Telemedicine-supported low-carb diet linked to type 2 diabetes remission, weight loss

Key takeaways:

• One-fifth of participants achieved diabetes remission at some point during the 3-year extension portion of the study.
• The intervention also reduced the need for diabetes medication.

A telemedicine-based nutrition counselling program emphasizing a low-carbohydrate diet resulted in sustained diabetes remission over half a decade for some individuals with type 2 diabetes, results of an open-label study showed.

The intervention proved effective even when study participants did not achieve remission, as findings published in Diabetes Research and Clinical Practice showed further health benefits like weight loss and decreased blood glucose levels.

Several interventions — including nutrition therapy and surgery — have achieved type 2 diabetes remission, but evidence of remission beyond 2 years “is sparse,” according to Amy L. McKenzie, PhD, from the medical device manufacturer Abbott, and colleagues

The nonrandomized study originally included 262 adults with type 2 diabetes assigned to a continuous care intervention or usual care for 2 years.

The continuous care intervention included an app that advised participants to follow a very low-carbohydrate diet — defined as less than 30 g of carbohydrates consumed daily — to achieve and sustain nutritional ketosis.

The app also allowed participants to monitor their weight, blood glucose and beta-hydroxybutyrate and to communicate with health coaches or physicians about medication adjustments.

After the 2 years, researchers approached 194 continuous care intervention participants about a 3-year extension of the program, of which 122 remained in the study for a total of 5 years.

Results showed 20% of the participants achieved diabetes remission, with sustained remission seen in 15.8% at 3 years and 12.5% at 5 years.

Reversal of type 2 diabetes to the point where researchers reported HbA1c levels less than 6.5% without medication or only metformin occurred in 32.5% of participants.

Diabetes remission served as the focus of the study but “it is important to note that the entire cohort sustained clinical benefits over 5 years, including among those who did not achieve remission,” McKenzie and colleagues wrote.

For example, other sustained improvements at 5 years included decreases in body mass, triglycerides, fasting insulin and HbA1c and an increase in HDL cholesterol.

Of participants who completed the 5 years, 61.3% sustained 5% weight loss, with a further 39.5% maintaining 10% weight loss.

Patients participating in the program also required less medication related to diabetes, with researchers observing a drop of from 85.2% receiving such treatments at baseline to 71.3% at 5 years.

“In total, 46.4% of diabetes medication changes were eliminations,” the researchers wrote. “Although improved diabetes management is often achieved through increased medication use, the results of this study demonstrate that marked and sustained reductions in medication need and use, even to the point that complete and sustained deprescription of diabetes medication resulting in remission is possible.”

McKenzie and colleagues acknowledged some study limitations. For example, the study included mostly white individuals — hurting the analysis’ general applicability to diverse populations with diabetes. Additionally, the analysis included endpoint data taken during the COVID-19 pandemic, where factors like illness and stay-at-home measures could have affected the results.

Still, the findings “[demonstrate] that even long-term remission of type 2 diabetes is feasible with this intervention focused on carbohydrate restricted nutrition therapy, targeting nutritional ketosis, plus continuous, rather than episodic, remote support from an expert care team,” McKenzie and colleagues concluded.