Adaptive Dietary Intervention (ADI) Leveraging Continuous Glucose Monitoring for Asian Americans with Type 2 Diabetes

About This Grant

We propose evaluating an adaptive dietary intervention leveraging continuous glucose monitoring (CGM) and the translated and adapted behavioral intervention in Asian Americans with type 2 diabetes (T2D). Despite being a fast-growing group in the U.S., Asian Americans face prominent diabetes care disparities. Compared with non-Hispanic Whites, Asian Americans have a higher prevalence of T2D, a higher incidence of T2D with lower body mass index, worse glycemic control, and poorer health status. They also have the highest prevalence of undiagnosed diabetes among all racial/ethnic groups. Dietary management is key to optimal glycemic control. However, limited dietary interventions have been tailored to Asian Americans’ unique barriers. These barriers include maintaining traditional Asian dietary patterns such as a high intake of starches (e.g., white rice, noodles) that significantly contribute to postprandial hyperglycemia and high glucose variability, consuming foods with high sugar and fat because of acculturation, lack of linguistically translated healthcare programs, unfamiliarity with the U.S. healthcare system, and rapid increase in income discrepancy. Our adaptive dietary intervention, which integrates CGM and translated and adapted Glycemic Excursion Minimization (GEM), targets glucose excursions rather than weight loss. This approach offers a feasible, paradigm-changing solution for Asian Americans with T2D, as over 80% of Asian Americans with T2D are not obese, and conventional lifestyle interventions targeting weight loss are not applicable. Our objective is to evaluate an adaptive dietary intervention leveraging CGM and translated and adapted GEM for Asian Americans with T2D. We will examine the feasibility and acceptability (Aim1) and effect (Aims 2&3) of the adaptive dietary intervention over 24 weeks. We propose to enroll 120 participants (60 Chinese Americans and 60 Vietnamese Americans) with T2D, who will be 2:1 randomized to one of two arms: adaptive dietary intervention and standard of care (SC). Recognizing high levels of heterogeneity in response to the same intervention, based on the principle of adaptive intervention design, our 12-week intervention will start with CGM use only during weeks 0-4. At week 4, participants who achieve the glycemic control goal (10% increase in time in range from baseline) will continue with the CGM alone during weeks 4-12 (CGM alone); otherwise, the translated and adapted GEM will be augmented (CGM-GEM). Our central hypothesis is that CGM alone will be better than SC and CGM-GEM will be superior to CGM alone to improve glycemic control, quality of life, and diabetes distress for Chinese and Vietnamese Americans with T2D. This R01 responds directly to PAS-23-086 (Small R01s), aiming to provide preliminary data and lay the foundation for future large-scale studies. We seek to shift the current dietary management paradigm for Asian Americans with T2D to reduce health disparities in diabetes management.