59-OR: Long-Term Sustainability and Durability of Diabetes Prevention via Nutritional Intervention

Abstract

The national Diabetes Prevention Program (nDPP) failed to translate the efficacy of the Diabetes Prevention Program (DPP) into real world effectiveness. We initiated a prevention program, previously publishing outcomes on 96 patients with prediabetes over two years with 75% retention. This single center observational trial examines the effectiveness of a very low carbohydrate intervention (VLCI) including nutritional ketosis delivered via a continuous remote care (CRC) model; here, we report sustainability and durability at 5 years. At completion of the 2-year trial, 58 of the original cohort (80%) renewed consent and 78% completed the 5 year follow-up. At baseline, all had prediabetes, with mean weight 109 kg and mean BMI 38.9 kg/m2. Using intention to treat analysis at 5 years, 22% regressed to normoglycemia, 13% progressed to diabetes, and 65% remained prediabetes. A1c remained unchanged (mean 5.9%) , and mean fasting glucose fell from 112 to 108 mg/dl (p=NS). Weight fell from 1 to 103 kg (p<0.001) , with insulin resistance falling from a HOMA-IR of 6.1 to 4.7 (p<0.05) . The nDPP utilizes 5% weight loss as a surrogate outcome for prevention. Forty-eight percent of the sample met that criteria at 5 years, with 19% achieving a 5-9.9% weight loss, 19% a 10-19.9% weight loss, and 10% with at least 20% weight loss. There was a 30% reduction in class 3 obesity (BMI ≥40) , contributing to a 2.7 fold increase in those now overweight (BMI 25-29.9). These results show that a VLCI delivered via CRC is sustainable in prediabetes, resulting in normalization of A1c without medication in over 20% with limited glycemic deterioration to the diabetes threshold. No other real world intervention has presented glycemic data on diabetes prevention, but only reported surrogate weight change as an outcome. Over 5 years, almost half of the cohort achieved that surrogate with significant population shifts to lower obesity classes. The promise of the DPP is met via telehealth-supported VLCI and is sustainable over the long term. Disclosure A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.Phinney: Employee; Virta Health Corp. S.Hallberg: Advisory Panel; Atkins Nutritionals Inc., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.J.Athinarayanan: Employee; Virta Health Corp. M.Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B.Fell: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. R.E.Ratner: Employee; Virta Health Corp. J.Volek: Advisory Panel; Abbott Diagnostics, Simply Good Foods, Stock/Shareholder; Virta Health Corp.