Adaptive Dietary Intervention (ADI) for Asian Americans With Type 2 Diabetes

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

The investigators will examine the feasibility, acceptability, and effect of an adaptive dietary intervention over 24 weeks (12-week intervention, 12-week follow-up) among Asian Americans with Type 2 diabetes. Participants (N=120; 60 Chinese Americans and 60 Vietnamese Americans) will be 2:1 randomized to one of two arms: adaptive dietary intervention or standard of care (SC). The intervention will begin with continued glucose monitoring (CGM) use only during weeks 0-4. At week 4, participants who achieve the glycemic control goal (at least an 8% increase in time in range [TIR] from baseline) will continue with the CGM alone during weeks 4-12 ("CGM Alone"); otherwise, culturally and linguistically adapted glucose excursion minimization (GEM) will be augmented with CGM ("CGM-GEM").

Inclusion Criteria:

• Eligible participants (N=120; 60 Chinese Americans and 60 Vietnamese Americans)
• Community-dwelling adults aged ≥ 18 with independent living;
• Diagnosed with T2D;
• Hb1Ac>7.0%
• Self-identified as first- or second-generation Chinese or Vietnamese immigrants;
• Able to communicate in English, Chinese, or Vietnamese. We will focus on Mandarin-, Cantonese- or English-speaking Chinese Americans because the two best-known and most-spoken variants of Chinese are Mandarin and Cantonese, who use the same writing system;
• Have a smartphone, iPad, tablet, or Apple watch

Exclusion Criteria:

• Taking hypoglycemia agents (e.g., insulin and sulfonylureas) with the major side effect of hypoglycemia that need close monitoring the occurrence of hypoglycemia to adjust/reduce medications to avoid future hypoglycemia.
• Taking medications that impede weight loss (e.g., prednisone) within the last 3 months.
• Currently pregnant, breastfeeding, or contemplating pregnancy within the next 6 months.
• Have serious physical complications (e.g., severe neuropathy cardiovascular disease, COPD/emphysema, osteoarthritis, or stroke) or mental disease (e.g., schizophrenia, bipolar disorder, manic depressive illness, severe depression, or active substance abuse).
• Have conditions that restrict diet, such as severe gastroparesis, ulcers, or food allergies. These conditions may need special dietary intervention.
• Undergoing treatment for cancer, as cancer treatment may impact the outcome of glucose changes.
• Have marked renal impairment (eGRF<45; CKD-3b), as renal impairment may needs special dietary intervention and they also may impact glucose changes.
• Are taking psychotropic medications that raise blood glucose (e.g., atypical antipsychotics).
• Are prior or current CGM users including both Dexcom and FreeStyle Libre and plan to continuously use these CGMs in the next 6 months.
• Are participating in another T2D intervention study.