Abstract
AIM: To evaluate the long-term effectiveness and safety of a remote, medically supervised ketogenic nutrition therapy intervention for Veterans with type 2 diabetes (T2D). MATERIALS AND METHODS: This retrospective observational analysis examined de-identified medical records of Veterans with T2D who engaged in a remote continuous care intervention. Outcomes were HbA1c, weight, diabetes medication use and cardiometabolic markers (lipids, liver enzymes, kidney function) among those who remained enrolled for 2 or 3 years. Separately, we assessed weight, glucose and medication changes at programme departure among Veterans who discontinued before 2 years. Outcomes were analysed across subgroups. Linear mixed-effects models and paired t-tests evaluated changes over time. RESULTS: Among 640 enrolled Veterans (mean age: 59 years, BMI: 35 kg/m(2), HbA1c: 8.4%), 310 (49%) remained engaged at 2 years and 197 (33%) at 3 years. At both time points, HbA1c was reduced by approximately 0.8%, alongside decreases in diabetes medication use. Weight decreased by approximately 9% at both 2 and 3 years. Overall, reductions in HbA1c and weight were seen across subgroups. Veterans who discontinued before 2 years experienced metabolic improvements, with greater benefits among those enrolled at least 6 months. CONCLUSIONS: For US Veterans, long-term participation in a remote ketogenic nutrition therapy intervention was associated with sustained improvements in glycaemic control, weight, medication use and select cardiometabolic markers. A 0.8% HbA1c reduction is associated with meaningful reductions in diabetes-related complications, highlighting the potential clinical relevance of these findings.