Long-Term Continuous Remote Care Intervention With Carbohydrate Restriction Reduces Need for Medication in T2D

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A remote care intervention with carbohydrate restriction demonstrated meaningful improvements in metabolic risk in type 2 diabetes.

After careful consideration, the Endocrine Society canceled its annual meeting (ENDO 2020), which was set to take place in San Francisco, California, from March 28 to 31, 2020, because of concerns regarding coronavirus disease 2019 (COVID-19). Research findings that were scheduled to be presented at the meeting have been published in a supplemental issue of the Journal of the Endocrine Society.

The society is hosting ENDO Online, a complimentary virtual event featuring on-demand and live programming, from June 8 to 22, 2020, to provide a platform for continued learning and research exhibition. For more information, visit the Endocrine Society’s website.

The use of carbohydrate restriction including nutritional ketosis in patients with type 2 diabetes undergoing a long-term continuous remote care intervention demonstrated meaningful improvements across multiple markers of metabolic risk, including levels of hemoglobin A1c (HbA1c), body weight, non-high-density lipoprotein cholesterol (HDL-C), and HDL-C. These improvements were associated with a reduced need for medication and sustained diabetes remission, according to study results intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

After a 2-year study assessing the efficacy of a continuous remote care intervention in patients on carbohydrate-restriction therapy, researchers offered participants the ability to enroll in a 3-year extension of the same study, with assessments at 3.5 and 5 years after initial enrollment. Of the 169 participants who consented, 143 provided data at the 3.5-year follow-up. Linear mixed effects models were used to assess change over time in diabetes-related outcomes and McNemar’s tests were used to assess differences in the proportion of individuals who met certain criteria at baseline compared with follow-up.

After treatment with the continuous remote care intervention for 3.5 years, patients showed improvements in HbA1c (-0.6%±0.1% from 7.4%±0.1%; P =1.9×10-5), body weight (-10.9±1.1 kg from 117.4 kg; P =6.9×10-17), and levels of non-HDL-C (-10±4 mg/dL from 139±3 mg/dL; P =.005), triglycerides (-41±11 mg/dL from 189±10 mg/dL; P =2.1×10-4), and HDL-C (9±1 mg/dL increase from 43±1 mg/dL; P =3.0×10-11) compared with baseline measurements. Total cholesterol and low-density lipoprotein cholesterol levels were unchanged.

Of note, 45.5% of patients who completed the full 3.5-year program achieved HbA1c <6.5% with no medication (52%) or metformin alone (48%) and 22% achieved diabetes remission.

The investigators concluded that the continuous remote care program provided sustained and “clinically meaningful improvements across multiple markers of metabolic risk…in patients with [type 2 diabetes].”

Disclosures: All study authors are employees of Virta Health. Please see the original reference for a full list of authors’ disclosures.


McKenzie A, Athinarayanan S, Adams R, Volek J, Phinney S, Hallberg S. A continuous remote care intervention utilizing carbohydrate restriction including nutritional ketosis improves markers of metabolic risk and reduces diabetes medication use in patients with type 2 diabetes over 3.5 years. J Endocr Soc. 2020;4(suppl 1):SUN-LB113.

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