Continuous Remote Care Model Utilizing Nutritional Ketosis Improves Type 2 Diabetes Risk Factors in Patients with Prediabetes

Prediabetes (preT2D) is a major U.S. public health concern, as over 84 million adults are at greater risk of cardiovascular disease and progression to type 2 diabetes (T2D). Abnormal glucose, BMI, blood pressure, and blood lipids are risk factors for progression to T2D. The purpose of this single-arm prospective longitudinal investigation was to assess change in risk factors after one year of treatment with a continuous remote care model utilizing nutritional ketosis, behavior change, and support from a health coach, medical provider, and peers provided via an online clinic. Patients with preT2D enrolled (n=116); at 1 year, 95 participants (82%) remained active.

Results are reported for participants with measurements completed at 1 year and baseline; n varied across measures (range: 77-95). Changes from baseline to 1 year included: weight -13.1±9.5 kg (from 110.6±23.5 kg, p<0.0001), BMI -5.0±3.5 kg/m2 (from 38.9 kg/m2, p<0.0001), HbA1c -0.3±0.3% (from 5.9±0.2%, p<0.0001), fasting glucose -9±14 mg/dL (from 110±15 mg/dL, p<0.0001), systolic BP -6±14 mmHg (from 130±13 mmHg, p=0.0003), diastolic BP -3±9 mmHg (from 83±8 mmHg, p=0.0032), triglycerides -43±55 mg/dL (from 148±67 mg/dL, p<0.0001), and HDL-C +7±9 mg/dL (from 52±14 mg/dL, p<0.0001). Seventy percent (54/77) of participants lost >7% body weight. At 1 year, 51.1% (45/88) participants achieved fasting glucose <100 mg/dL (up from 24/94, 25.5% at baseline). No completer progressed to T2D, and 60.7% (54/89) achieved HbA1c <5.7% (up from 14/94, 14.9% at baseline). Most participants (56.3%, 54/96) maintained mean blood beta-hydroxybutyrate concentrations ≥0.5 mmol/L, indicating moderate adherence to nutritional advice.

These results demonstrate that patients with preT2D can be supported remotely with this continuous care model to improve risk factors associated with progression of preT2D to T2D. Ongoing research will evaluate the continued sustainability of this intervention and prevention of T2D.