Multiple studies demonstrate that reduced dietary carbohydrate can significantly improve glycemic control and reduce medication use; however, safety and sustainability of this approach has not been tested in a large population.

We evaluated if patients with type 2 diabetes (T2D) could be supported by a remote care team to sufficiently limit dietary carbohydrate and protein to improve glycemic control, reduce weight, and reduce medications over one year.

262 adults with T2D enrolled in this ongoing, 2-yr intervention[1] where they received personalized nutrition and behavioral recommendations via continuous remote care by a health coach, medication management by a physician, biometric feedback, and peer support. At the time of this interim analysis, 130 of 158 subjects remain actively enrolled past the 1-yr time point (82% retention). Of these, we have data from 111 patients (mean±SEM; 54±1 y, 40±1 kg·m-2, 75% female) who have completed 1-yr testing.

HbA1c at enrollment (7.4±0.1%) improved to 6.1±0.1% (p<.0001) at 1-yr, and 58% of patients achieved HbA1c <6.5% at 1-yr while taking no diabetes medications or metformin only.

Insulin was reduced or halted in 97% of users; oral glucose control prescriptions (excluding metformin) were reduced from 51 at baseline to 8 at 1-yr.

Weight was reduced 13.6±0.8% at follow up (116±2 kg to 100±2 kg, P<.0001).

At 1-yr, significant improvements in TG (176±13 to 132±11 mg·dL-1, P=.002), HDL-C (46±1 to 53±1 mg·dL-1, p<.001), hsCRP (7.5±0.6 to 5.0±0.6 mg·dL-1, p<.0001), and ALT (29.7±2.7 to 20.8±1.2 U·L-1, P=.0011) were achieved. LDL-P (1269±42 to 1218±39 mmol·L-1, P=.16) was unchanged.

There were no significant adverse events attributed to the intervention. These initial data demonstrate that adults with T2D can be supported by a remote care team to maintain adequate carbohydrate restriction and achieve significant reductions in HbA1c, weight, and medications. Ongoing work will assess 2-yr safety, efficacy and sustainability.

 

Work cited:

1. McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD. A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. JMIR Diabetes. 2017;2(1):e5