Abstract
INTRODUCTION: Carbohydrate restriction markedly improves glycemic control in patients with type 2 diabetes (T2D) but necessitates prompt medication changes. Therefore, we assessed the effectiveness and safety of a novel care model providing continuous remote care with medication management based on biometric feedback combined with the metabolic approach of nutritional ketosis for T2D management. METHODS: We conducted an open-label, non-randomized, controlled, before-and-after 1-year study of this continuous care intervention (CCI) and usual care (UC). Primary outcomes were glycosylated hemoglobin (HbA(1c)), weight, and medication use. Secondary outcomes included fasting serum glucose and insulin, HOMA-IR, blood lipids and lipoproteins, liver and kidney function markers, and high-sensitivity C-reactive protein (hsCRP). RESULTS: 349 adults with T2D enrolled: CCI: n = 262 [mean (SD); 54 (8) years, 116.5 (25.9) kg, 40.4 (8.8) kg m(2), 92% obese, 88% prescribed T2D medication]; UC: n = 87 (52 (10) years, 105.6 (22.15) kg, 36.72 (7.26) kg m(2), 82% obese, 87% prescribed T2D medication]. 218 participants (83%) remained enrolled in the CCI at 1 year. Intention-to-treat analysis of the CCI (mean ± SE) revealed HbA(1c) declined from 59.6 ± 1.0 to 45.2 ± 0.8 mmol mol(-1) (7.6 ± 0.09% to 6.3 ± 0.07%, P < 1.0 × 10(-16)), weight declined 13.8 ± 0.71 kg (P < 1.0 × 10(-16)), and T2D medication prescription other than metformin declined from 56.9 ± 3.1% to 29.7 ± 3.0% (P < 1.0 × 10(-16)). Insulin therapy was reduced or eliminated in 94% of users; sulfonylureas were entirely eliminated in the CCI. No adverse events were attributed to the CCI. Additional CCI 1-year effects were HOMA-IR - 55% (P = 3.2 × 10(-5)), hsCRP - 39% (P < 1.0 × 10(-16)), triglycerides - 24% (P < 1.0 × 10(-16)), HDL-cholesterol + 18% (P < 1.0 × 10(-16)), and LDL-cholesterol + 10% (P = 5.1 × 10(-5)); serum creatinine and liver enzymes (ALT, AST, and ALP) declined (P ≤ 0.0001), and apolipoprotein B was unchanged (P = 0.37). UC participants had no significant changes in biomarkers or T2D medication prescription at 1 year. CONCLUSIONS: These results demonstrate that a novel metabolic and continuous remote care model can support adults with T2D to safely improve HbA(1c), weight, and other biomarkers while reducing diabetes medication use. CLINICALTRIALS. GOV IDENTIFIER: NCT02519309. FUNDING: Virta Health Corp.