Personalized Dietary Management in Type 2 Diabetes

Prior treatment

• those who have been prescribed: (1) antibiotics or antifungals in the past 3 months, (2) diabetic medications other than metformin, (3) weight loss medications, (4) chronic use of steroids or immunosuppressants, (5) atypical antipsychotics, and (6) chemotherapy.
• those who have previously had bariatric surgery, or are unwilling to delay bariatric surgery for the next 7 months

Other illness

• those who have conditions or treatments likely to alter the underlying function of the microbiome, an insulin response that is driven by factors other than glycemic response to food, conditions/treatments that make it difficult to isolate the true nature of the relationship between randomization assignment and weight loss, characteristics or preferences that would preclude meaningful participation in the study
• those who require special dietary management (end-stage kidney disease, cirrhosis, HIV)
• those who are unable to participate meaningfully in an intervention that involves self-monitoring using software available in English (e.g., uncorrected sight impairment, illiterate, non-English-speaking, dementia)
• those who have been diagnosed with a chronic active inflammatory or neoplastic disease in the past 3 years
• those who have been diagnosed with a chronic gastrointestinal disorder (e.g., inflammatory bowel disease or celiac disease)
• those who have an active substance use disorder

Lab values

• those who have a chronic disease that affects energy/glucose metabolism (e.g., Cushing's syndrome, acromegaly, hyperthyroidism)

Other

• those who are unable or unwilling to adhere to an intervention that requires dietary self-monitoring
• those who are pregnant, planning to become pregnant during the study period, or become pregnant during the study
• those who are unable or unwilling to provide informed consent
• those who are unwilling to accept randomization assignment
• those who have limited control over diet (e.g., are homeless or institutionalized, in a nursing home or personal care facility, or incarcerated)
• those who are unable to walk without a walker or cane for 2 city blocks

• must be an adult 21-80 years of age
• must be diagnosed with early-stage T2D defined as HbA1c\<8% and managed for the past 3 months on a diabetes regimen that included lifestyle plus metformin.
• those who are willing and able to use a smart phone to self monitor their diet and to attend WebEx sessions