Two-thirds of adults with newly diagnosed type 2 diabetes achieved remission after 3 months by minimizing postprandial glucose excursions, according to results presented in a perspective.
Researchers detailed current and emerging treatment strategies for adults recently diagnosed with type 2 diabetes (T2D) in Family Medicine and Community Health. They noted the clinical importance of early intervention and individualized care, presenting data on novel lifestyle approaches and pharmacologic therapies.
Tamara K. Oser, MD, of the University of Colorado Anschutz School of Medicine, Aurora, and colleagues highlighted glycemic excursion minimization (GEM) as a lifestyle intervention designed to reduce postprandial glucose elevations rather than focusing solely on weight loss.
GEM incorporates dietary modifications—specifically, the substitution or avoidance of high glycemic load foods—and encourages skeletal muscle activity 1 to 2 hours following meals. In a feasibility trial referenced by the authors, adults with recently diagnosed T2D who participated in GEM experienced a mean reduction in hemoglobin A1c (HbA1c) of 1.8% over 1 month. The intervention also improved measures of diabetes distress, empowerment, depression, and body mass index.
In a subsequent randomized controlled trial, GEM was found to be superior to weight loss–focused therapy. At 12-month follow-up, 66% of patients in the GEM group were classified as responders, achieving a mean HbA1c reduction of 1.6%. Continuous glucose monitoring data illustrated the physiologic impact of GEM, with area under the curve decreasing from 66,575 to 39,825 and HbA1c decreasing from 8.8% to 5.7% following the intervention.
Pharmacologic options, particularly GLP-1 and GIP receptor agonists, were also reviewed by the researchers. Tirzepatide, a dual GLP-1/GIP receptor agonist approved by the FDA in 2022, demonstrated superior glycemic control and weight loss compared with semaglutide and liraglutide across 3-, 6-, and 12-month endpoints in clinical trials. Although gastrointestinal side effects occurred in up to 80% of patients, most were mild to moderate. Meta-analyses did not reveal an increased risk of pancreatitis or thyroid cancer at therapeutic doses.
Optimal management of T2D at diagnosis requires aligning treatment approaches with patient preferences and capacities concluded the authors. Shared decision-making and ongoing reassessment in primary care are essential to ensure sustainable glycemic control.
Full disclosures can be found in the published perspective.