834-P: Two-Year Effects of Carbohydrate-Restricted Nutrition Therapy Delivered via Continuous Remote Care among Veterans with Type 2 Diabetes: A Nationwide, Real-World Study

Abstract

Type 2 diabetes (T2D) affects about one in four Veterans, a rate nearly three times the general population, and diabetes medications and supplies constitute about one quarter of these Veterans’ pharmacy spend. The Veterans Health Administration partnered with Virta Health to provide carbohydrate restricted nutrition therapy via a continuous remote care model to Veterans in a pilot program. Five-month outcomes demonstrated significant reductions in HbA1c, BMI, diabetes medications and cost, and outpatient visits, but long term sustainability in this population is unknown. This retrospective, real-world, longitudinal analysis assessed the 1- and 2-year effects of the treatment on glycemia, diabetes medications, and body weight using medical record data. Veterans retained at least two years at time of analysis were included (n=254, 58.5% of 434 eligible enrolled, 60±8 years, 12% female) . With initiation of nutritional intervention, glycemia fell necessitating medication titration and elimination to prevent hypoglycemia. The number of diabetes medications prescribed to each person significantly decreased from 2.4±0.9 to 1.3±0.9 and 1.6±0.8 at one and two years, respectively (ps<0.0001) . Despite this significant reduction in pharmacologic therapy, HbA1c was significantly reduced at one year (-0.7±1.6%, p<0.0001) and two years (-0.6±1.7%, p<0.0001) compared to enrollment (8.1±1.5%) . Body weight also declined from 241.1±50.1 lb to 223.2±44.4 lb at one year and 222.1±46.8 lb at two years (ps<0.0001) , reflecting 6.8±7.6% and 7.0±9.4% weight loss per person at one and two years, respectively. These findings demonstrate that sustained improvement in glycemia concurrent with medication deprescription and clinically significant weight loss are achievable in the real world among Veterans who choose this therapy. Disclosure A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. M.Vantieghem: 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.