A University of Virginia diabetes researcher has introduced a behavior-based program that aims to help people with prediabetes and type 2 diabetes regulate blood glucose through immediate, day-to-day decisions rather than relying exclusively on weight loss, medication, insulin or supplements. The approach, called Glucose Everyday Matters, or GEM, is described in a new book by Daniel J. Cox, PhD, a diabetes expert affiliated with UVA Health’s Center for Diabetes Technology. The program is built around a simple but consequential premise: blood sugar is influenced not only by a person’s long-term health status, but also by what happens after individual meals, snacks and periods of physical activity.
Cox developed GEM over 16 years of research and clinical testing, and says he has used the program to manage his own type 2 diabetes. According to the University of Virginia, he has kept his disease in remission for approximately 15 years. Rather than framing diabetes management primarily as a long-term effort to lose weight or follow a rigid diet, GEM emphasizes continuous feedback. Participants are encouraged to observe how their bodies respond to particular foods and activities, then use that information to make targeted adjustments. The system therefore treats blood-glucose monitoring as a form of personal experimentation, allowing people to connect specific behaviors with measurable physiological consequences.
Type 2 diabetes develops when the body cannot regulate glucose effectively. In many cases, cells become less responsive to insulin, a hormone that helps move glucose from the bloodstream into tissues where it can be used for energy. This condition, known as insulin resistance, places additional demands on pancreatic beta cells, which may compensate by producing more insulin. Over time, that compensation can become insufficient, causing blood glucose to remain elevated. Persistent hyperglycemia can damage blood vessels and nerves and increase the risk of cardiovascular disease, kidney disease, vision loss and cognitive complications. Prediabetes represents an earlier state of abnormal glucose regulation and can progress to type 2 diabetes, although progression is not inevitable.
The GEM program focuses on influencing glucose directly by combining food awareness with strategically timed exercise. A meal containing rapidly digested carbohydrates can cause blood glucose to rise quickly, particularly when it is consumed in a large portion or without other foods that slow digestion. A short walk after eating may increase glucose uptake by skeletal muscle, where contractions can stimulate glucose transport through pathways that operate partly independently of insulin. This mechanism allows active muscle to draw glucose from the bloodstream even when insulin sensitivity is impaired. By pairing a person’s food choices with appropriate movement, GEM seeks to reduce post-meal glucose excursions without requiring complete avoidance of foods that contain sugar or starch.
Cox describes the program as an alternative to approaches that control blood sugar indirectly. Many standard treatments increase insulin availability, improve the body’s response to insulin, or promote the removal of glucose through the urine. Medication and insulin remain essential for many people, particularly those whose pancreatic function or glucose regulation cannot be adequately controlled through lifestyle changes alone. GEM instead emphasizes actions that can be taken immediately, such as selecting a smaller serving, combining foods differently or walking after a meal. The program does not present diabetes as a condition that can be managed through willpower alone, but as a physiological process that can be observed and influenced through repeated decisions.
The book, “A GEM for Your Pre- or Type 2 Diabetes,” also presents flexibility as a central feature of the system. Under the approach, a person who wants a sugary food is not necessarily expected to eliminate it permanently. Instead, the individual might eat a smaller portion and compensate with physical activity or a different choice later. This strategy reflects the importance of glucose exposure over time rather than the effect of one isolated bite. Repeated spikes in blood glucose can contribute to higher average glucose levels, commonly assessed through glycated hemoglobin, or HbA1c. By helping users identify which combinations of food and activity produce the greatest glucose increases, the program aims to reduce those repeated excursions while making adherence more realistic.
The researchers and clinicians behind the program also report effects that extend beyond glucose measurements. Participants may experience fewer cravings, less fatigue and fewer abrupt energy declines, Cox says. These changes could arise partly from more stable glucose patterns, although subjective improvements can also be influenced by sleep, activity, eating patterns and psychological expectations. The program’s emphasis on immediate feedback is intended to strengthen motivation by showing users that their actions can produce visible changes. Cox argues that this can shift the emotional experience of diabetes from helplessness to control. Many users also lose weight, he says, not because weight reduction is imposed as the primary objective, but because more deliberate choices may alter total food intake and activity levels.
GEM has been evaluated in multiple clinical trials, and Cox reports that most participants benefited substantially, while acknowledging that the approach does not work for everyone. The public description of the research does not provide detailed trial data, including sample sizes, comparison groups, duration of follow-up or the precise effects on HbA1c and other clinical outcomes. Those details are important for determining whether a program produces benefits beyond standard diabetes education or routine self-monitoring. Diabetes specialists generally caution that people should not stop prescribed medication or insulin without medical supervision, since abrupt changes can result in severe hyperglycemia or, in some circumstances, dangerous hypoglycemia. Any behavioral program must therefore be integrated with individualized clinical care, glucose monitoring and appropriate laboratory testing.
The need for practical diabetes-management tools is expanding rapidly. The University of Virginia announcement cites more than 600 million people worldwide as living with prediabetes and approximately 530 million with type 2 diabetes. The condition, once more commonly associated with older adults, is increasingly diagnosed in children, adolescents and young adults. Rising prevalence has intensified interest in interventions that are affordable, scalable and less dependent on complex treatment regimens. Digital glucose sensors, mobile health applications and personalized coaching are also transforming diabetes care by giving patients more immediate information about their physiology. GEM fits within this broader movement toward feedback-driven, personalized medicine, although its long-term effectiveness and accessibility will depend on independent evaluation and sustained engagement.
Cox’s book is available through Amazon in electronic and print formats, with the electronic edition listed at $2.99. The work is intended not only for people with prediabetes or type 2 diabetes, but also for family members and partners whose shared meals and routines influence daily behavior. Its central message is that glucose regulation can be approached one decision at a time: a food selected, a portion adjusted or a walk taken after eating. For some patients, that framework may provide a practical complement to medical treatment and a way to understand their own metabolic responses. The University of Virginia emphasizes, however, that the program is not universally effective, and its claims should be considered alongside evidence-based medical guidance rather than as a replacement for professional diabetes care.
Subject of Research: A behavior-based glucose-management program for prediabetes and type 2 diabetes
Article Title: UVA Researcher Promotes Behavior-Based GEM Program for Managing Type 2 Diabetes
Web References: https://www.uvahealth.com/making-of-medicine ; https://mediasvc.eurekalert.org/Api/v1/Multimedia/a7343998-a3cb-49c6-a513-8b51f92d38aa/Rendition/low-res/Content/Public
Image Credits: UVA Health
Keywords: Type 2 diabetes, prediabetes, blood glucose, insulin resistance, diabetes management, Glucose Everyday Matters, GEM program, post-meal exercise, personalized medicine, metabolic health, diabetes technology, clinical research
