Science
Sarah J. Hallberg , Amy L. McKenzie , Paul T. Williams , Nasir H. Bhanpuri , Anne L. Peters , Wayne W. Campbell , Tamara L. Hazbun ,
Brittanie M. Volk , James P. McCarter , Stephen D. Phinney , Jeff S. Volek
Introduction: Carbohydrate restriction mark- edly 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 (HbA1c), 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-reac- tive 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 m2, 92% obese, 88% prescribed T2D medication]; UC: n = 87 (52(10) years, 105.6 (22.15) kg, 36.72 (7.26) kg m2, 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 HbA1c declined from 59.6 ± 1.0 to 45.2 ± 0.8 mmol mol-1 (7.6 ± 0.09% to 6.3 ± 0.07%, P less than 1.0 9 10-16), weight declined 13.8 ± 0.71 kg (P less than 1.0 9 10-16), and T2D medication prescription other than metformin declined from 56.9 ± 3.1% to 29.7 ± 3.0% (P less than 1.0 9 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 9 10-5), hsCRP – 39% (P less than 1.0 9 10-16), triglycerides – 24% (P less than 1.0 9 10-16), HDL-cholesterol ? 18% (P less than 1.0 9 10-16), and LDL-cholesterol ? 10% (P = 5.1 9 10-5); serum creatinine and liver enzymes (ALT, AST, and ALP) declined (P
