucose (GEM): A paradigm shift in the treatment of type 2 diabetes mellitus.
abstract: OBJECTIVE
  This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postprandial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose (GEM) could improve metabolic control of adults with type 2 diabetes mellitus, without compromising other physiological parameters.
  
  
  METHODS
  Forty-seven adults (mean age 55.3 years) who were diagnosed with type 2 diabetes mellitus for less than 5 years (mean 2.1 years), had HbA1c ≥ 7% (mean 8.4%) and were not taking blood glucose lowering medications, were randomized to routine care or five 1-h instructional sessions of GEM. Assessments at baseline and 6 months included a physical exam, metabolic and lipid panels, and psychological questionnaires.
  
  
  RESULTS
  The GEM intervention led to significant improvements in HbA1c (decreasing from 8.4 to 7.4% [69-57 mmol/mol] compared with 8.3 to 8.3% [68-68 mmol/mol] for routine care; Interaction p<.01) and psychological functioning without compromising other physiological parameters.
  
  
  CONCLUSIONS
  Consistent with a patient-centered approach, GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus.
authors.affiliation: Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA. Electronic address: djc4f@virginia.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cox
authors.affiliation: University of Virginia School of Nursing, PO Box 800782, Charlottesville, VA 22908, USA.
authors.forename: Ann G
authors.initials: AG
authors.lastname: Taylor
authors.affiliation: Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA.
authors.forename: Harsimran
authors.initials: H
authors.lastname: Singh
authors.affiliation: Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Moncrief
authors.affiliation: Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Diamond
authors.affiliation: Duke University School of Medicine, Durham Veterans Affairs Medical Center, 508 Fulton St # 3, Durham, NC 27705, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.affiliation: Center for Behavioral Medicine Research, University of Virginia School of Medicine, PO Box 800223, Charlottesville, VA 22908, USA.
authors.forename: Shefali
authors.initials: S
authors.lastname: Hegde
authors.affiliation: Endocrinology and Metabolism, University of Virginia School of Medicine, PO Box 801407, Charlottesville, VA 22908, USA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: McCall
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy*; D015444:Exercise / Q000502:physiology*; D005260:Female; D000067940:Glycemic Load / Q000502:physiology*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D019518:Postprandial Period; D012648:Self Care / Q000379:methods; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose
keywords: Exercise; Glycemic load; Physical activities; Postprandial blood glucose; Self-monitoring of blood glucose; Type 2 diabetes mellitus