Diagnosed with Diabetes, Now Funded to Fight It

That day, Egede shared some unwelcome news: Fraser was diagnosed with Type 2 diabetes. 

At that time, Fraser and Egede were both on faculty at the Medical College of Wisconsin. Fraser had long studied bone marrow transplants and data-driven approaches to enhance health outcomes. But his diagnosis shifted his focus to Type 2 diabetes.

“I figured since I have the disease, I might just start working in that area,” Fraser says.

Fraser worked with Egede, a renowned diabetes researcher, who is now the Charles and Mary Bauer Professor and Chair of medicine at the Jacobs School of Medicine and Biomedical Sciences, to figure out how he could enter the field. He landed on studying the intersection of data science, artificial intelligence, and wearable devices, leveraging his statistician background to analyze and study data.

Now a Jacobs School research associate professor of medicine in the Division of Population Health, Fraser recently received a three-year, $600,000 grant from the American Diabetes Association to study how wearable continuous glucose monitoring devices could enhance Type 2 diabetes prevention. The study is titled “A Novel Continuous Glucose Monitoring Enhanced DPP Intervention to Prevent Type 2 Diabetes in Adults with Prediabetes.”

The National Diabetes Prevention Program (DPP) is a yearlong interactive lifestyle change program aimed at preventing Type 2 diabetes onset. The DPP is a landmark study demonstrating that structured lifestyle interventions can reduce the risk of Type 2 diabetes by up to 58%. Further, compared to taking metformin, the first-line treatment for Type 2 diabetes, lifestyle changes can more effectively prevent diabetes, Fraser says. 

Fraser and his colleagues will build on this research by investigating whether using continuous glucose monitoring, or CGM, devices to monitor blood sugar levels can enhance diabetes prevention.

Fraser likens blood sugar monitoring to a car’s speedometer. “Without looking at your speedometer, you don’t know how fast you’re going,” he says. “So, if you don’t check your glucose, you don’t know what’s happening and whether it’s high or low.”

Low blood sugar can cause dizziness, fatigue, headaches, and confusion. But when blood sugar spikes, people can’t feel it, Fraser says. Over time, hyperglycemia can damage the heart, kidneys and other organs. It can affect nerves in the fingertips and bottoms of feet, reducing sensitivity, and can even cause blindness. “Anywhere the blood goes — because the glucose is in your blood — it affects,” Fraser says.

The study involves two randomized participant groups of individuals with prediabetes, a condition marked by elevated blood glucose levels that still fall short of diabetes diagnosis criteria. One group will receive DPP alone and the other will receive DPP coupled with a CGM device and coaching from a health educator. The CGM group will actively monitor their blood glucose and be able to see how what they eat and how their activities, such as exercise, affect glucose levels.

Currently, the DPP has low uptake and high dropout rates, Fraser says. But monitoring blood glucose, coupled with coaching, could help keep participants engaged and motivated to stay in the program, Fraser says. 

“Prevention is better than a cure,” Fraser says. “If we can prevent people from having diabetes, we think that’s priceless.”

The study will also track participants’ A1C levels, which indicate average blood sugar levels over time. An A1C below 5.7% is considered healthy; 5.7% to 6.4% signals prediabetes; and 6.5% or higher indicates diabetes.

Fraser is hoping to see a 0.5% to 1% change in the CGM group participants’ A1C levels, as that is considered a clinically meaningful target, he says. 

Over one-third of U.S. adults have prediabetes, Fraser says. This condition significantly increases the risk of progression to Type 2 diabetes, cardiovascular disease, and other complications. Without intervention, 5% to 10% of individuals with prediabetes develop diabetes annually, and nearly 70% progress to Type 2 diabetes over their lifetime.

According to the U.S. Centers for Disease Control and Prevention, 38.4 million — 11.6% of the U.S. population — had diabetes in 2021. Diabetes accounted for $413 billion in U.S. medical costs and lost work and wages in 2022.

“It’s not a small issue,” Fraser says. Yet he’s optimistic.

There’s no shortage of innovations to address diabetes, Fraser notes. He points to the growing use of GLP-1 medications used to help manage blood sugar levels and which helped him lose weight after his own diabetes diagnosis. He’s also encouraged by emerging AI technologies that can monitor blood glucose and automatically deliver insulin.

If the CGM study is successful, it could lead to a “paradigm shift” in diabetes prevention, Fraser says. The DPP is a national program, and supplementing with continuous glucose monitoring is both scalable and easy to implement.

Through diet, exercise and lifestyle changes, Fraser was able to get his own diabetes under control. Now, he’s eager to help others do the same.